1 general descent theory
Dong Lao thinks that Dong Yuan's theory of spleen and stomach diseases is mostly caused by internal injuries; Internal injuries are insufficient, so the method of tonifying is used, so Buzhong Yiqi Decoction is created to replenish qi and promote yang. Dong Lao should treat spleen and stomach diseases from the physiological characteristics of stomach and health. Stomach diseases of yang and fu organs are mainly caused by dredging and descending. If the spleen or body is deficient for a long time, the spleen and stomach will be harmonious and the middle jiao will rise and fall.
The physiological characteristics of "harmony and decline" of stomach qi are closely related to the mutual harmony between Yang Qi and yin fluid in stomach fu-organs, that is, the temperature rise of Yang Qi in stomach fu-organs is properly matched with the moistening of yin fluid, and the diet can be decomposed and moistened when it enters the stomach. Ye also stressed: "Spleen ascending is healthy, while stomach descending is harmonious." The key to harmonizing stomach lies in the moistening and descending of stomach qi. However, the harmony of the stomach is closely related to the functions of other zang-fu organs, such as the transportation and transformation of the spleen, the drainage of the liver, the movement and decline of bile and bile fire, the expansion and decline of the lungs and the expansion and decline of the large intestine.
The stomach is a fu-organ. Only by maintaining its ascending and descending function can Shui Gu spread to the small intestine to distinguish turbidity. The stomach is fond of stagnation, but it is evil. If you are sick, your stomach will lose balance and fall, and if you go in and out, you will feel depressed. Therefore, Dong Lao emphasized the importance of dredging and descending in treatment. The so-called "unblocking" is to regulate qi and blood, relieve stasis, and make the stomach and intestines smooth and the qi flow smooth. If the stomach is full of fu-organs, it is advisable to eliminate evil and guide stagnation and regulate the stomach; If the stomach qi is insufficient, the qi will not be transported, and there will be stagnation in the deficiency, so it is advisable to tonify the deficiency and stagnation and harmonize the stomach.
When treating spleen and stomach diseases with the following methods, Dong Lao summarized them into ten methods: regulating qi and removing blood stasis, purging fu-organs and removing heat, dispelling cold, calming the liver and lowering adverse reactions, guiding stagnation and lowering the stomach, raising the clear and lowering turbidity, relieving fatigue, warming the heart and soothing yang, nourishing yin and lowering adverse reactions. It can be seen that Dong Lao's treatment of spleen and stomach diseases focuses on "communication", and the method of tonic often lies in "communication".
2 Qi and blood theory
Mr. Dong concluded the physiological characteristics of the spleen and stomach, and thought that the spleen and stomach in the middle jiao were the sea of water and valleys, the source of qi and blood biochemistry, and the root of viscera and meridians, which were closely related to the rise and fall of human qi and blood.
The collateral system of the spleen and stomach in the middle energizer is richer than other viscera, including "spleen collaterals" and "stomach collaterals" in addition to the collateral of the meridian branch with the same name; Spleen and stomach collaterals not only nourish the spleen and stomach itself, but also inject qi, blood and body fluid into the meridians, filling all directions. Therefore, the function of spleen and stomach directly affects the rise and fall of qi and blood and other visceral functions.
The stomach is the fu-organ, and there are many qi and blood, so it is more important to regulate qi and blood. If the stomach fu-organs are affected by evil, the stomach qi stagnates, the liver and gallbladder are blocked, and the soil is depressed, resulting in stagnation of liver and stomach qi, and even liver and stomach qi are reversed. Long-term qi stagnation and weak blood circulation will inevitably lead to blood stasis.
How to distinguish qi stagnation and blood stasis in the stomach? From the nature of pain, if the pain is mainly swelling and accompanied by belching, it belongs to qi stagnation, and if the pain is like a thorn, it belongs to blood stasis. From the point of pain, if the pain is uncertain, it is qi stagnation, fixed pain, or blood stasis; From the course analysis, the initial disease belongs to qi stagnation, and the long-term disease belongs to blood stasis. Gastropathy can't be cured for a long time, and qi stagnation and blood stasis are mutually causal.
Dong Lao often treats stomach-qi separation by regulating qi and relieving depression, clearing heat and relieving depression, soothing liver and regulating stomach, and benefiting gallbladder and regulating stomach. The treatment of patients with chronic diseases entering collaterals can be roughly summarized into the following six methods: regulating stomach, regulating qi and removing blood stasis, warming channels and dispelling cold and removing blood stasis, soothing liver and spleen, invigorating spleen and qi, nourishing yin and benefiting stomach and removing blood stasis.
Dong Lao's commonly used drug pairs for treating blood stasis syndrome of spleen and stomach diseases are: Jin Lingzi and Yuanhu; Hedgehog skin and aspongopus; Pollen Typhae and Oletum Trogopterori; Cortex Moutan and Radix Paeoniae Rubra; Salvia miltiorrhiza, Adenophora adenophora, etc.
3 damp-heat theory
Dong Lao pointed out that "damp heat" was regarded as an important pathogenic factor as early as Neijing, and all previous generations of physicians had exerted their theories on the pathogenic mechanism of damp heat, the most detailed of which was Xue's Theory of Dampness and Heat in Qing Dynasty.
The pathogenic factors of damp-heat are closely related to seasonal climate. In the early summer and autumn, forced by the intense heat, the ground was wet and steaming, and heat was generated in the wet. People are in qi communication, and they are weak and prone to illness. Dong Lao thinks that exogenous damp-heat is an important external cause, but it is not a decisive factor. The key to the disease is the strength of spleen and stomach function. If the spleen and stomach are injured internally, the transport and transformation are abnormal, and the dampness stays inside, while the heat accumulates outside, although there is no disease, it lays an opportunity for the disease. Once you feel the evil of damp and heat from the outside, you will "seek common ground" and "appear to be different" and get sick. Xue clearly put forward the theory that damp-heat mainly hurts the spleen and stomach, that is, the spleen and stomach are the center of damp-heat lesions.
Damp-heat obstruction is mainly manifested as epigastric distension and pain, nausea and vomiting, noisy acid swallowing, chest tightness and anorexia, sticky mouth, upset and bitter taste, sticky stool, yellow and greasy tongue coating, and slippery pulse. To treat damp-heat and stomach, Dong Lao Lian Pu Cao Lin Decoction is modified: Coptidis Rhizoma, Magnolia Officinalis, Pogostemon cablin, Eupatorium odoratum, Poria, medulla Tetrapanacis, Pericarpium Citri Tangerinae, etc.
If dampness is heavier than heat, bitter, warm and dry dampness are the main drugs; If heat is heavier than dampness, clearing stomach and clearing heat is the main drug; Dampness and heat for a long time will consume qi and hurt yin. Therefore, people with qi deficiency should add lentils and yam. Strengthening the spleen and promoting diuresis, while those with yin deficiency can choose reed rhizome, Dendrobium and so on. Nourishing yin and regulating stomach.
Dong Lao pointed out that heat is yang evil, which cannot be eliminated unless it is bitter and cold; Dampness is a kind of yin evil, which cannot be clarified unless it is pungent and warm. Therefore, this policy combines bitter and cold with pungent and warm, and fragrance with dryness and dampness to relieve damp-heat stagnation. If the former sages want to clear their heat, they should melt their dampness, so they preach the theory of ventilation. In the clinical application of this method, we must grasp the balance between clarity and culture. Only by defining the degree of integration can we get rid of heat loneliness, heat dehumidification and cure the disease quickly.
Four-sample theory
Dong Lao's treatment of spleen and stomach diseases emphasizes the priority of specimens, either eliminating pathogenic factors first and then tonifying deficiency, or reinforcing and reducing simultaneously. Gastropathy lasts for a long time, spreads from the viscera, damages the spleen and soil, and may have virtual images; But we can't just see its emptiness, ignore its reality, or just focus on its essence, regardless of its goal.
Therefore, the treatment of deficiency syndrome of spleen and stomach diseases should not only aim at the etiology, but also examine the specimens of diseases and syndromes to determine the treatment order, which is an important link in syndrome differentiation and treatment. For example, Su Jing, Rhizoma Cyperi, Pericarpium Citri Tangerinae, Pericarpium Citri Tangerinae, Fructus Citri Sarcodactylis, etc. It was first used to regulate qi and relieve depression, but for deficiency syndrome, Codonopsis pilosula, Atractylodes macrocephala, Radix Glycyrrhizae Preparata and so on. It was obviously added.
Dong Lao thinks that "a long illness will lead to deficiency" is only the general experience summarized by former sages, and "a long illness may not lead to deficiency" is not uncommon in clinic. Long-term illness entering collaterals from qi can be a syndrome of blood stasis; Long-term illness damages the spleen, transport and transformation disorder, water stagnation or emotional and dietary injury, often accompanied by qi stagnation, phlegm dampness, food accumulation and so on. , forming a syndrome of combination of excess and deficiency.