I. Introduction to Zhang Xichun
Zhang Xichun (1860~ 1933), a native of Yanshan county, Hebei province, was a famous modern innovative physician. He not only made profound academic achievements in traditional Chinese medicine, but also conformed to the trend of scientific development, absorbed the advantages of western medicine at that time, and tried to communicate the two medical systems, which was called "consulting the west with his heart". His academic experience all his life is included in "Learning Medicine with Passion for Western Learning".
This book is novel in conception, unique in viewpoint, practical and therapeutic. Those who make good use of its prescription have abnormal effects, so it can spread at home and abroad and is very popular. Today, I will briefly introduce the unique experience of treating spleen and stomach in the book in order to attract more attention.
Second, supporting spleen yang and benefiting stomach yin.
In the medical history of China, Heye is a famous expert in treating spleen and stomach diseases. Shi Li is good at ascending and tonifying spleen yang, and the medication is too dry; Leaves are good at nourishing stomach yin, and the medicine is more gentle and moist. Zhang, on the other hand, combined the strengths of the two schools and created many effective prescriptions for regulating the spleen and stomach. Such as breeding soup, breeding Tongmai soup, Fuzhong soup and so on. The prescription combines rigidity with softness, moistening dryness, supporting spleen yang and benefiting stomach yin, which complement each other. Both of them have their own advantages and are widely used in many diseases.
Why does Zhang have to start with nourishing the spleen and stomach to treat various diseases? Why does Zhang always help spleen yang and stomach yin at the same time when tonifying spleen and stomach? My understanding is that he treats many diseases, such as fatigue, amenorrhea, diaphragmatic food, chronic diarrhea and so on. All belong to chronic debilitating diseases with complex symptoms and loss of qi, blood, yin and yang. It is difficult to make up the disadvantages simply by supplementing qi, blood, yin and yang. Only by regulating the spleen and stomach and rebuilding the middle qi can we start.
The article "Lingshu Zhong Shi" says: "Both yin and yang are deficient, nourishing yang and exhausting yin, purging yin and eliminating yang. If so, you can use sweet medicine, but you can't even drink it. "That's almost what it means. Zhongjing's treatment of yin-yang deficiency syndrome with Xiaojianzhong decoction can strengthen qi activity and balance yin and yang, which has ended this situation. Zhang Zeng explained: "people's spleen and stomach belong to the earth ..., so they can also be given life." If the spleen and stomach are strong and can digest food, then the whole body will naturally be strong. You have seen people who drink and eat more, people who are sick and tired (quoted from Hebei People's Publishing House, 1957 edition, the same below). " As for those who must support spleen yang and benefit stomach yin at the same time when regulating spleen and stomach, it is not simply spleen yang deficiency or stomach yin deficiency, but first damage spleen yang and yang damage yin; Or damage the stomach yin first, and the yin will damage the yang, showing the symptoms of deficiency of both spleen yang and stomach yin. Therefore, supporting spleen yang and benefiting stomach yin must be organically combined. There are many opportunities to use this method in clinic, and it is an effective method to treat chronic debilitating diseases and some acute diseases in recovery period.
Third, nourishing the liver and strengthening the spleen, lowering the gallbladder and regulating the stomach are wonderful.
Spleen and stomach coexist in the middle energizer, which is the hinge of human qi movement. Only when the temper rises can Shui Gu be transported to irrigate the Quartet; Only when the stomach qi drops can Shui Gu be absorbed and decomposed, and the dregs can be transferred into the body. Zhang believes that spleen ascending stomach descending is not only a sign of normal spleen and stomach function, but also a sign of normal liver and gallbladder function. In order to prove his important academic thought, he quoted Huang Kunzai's words: "Liver qi should rise;" The gallbladder fire is going down. However, if the spleen does not rise, the liver qi will not rise; The gallbladder fire will not drop unless the stomach qi drops. "
He thinks that these famous sayings of Huang are the best annotations of "Jue Yin is not healed, seeking Yangming" and "Seeing the disease of liver, knowing that the liver transmits the spleen, strengthening the spleen first" in Neijing, and made a detailed play: "Those who want to treat the liver should nourish the spleen and lower the stomach, repair the middle uterus, so that the middle uterus can be gasified and thick, so as to listen to the liver and protect itself. In other words, drugs that regulate the liver are sometimes used in moderation, but they are only auxiliary products in spleen and stomach conditioners. Therefore, the land of the five elements can include the four lines of fire and water in Jin Mu; People's spleen and stomach belong to the earth, and its gasified dressing can also include Jin Mu's internal organs. So when the temper goes up, the liver qi comes up; When the stomach gas goes down, the gallbladder fire will also drop. " As for the specific application of ascending liver and spleen and descending gallbladder and stomach, there are probably four ends:
1, invigorating spleen and regulating stomach
For example, "Peipi Shugan Decoction" can be used to treat liver qi stagnation, spleen and stomach qi can not rise and fall, chest fullness is often short of breath. "Atractylodes macrocephala and Astragalus membranaceus" in the prescription, like cassia twig and Bupleurum root, can help to raise the temper, and like dried tangerine peel and magnolia bark, can help to reduce the stomach qi. Clear is turbid, full is annoying, and there is nothing to deal with liver qi, which protects itself. Its "Jiang Sheng Decoction" for treating liver depression and spleen deficiency, fullness in chest and hypochondrium, and inability to eat is similar to this recipe. Another example is "chicken pit soup", which treats qi stagnation, abdominal distension, spleen and stomach deficiency and cold, and diet cannot be transported. In the prescription, Atractylodes macrocephala and Bupleurum chinense help the spleen to rise, Endothelium Corneum Gigeriae Galli and Pericarpium Citri Tangerinae help the stomach to fall, and the qi is natural. If the spleen does not rise, the stomach does not fall, accompanied by lung and gastric juice injury, or liver and kidney yin deficiency, it is not suitable to use Cimicifuga rhizome, Bupleurum root and dried tangerine peel, then use malt to rise the spleen (malt rises), cassia twig to rise and fall the stomach (qi rises, while qi falls), and use pollen and Scrophularia root to adjust the temperature of cassia twig to make the medicine mild. It's really a circular knitting machine, and it's bidirectional!
2. Nourishing the liver and lowering the stomach
Treatment of stagnation of liver qi and stagnation of stomach qi: "The liver governs the left and the stomach governs the right. ..... with raw malt, wormwood (according to the author's research, wormwood is actually Artemisia annua) to nourish the liver, raw ochre, Pinellia ternata and bamboo shavings to lower the stomach, that is, with Anchong; Use dipsacus root, because it can nourish the liver and help the liver qi rise; If you use raw yam and winter wheat, you can moisturize and replenish your stomach, which can help your stomach decline. " Bupleurum is the most effective drug to promote liver function. However, it is not necessary to use Bupleurum root to treat the syndrome that the liver does not raise the stomach and does not fall, but raw malt can be used instead. Because Bupleurum can not only raise liver, but also raise stomach qi. "Although raw malt can improve the liver, it has no harm to the decline of stomach qi. By covering its germination and combining with liver wood, it can promote the stagnation of liver qi, so that it can be alleviated and naturally rise, unless the purity of Bupleurum is rising. " On the other hand, in the case of simple stomach qi not falling, when using drugs such as ochre, endothelium corneum gigeriae galli and magnolia officinalis. To lower the stomach, a small amount of Bupleurum chinense (below 3g) is also used to raise the liver, because "however, reusing the drugs for lowering the stomach may hinder the gasification, so adding less Bupleurum chinense to promote it, so gasification is also common". If I hadn't experienced it, how could I have such a theory of exploring the deep and remote!
3. Both gallbladder and stomach drop.
If vomiting is treated, indigo naturalis, Radix Gentianae and Radix Paeoniae Rubra are used to clear gallbladder fire, and ochre and Pinellia are used to calm stomach qi. At the same time, imitating the meaning of Zuojin Pill, 3 grams of Evodia rutaecarpa was used to relieve liver depression. The author has used this prescription to treat acute cholecystitis and acute pancreatitis vomiting, which is quite effective.
4. Liver and spleen rise together.
Zhang believes that the spleen is in the middle jiao, which is the foundation of drinking water. If the cardinal is not prosperous, he can't help if he loses. "However, the method of drinking water is also different. Neijing also says:" People with liver heat must urinate yellow first ",and also says:" When the liver is full, they will lie in shock and cannot urinate. "Besides, Paeonia lactiflora is the main drug for regulating the liver and promoting diuresis. From the outside to the inside, water enters the liver from the stomach and the bladder leaks. " So I made "Jianpi Huashen Decoction" to treat spleen deficiency, extremely depressed temper, and urine can't help. "Astragalus membranaceus, Atractylodes macrocephala and Glycyrrhiza uralensis are used in the prescription to strengthen the spleen, that is, Astragalus membranaceus is parasitic, Dipsacus aspergillus is used to enhance liver qi, and keel, oyster, dogwood meat and decoction are used to stabilize the small intestine." The author treats this syndrome by continuously adding 30 grams of Semen Cuscutae, or taking Semen Cuscutae by frying, rolling Semen Cuscutae and medicinal juice, each time 10 grams, which is very effective.
Fourth, tonify liver qi, strengthen spleen and stomach, and be original.
It is an important academic thought of Zhang Xichun that nourishing liver qi can strengthen spleen and stomach. However, the term "liver-qi" has traditionally only been used as a pathological concept, so few people speak to replenish liver-qi. Zhang has a different understanding of nourishing liver qi, and his words are reasonable and easy to convince people: "The liver belongs to wood, and it should be in spring, and its temperature is pleasant. The temperature of Astragalus membranaceus is raised to nourish the liver, which is a wonderful use of seeking common ground." From the beginning of clinical experience, whenever the liver qi is weak and all drugs for nourishing the liver are ineffective, I mainly use Astragalus membranaceus, use less products for regulating qi, and take it repeatedly and get immediate results ... Those who know the method of tonifying liver deficiency are not talking about the truth. "Nourishing liver qi can strengthen the spleen and stomach." Because of the five elements, wood can regret the soil, and wood can also sparse the soil.
Ceng Zhi's diet can't be digested, and it's useless to take a hundred doses of medicine to strengthen the spleen and warm the stomach. The diagnosis of left guan is too weak, and it is known that liver yang is weak (according to the author Zhang, liver qi is sometimes confused with liver yang). Give one or two tablets each to Astragalus membranaceus and Guizhi, and cure them in several doses. It also treats jaundice, and the diagnosis of left clearance is extremely weak. Huangqi decoction is reused and sent to the golden chamber to treat jaundice slightly.
Zhang's repeated emphasis on nourishing liver qi and strengthening spleen and stomach was actually a disadvantage of the medical profession at that time. He angrily criticized: "secular doctors all say that they should calm the liver, so when they encounter the syndrome of liver depression, they often use drugs to break the liver qi." "I don't know that human vitality is rooted in the kidney and germinates in the liver. Everything is tender, brittle and easily damaged. The liver is the dirty part of the vitality bud, but if it is broken, don't you care about damaging the vitality bud? " The author believes that Zhang's criticism still has its practical significance today.
Five, be careful to break, be good at nourishing and use unique drugs.
Yangming stomach qi runs smoothly at rest. If the stomach qi is blocked, it will turn up, fill up and knot down. The healer will prescribe medicine to break the gas. If the medicine is not selected properly, it is often ineffective, and even the more broken it is, the more congested it is, the exhaustion of vitality and the symptoms are numerous. Therefore, Zhang is particularly cautious in treating this syndrome. He earnestly warned doctors not to abuse drugs such as Pinellia ternata, Perilla frutescens, Fructus Trichosanthis, magnolia officinalis, Fructus Aurantii Immaturus, etc. And prefer to reuse ochre to reduce stomach and relieve chong, often taking effect at will. It is believed that ochre is mild in nature, reducing the stomach without hurting it, and it cannot cure serious diseases unless it is reused. He doesn't like to use digestion drugs such as fried Sanxian and radish seeds, but prefers to use raw chicken's gizzard-membrane, which he thinks is the best digestion drug because it has all the functions of reducing stomach, promoting digestion, grinding and promoting blood circulation.
He also believes that traditional medicines for regulating qi and breaking qi, such as Rhizoma Cyperi, Radix Curcumae, Radix Aucklandiae, Pericarpium Citri Reticulatae Viride and Pericarpium Citri Tangerinae, are very light, or a few cents, or one to two dollars. If you take it for a short time, it is difficult to show their shortcomings. If you take it for a long time, it will consume people's vitality, so you must be vigilant! Traditionally, drugs that break qi and blood are considered to be heavier, such as Rhizoma Sparganii, Rhizoma Curcumae, Olibanum and Myrrha. Insects, leeches, etc. However, I think the medicine is peaceful and I always like to use it. His experience needs to be further verified in clinical practice.
On the other hand, he has accumulated rich experience in treating spleen and stomach weakness with nourishing drugs. At least two things are unique:
First, be good at reusing tonics.
Such as reusing yam, Atractylodes macrocephala, Astragalus membranaceus, etc. Among them, yam is not only sweet and spleen-strengthening, but also white and thicker than kidney. It can nourish stomach yin and promote diuresis, and it is smooth and convergent, very peaceful. If you don't be reused, you can't be meritorious, and you can't be abused. Zhang Zhi purges heat, and dares to use boldness. Atractylodes macrocephala is good at invigorating spleen and stomach, resolving phlegm and stopping diarrhea. Because of its heavy quality, it must be reused to show good results.
For example, when Zhang treated a teenager, his throat was often dry, and drinking water repeatedly did not quench his thirst. When the pulse condition is weak and late, the spleen and stomach are cold and wet, so they can't exercise, so that the qi does not rise. Sijunzi decoction is added with dried ginger and cassia twig, and Atractylodes macrocephala is reused twice in the prescription, and one dose is used to quench thirst. In addition, she also treated a woman with menstrual bleeding, which was caused by weakness of the spleen and stomach, failure to take the middle energizer and unstable lower energizer. Add 30 grams of Atractylodis Rhizoma and 30 grams of Endothelium Corneum Gigeriae Galli to the blood prescription, and take a dose of Xuezhi.
Astragalus membranaceus, formerly known as nourishing spleen and lung, is a special product, which is famous for nourishing liver, spleen and lung and tonifying the qi of liver and spleen. Whenever encountering the syndrome of liver depression and spleen deficiency, the diet is not as good as it is, and it is not cold-tolerant. It stays in the recipe of strengthening the spleen and regulating the stomach, and the effect is quite good (the author presses: Huangqi in Shennong Materia Medica Classic treats "all diseases in children"; Ye Note: "Young children are young, young children are young, and young children are angry. What happened to the child? " Astragalus membranaceus is almost the main disease of children because it has less yang and supplements the vitality of life. "Although it is not clear whether Astragalus can nourish liver qi, it has a certain meaning.
Therefore, Zhang's point of view is not groundless. In addition, Zhang also likes to reuse Paeonia lactiflora and Glycyrrhiza uralensis, that is, "Shaogan Decoction". He thinks that sweet and sour can nourish yin, and sweet and sour can turn Jia Jia into earth, which tastes close to ginseng and is beneficial to the spleen and stomach.
Second, make good use of tonics and prescription drugs.
If you like to use ginseng, astragalus root, medicine, Rhizoma Sparganii and Rhizoma Curcumae together, "those who can greatly stimulate your appetite will be stupid enough to try it again and again." To treat spleen and stomach weakness, take 60 grams of raw Atractylodis Macrocephala, 60 grams of raw Endothelium Corneum Gigeriae Galli and roll baked honey pills. To treat flaccidity and waste, we should follow the principle of "treating flaccidity and taking Yangming alone" and draw up a "Zhentui Decoction", in which ginseng, qi and Shu tonify the spleen and stomach, angelica, frankincense, myrrh and clematis promote qi and blood, dispel wind and resolve phlegm. Atractylodis Rhizoma, Radix Angelicae Sinensis, Olibanum, Myrrha, Pericarpium Citri Tangerinae, Cortex Magnolia Officinalis, etc. It is also used to treat leg pain and low back pain. For the treatment of stagnation of stomach qi, chest tightness and diaphragm, and dry stool, 265,438+0g of raw and cooked yam and 30g of ochre are used.
For the coordination of tonic and prescription drugs, Zhang also has a deep understanding of how to do it just right. He said: "When we weigh the supplementing power of Astragalus membranaceus and the breaking power of Rhizoma Sparganii and Rhizoma Curcumae, we can't treat them equally. Try Rhizoma Sparganii and Rhizoma Curcumae with San Qian to cure the abdominal pain and stagnation between zang-fu organs, for fear of hurting their vitality. With the help of Radix Astragali with six dollars, they will get well after taking dozens of doses, but they will not hurt their vitality, and some people will grow stronger as they eat more. If you are deficient in qi, take a few more doses, that is, it is difficult to nourish qi, and you must add Radix Astragali, Rhizoma Sparganii and Rhizoma Curcumae to take it for a long time. It is hard to hide the weak, but it is easy to see the broken medicine. If it is popular and depressed, it is necessary to use more Rhizoma Sparganii and Rhizoma Curcumae, or use less Radix Astragali, and then take it without being bored. " These direct experiences from decades of medical practice are really valuable.
As can be seen from the above introduction, Zhang Xichun does have his unique views on treating spleen and stomach: spleen yang and stomach yin are equally important; Soothing the liver and strengthening the spleen, lowering gallbladder and stomach simultaneously; Replenishing liver qi is to replenish spleen and stomach; The combination of nourishing and enlightening is unique and just right. These valuable experiences are worthy of our repeated verification in clinic and careful study and arrangement in theory.