从肾与脾胃论治胸痹探析(1)
〔摘要〕 中医重视整体观念，脏腑之间在生理上相互联系，病理上相互影响。心肾水火既济，心胃土火相生，医籍中对心肾、心胃关系多有论及，可见从肾、胃论治胸痹有着深厚的理论基础。笔者探析了肾、脾胃与心的生理联系，与胸痹病机“痰瘀滞虚”的理论基础，在临床应用上运用从肾论治、从脾胃论治的方法治疗胸痹。在中医整体观的指导下，倡导在治疗胸痹时不要单从心出发，应整体把握，综合考虑，重视心与肾、胃的先后天关系，标本兼治，为临床治疗胸痹提供新的思路。
〔关键词〕 胸痹;从肾论治;从脾胃论治
〔中图分类号〕R256.22 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.03.016
〔Abstract〕 Traditional Chinese medicine attaches great importance to the concept of viewing the situation as a whole. Zang-fu viscera are related to each other physiologically and affect each other pathologically. It is known that there are intercourse between heart and kidney， and mutually promotion of heart and stomach， earth and fire. In medical books， there are many discussions on the relationship between heart and kidney and heart and stomach. It can be seen that there is a deep theoretical basis for treating chest paralysis from kidney and stomach. The author explores the physiological relationship between kidney， spleen and stomach and heart， and the theoretical basis of the chest palsy， which is phlegm stagnation and deficiency. In clinical application， he treated thoracic palsy by treating kidneys， spleen and stomach. Under the guidance of the overall view of traditional Chinese medicine， it is advisable not to start from the heart alone when treating chest palsy， but to grasp it as a whole， to consider it comprehensively， to pay attention to the innate and acquired relationship between heart， kidney， and stomach， and treat both the symptoms and the symptoms， and to provide new ideas for clinical treatment of chest palsy.
〔Keywords〕 chest palsy; treatment from kidney; treatment from spleen-stomach
張仲景在《金匮要略·胸痹心痛短气病脉证并治》中提出“胸痹”病名，并对胸痹的病机做了详细阐述：“夫脉当取太过不及，阳微阴弦，即胸痹而痛，所以然者，责其极虚也。今阳虚知在上焦，所以胸痹、心痛者，以其阴弦故也。”胸痹为本虚标实之证，“痰瘀滞虚”的病机[1]贯穿其全过程。在脏腑生理上，心与肾、脾胃相联系，在胸痹病机中，其“痰瘀滞虚”的发生发展又多可责之于肾、脾胃。故中医从肾与脾胃论治胸痹有其理论渊源，将其验之于临床，又可收到良好的临床效果。在中医整体观的指导下，治疗胸痹不仅需要从心论治，还应从整体分析，综合考虑。笔者将从理论和临床应用等方面，从肾与脾胃论治胸痹进行探讨。
1 理论基础
1.1 肾、脾胃与胸痹之经络、脏腑相关
胸痹之病位在心，而心与肾、脾胃之经络、脏腑密切相关。《灵枢·经脉》提到足少阴经属肾，绕心，注胸。又提出了“心痛引背不得息， 刺足少阴”的治疗方法。在《经络汇编·心脏之图》中也提到心有四系，其中一系贯脊髓，与肾相通。由此可见，足少阴肾经贯心，手少阴心经通于肾，手、足少阴经关系密切，若一脏发生病变，则可通过经络影响到另一脏，故《灵枢·经脉》言：“是主肾所生病者……烦心，心痛。”《素问·平人气象论》云：“胃之大络，名曰虚里，贯膈络肺，出于左乳下，其动应衣，脉宗气也”，又提到“脾足太阴之脉……其支者，复从胃，别上鬲，注心中”，明确指出心与脾胃经脉相通。
肾者水也，心者火也，心火下降于肾，温煦肾阴，使肾水不寒;肾水上济于心，涵养心阳，使心火不亢，此谓心肾相交，水火既济。朱丹溪曰：“人之有生，心为之火居上，肾为之水居下，水能升而火能降，一升一降无有穷已，故生意在焉。”心与肾二者循环往复，一升一降构成了动态平衡。若心肾阴阳、水火动态失衡，肾水无力上济于心，心火无法温煦肾水，则出现水不济火，火不暖水之候，表现出心肾阴虚，或水气凌心、心肾阳虚等证[2]。《傅氏男科·虚劳门》曰：“肾无心之火则水寒，心无肾之水则火炽。”, http://www.100md.com(李玉馨 王伟松 刘建和)
〔关键词〕 胸痹;从肾论治;从脾胃论治
〔中图分类号〕R256.22 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.03.016
〔Abstract〕 Traditional Chinese medicine attaches great importance to the concept of viewing the situation as a whole. Zang-fu viscera are related to each other physiologically and affect each other pathologically. It is known that there are intercourse between heart and kidney， and mutually promotion of heart and stomach， earth and fire. In medical books， there are many discussions on the relationship between heart and kidney and heart and stomach. It can be seen that there is a deep theoretical basis for treating chest paralysis from kidney and stomach. The author explores the physiological relationship between kidney， spleen and stomach and heart， and the theoretical basis of the chest palsy， which is phlegm stagnation and deficiency. In clinical application， he treated thoracic palsy by treating kidneys， spleen and stomach. Under the guidance of the overall view of traditional Chinese medicine， it is advisable not to start from the heart alone when treating chest palsy， but to grasp it as a whole， to consider it comprehensively， to pay attention to the innate and acquired relationship between heart， kidney， and stomach， and treat both the symptoms and the symptoms， and to provide new ideas for clinical treatment of chest palsy.
〔Keywords〕 chest palsy; treatment from kidney; treatment from spleen-stomach
張仲景在《金匮要略·胸痹心痛短气病脉证并治》中提出“胸痹”病名，并对胸痹的病机做了详细阐述：“夫脉当取太过不及，阳微阴弦，即胸痹而痛，所以然者，责其极虚也。今阳虚知在上焦，所以胸痹、心痛者，以其阴弦故也。”胸痹为本虚标实之证，“痰瘀滞虚”的病机[1]贯穿其全过程。在脏腑生理上，心与肾、脾胃相联系，在胸痹病机中，其“痰瘀滞虚”的发生发展又多可责之于肾、脾胃。故中医从肾与脾胃论治胸痹有其理论渊源，将其验之于临床，又可收到良好的临床效果。在中医整体观的指导下，治疗胸痹不仅需要从心论治，还应从整体分析，综合考虑。笔者将从理论和临床应用等方面，从肾与脾胃论治胸痹进行探讨。
1 理论基础
1.1 肾、脾胃与胸痹之经络、脏腑相关
胸痹之病位在心，而心与肾、脾胃之经络、脏腑密切相关。《灵枢·经脉》提到足少阴经属肾，绕心，注胸。又提出了“心痛引背不得息， 刺足少阴”的治疗方法。在《经络汇编·心脏之图》中也提到心有四系，其中一系贯脊髓，与肾相通。由此可见，足少阴肾经贯心，手少阴心经通于肾，手、足少阴经关系密切，若一脏发生病变，则可通过经络影响到另一脏，故《灵枢·经脉》言：“是主肾所生病者……烦心，心痛。”《素问·平人气象论》云：“胃之大络，名曰虚里，贯膈络肺，出于左乳下，其动应衣，脉宗气也”，又提到“脾足太阴之脉……其支者，复从胃，别上鬲，注心中”，明确指出心与脾胃经脉相通。
肾者水也，心者火也，心火下降于肾，温煦肾阴，使肾水不寒;肾水上济于心，涵养心阳，使心火不亢，此谓心肾相交，水火既济。朱丹溪曰：“人之有生，心为之火居上，肾为之水居下，水能升而火能降，一升一降无有穷已，故生意在焉。”心与肾二者循环往复，一升一降构成了动态平衡。若心肾阴阳、水火动态失衡，肾水无力上济于心，心火无法温煦肾水，则出现水不济火，火不暖水之候，表现出心肾阴虚，或水气凌心、心肾阳虚等证[2]。《傅氏男科·虚劳门》曰：“肾无心之火则水寒，心无肾之水则火炽。”, http://www.100md.com(李玉馨 王伟松 刘建和)