叶天士宣透上焦法在新型冠状病毒感染后遗症之痞证中的运用OA
Application of YE Tianshi's Method of Dispersing the Upper-Jiao in the Treatment of Epigastric Fullness of COVID-19 Infec-tion Sequela
[目的]分析叶天士宣透上焦法诊治痞证的经验,并探讨其在新型冠状病毒感染(以下简称新冠)后遗症之痞证中的运用.[方法]通过明确叶天士宣透上焦法的概念,厘正宣透上焦法的内涵,并结合《临证指南医案》进一步阐释说明,分析叶天士宣透上焦法诊治痞证的经验.同时整理新冠后遗症之痞证的中医理法,举隅临证案例,从而探讨叶天士宣透上焦法在新冠后遗症之痞证中的运用.[结果]叶天士治疗痞证时极为注重宣透上焦气机.据《临证指南医案》总结,其宣透上焦法包括芳香宣透与宣发郁热两个方面.芳香宣透法适用于痞证病机属湿阻上焦气分者,常取白豆蔻、杏仁、橘红等轻苦微辛具流动之品;宣发郁热法适用于痞证病机属气滞热郁者,组方多以经方栀子豉汤为基础.新冠并发痞证的根本病机在于肺气失宣,以湿遏与热郁为重要发生因素,因此治疗上可考虑选择叶天士宣透上焦法.所附验案为新冠感染后上焦肺气郁滞、化热生痰,影响中焦升降枢机所形成的痞证,治以辛凉透解、宣发郁热之法,疗效颇佳.[结论]宣透上焦法是叶天士诊治痞证的独到经验,是从中医学整体观念立论疾病诊治的生动体现.总结叶天士宣透上焦法诊治痞证的经验,不仅直接完善了对叶天士学术经验的相关研究,对新冠后遗症的临床治疗亦具有启示借鉴意义.
[Objective]To introduce YE Tianshi's experience in the diagnosis and treatment of epigastric fullness by dispersing the upper-Jiao,and explore the feasibility of applying this method to treat epigastric fullness of Corona Virus Disease 2019(COVID-19)infection sequela.[Methods]By clarifying the concept of YE Tianshi's method of treating epigastric fullness by dispersing the upper-Jiao,rectifying its connotation,and further elaborating on it in combination with Clinic Guideline of Medical Records,the experience of YE Tianshi in the diagnosis and treatment of epigastric fullness by dispersing the upper-Jiao was analyzed.Meanwhile,by sorting out traditional Chinese medicine(TCM)principles and methods of epigastric fullness of COVID-19 infection sequela,and providing clinical medical records,the feasibility of applying dispersing the upper-Jiao method to treat epigastric fullness of COVID-19 infection sequela was explored.[Results]It was found that YE Tianshi extraordinarily paid attention to dispersing the Qi movement in upper-Jiao when treating the epigastric fullness,and according to Clinic Guideline of Medical Records,the relevant method includes two aspects:aromatic medicine opening Qi depression and cold-pungent and diaphoretic drugs dispersing fire.The former is mostly used to take Amomi Kravanh Fructus,Semen Armeniacae Amarum,Tangerine cortices and other mild bitter and mild flowing products.The latter is used for the epigastric fullness of Qi stagnation with fire,and classical prescription Zhizichi Decoction is the core formula to treat this type.The fundamental pathogenesis of epigastric fullness of COVID-19 infection sequela lies in the failure of lung Qi to diffuse,with dampness oppression and latent heat being important contributing factors.Therefore,the treatment can consider YE Tianshi's method of dispersing the upper-Jiao.The attached case was an epigastric fullness formed after COVID-19 infection due to the stagnation of lung Qi in the upper-Jiao,which generated heat and phlegm,and affected the ascending and descending mechanism of the middle-Jiao.The treatment method was to use pungent and cool substances to clear and diffuse the latent heat,and the therapeutic effect was quite good.[Conclusion]The method of dispersing the upper-Jiao is a unique experience of YE Tianshi in the treatment of epigastric fullness,which is a vivid embodiment of the overall and interconnected perspective of TCM in the diagnosis and treatment of diseases.Summarizing YE Tianshi's experience in the diagnosis and treatment of epigastric fullness by dispersing the upper-Jiao,not only directly improves the relevant research on YE Tianshi's academic experience,but also offers valuable insights and references for the clinical treatment of sequelae of COVID-19.
沈祥峰;金禹衡;金城钟;司鹏飞
浙江中医药大学基础医学院 杭州 310053浙江中医药大学基础医学院 杭州 310053台州学院附属市立医院浙江中医药大学基础医学院 杭州 310053
医药卫生
宣透上焦痞证新冠后遗症湿遏热郁《临证指南医案》叶天士温病医案
dispersing the upper-Jiaoepigastric fullnesssequelae of COVID-19dampness repression and heat depressionClinic Guideline of Medical RecordsYE Tianshifebrile diseasemedical records
《浙江中医药大学学报》 2026 (3)
319-324,6
浙江省社科联年度项目(2022N35)浙江省中医药科研基金项目(2022ZB290) Annual Project of Zhejiang Federation of Humanities and Social Sciences(2022N35)Zhejiang Traditional Chinese Medicine Scientific Research Fund Project(2022ZB290)
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