张声生教授“以静制动、动静结合”辨治慢性腹泻

来源:用户上传      作者:朱悦尔 张声生

　　摘要 慢性腹泻属于中医“久泻”范畴，其病位在肠，病变脏腑在脾，并且与肝、肾相关。张声生教授主张“以静制动、动静结合”，在辨证的基础上精准用药，治疗慢性腹泻时运用动静药物，取得良好的临床疗效。将药物根据阴阳动静属性进行区分，以“静为主，动为辅”，在脾虚湿盛、脾肾阳虚、肝郁脾虚等证候中，静药可以发挥健脾益气、温阳涩肠、健脾柔肝等作用，动药多发挥化湿行气、通阳散寒、行气解郁等作用。“动静”药物的结合，实际上也是“动静”治法的结合，临床中应用广泛。深入学习、传承张声生教授“动静结合”的中医治疗思路，可以更好地理明疾病的病机及灵活掌握配伍用药，以提高临床疗效。
　　关键词 慢性腹泻;久泻;动静结合; @ 张声生;经验
　　Abstract Chronic diarrhea belongs to the category of lasting diarrhea in traditional Chinese medicine.The location of disease is in the intestines，and the pathological viscera is in the spleen，often related to the liver and the kidney.Professor Zhang Sheng-sheng received good curative effect on patients with chronic diarrhea with the therapy of ‘subduing activity with inertia and combining activity and inertia’，which is accurate medication based on syndrome differentiation and treatment.According to the properties of Yin and Yang，active and tranquil，TCM medicinal materials could be divided into different categories.In the syndromes of spleen deficiency and excess dampness，deficiency of spleen Yang and Kidney Yang，and liver-qi stagnation and spleen deficiency，inertia drugs play the roles of strengthening spleen and tonifying qi，warming Yang and astringing intestines，strengthening spleen and softening liver，etc.Active drugs mostly play the roles of resolving dampness and invigorating qi，circulating Yang and dispersing cold，accelerating the circulation of qi，etc.The combination of ‘active and inertia’ drug is actually the combination of ‘active and inertia’ treatment，which is widely used in clinical practice.Learning and inheriting professor Zhang Sheng-sheng′s therapy of treating chronic diarrhea can better clarify disease pathogenesis and skillfully mastering the compatibility of drugs in order to improve the clinical curative effect.
　　Keywords Chronic diarrhea; Lasting diarrhea; Combination of motion and inertia; @ Zhang Sheng-sheng; Clinical experience
　　中D分类号：R249.2/.7;R256.34文献标识码：Bdoi：10.3969/j.issn.1673-7202.2021.24.018
　　腹泻是一类由多因素、多病因导致以排便次数增加、大便性状改变为特征的临床综合征。病程>2个月即可定义为慢性腹泻[1-2]。慢性腹泻属于中医“久泻”范畴，是迁延不愈、反复发作的一类疾病。其病位在脾，与肝、肾相关。久泻因病程迁延，病性由实转虚，常表现为虚实夹杂的证候[3]。张声生教授是世界中医药学会联合会消化病专业委员会会长，第一、二届中华中医药学会脾胃病分会主任委员，从医30年，具有丰富的临床诊疗经验，在治疗慢性腹泻方面，善于采用“以静制动、动静结合”治疗思路，采用“静药”防止正气的脱失，用“动药”恢复脾胃气机的功能、祛除有形实邪，临床中取得了良好的效果。现将张声生教授“以静制动、动静结合”辨治慢性腹泻经验报道如下。
　　1 治法用药当辨阴阳动静
　　阴阳为医道之纲领，辨证论治当首辨阴阳。无论在辨病、辨证之中，均是透过辨别阴阳的盛衰，并利用其相互对立制约的关系，施以治疗，故《素问・阴阳应象大论》云：“审其阴阳，以别柔刚。阳病治阴，阴病治阳。”张教授认为，以治法而言，应结合药物性味和功能主治，将药物归纳为“动”和“静”2种属性。正如张景岳在《景岳全书・传忠录》中所述：“性动而走者为阳，性静而守者为阴。”根据药物的四气、五味、升降浮沉可以区分其动静属性。其中“动药”药性多温热，药味多味辛，具有升浮于上、向外发散的特质，功效多为行气、活血、祛湿、消导等;“静药”药性多寒凉，药味多味酸、苦、甘、咸，具有沉降于下、向内收敛的特质，功效多以补益、清热、收敛、固涩为主[4]。药物的动静属性并非绝对，在不同的证候和组方中可以发挥出不同的作用。
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