Research On Zhang Zhongjing's Theory Of Spleen And Stomach Treatmen

Objective: This paper discusses the theoretical origin of Zhang Zhongjing’s theory of treating the spleen and stomach separately,expounds its basic content,illustrates the application in guiding clinical treatment of diseases,so as to condense the core idea of Zhang Zhongjing’s theory of treating the spleen and stomach separately,enrich the content of Zhang Zhongjing’s theory of spleen and stomach,and provide theoretical basis for clinical application of classical prescriptions.Methods: Systematically arrange the ancient medical literature,discuss the influence of ancient medical literature on Zhang Zhongjing ’s theory of treating the spleen and stomach separately from three angles of theory,medicine and prescription,and expound its theoretical origin.Comprehensive Zhang Zhongjing’s theory in the System of Syndrome Differentiation and Treatment of Six Classics and Miscellaneous Diseases,TCMICS V3.0 software is used to analyze the rules of syndrome and treatment of the theory,sort out the basic syndromes and drugs,and study the basic content of Zhang Zhongjing’s theory of treating the spleen and stomach separately.The theory was applied to the clinical treatment of jaundice,new coronavirus pneumonia and depression,and its clinical application was illustrated with examples.Results: 1 The theory,medicine and prescription of Zhang Zhongjing’s theory of treating the spleen and stomach separately,originated from ‘ Huangdi Neijing ’,‘ Shennong Bencaojing ’ and ‘ Tangyejing ’.2 In the system of syndrome differentiation and treatment of six meridians,Zhang Zhongjing attributed spleen disease and stomach disease to Taiyin disease and Yangming disease respectively,highlighting Taiyin disease as cold,deficiency and dampness syndrome,treating with pungent,sweet and warm,Yangming disease into heat,excess and dryness syndrome,and treating with bitter,sweet and cold.Although Yangming has the universality of heat syndrome,it also has the particularity of cold and dampness.Although it is both cold syndrome and dampness syndrome,due to its different pathogenesis,there are also differences in prescription.The common disorder of middle-jiao qi activity in Taiyin-Yangming syndrome is characterized by cold and heat of spleen and stomach.The treatment is to dry ginger and ginseng with pungent temperature to disperse cold and supplement spleen,Scutellaria baicalensis and Coptis chinensis with bitter cold and clear heat and dry dampness,Pinellia ternata,Glycyrrhiza uralensis and Jujube with the same regulation of spleen and stomach as the basic prescription.The combination of pungent and bitter,cold and warm,the same regulation of spleen and stomach,and the recovery of qi activity are based on the emphasis on phlegm dampness,water drinking and spleen deficiency.3 In the system of syndrome differentiation and treatment of miscellaneous diseases,it mainly reflects Zhang Zhongjing ’ s thought of simultaneous disease and spleen and stomach diseases.For jaundice,abdominal fullness,blood syndrome,diarrhea,abdominal pain,chest obstruction and other diseases,the treatment principle is ‘deficiency and cold belong to spleen,excess and heat belong to stomach’.According to the respective pathological characteristics of spleen and stomach,the corresponding prescriptions are selected for treatment.For patients with spleen-stomach syndrome,the cold-heat deficiency-excess attribute of spleen-stomach pathogenesis should be discussed and treated with corresponding drugs.4 By TCMICS V3.0 platform analysis,Zhang Zhongjing’s theory of treating the spleen and stomach separately of syndrome differentiation and treatment rules are :spleen disease belongs to deficiency,belongs to cold,treatment should be spleen warm,drug taste more pungent sweet warm,and slightly adjuvant cold white peony root,huaishan anti-warm heat too dry spleen injury.Stomach disease is mostly solid,belongs to heat,to clear heat,drug taste bitter cold.Stomach disease can be characterized by dryness-heat and dampness-heat.Therefore,dryness and dampness should be distinguished to benefit stomach and promote body fluid,or clear heat and promote dampness.Spleen and stomach diseases are mostly mixed with cold,heat,deficiency and excess,with qi disorder as the main pathogenesis,often treated with cold and warm,pungent,sweet and bitter,cold and warm,pungent,bitter,coordinated spleen and stomach,restore qi.5 The syndrome and treatment of spleen diseases mentioned by Zhang Zhongjing included Lizhong Pill or Sini Decoction in the treatment of cold and dampness trapped spleen syndrome,Xiaojianzhong Decoction or Huangqi Jianzhong Decoction in the treatment of spleen qi and blood deficiency syndrome,Houpu Shengjiang Banxia Gancao Renshen Decoction in the treatment of spleen deficiency and qi stagnation syndrome,Dajianzhong Decoction in the treatment of spleen yang deficiency syndrome,and Fuling Guizhi Baizhu Gancao Decoction in the treatment of spleen yang deficiency and water flooding syndrome.The syndrome and treatment of stomach diseases include the treatment of bowel excess with Chengqi Decoction,the treatment of stomach heat flourishing with Baihu Decoction,the treatment of heat disturbing chest diaphragm with Zhizichi Decoction,the treatment of stomach heat transforming into fire with Dahuang Huanglian Huangqi Xiexin Decoction,the treatment of Qi and Jin injury with Zhuye Shigao Decoction,the treatment of phlegm heat obstructing stomach with Xiaoxianxiong Decoction and Jupi Zhuru Decoction,the treatment of stomach yang stagnation with Jupi Shengjiang Decoction or Juzhi Jiang Decoction,the treatment of stomach yang deficiency with Wuzhuyu Decoction,and the treatment of intestinal damp heat with Gegen Huangqi Huanglian Decoction or Huangqin Decoction.Intestinal damp-heat abscess treated with Yiyi Fuzi Baijiang Powder,intestinal stagnation treated with Dahuang Mudan Decoction.The syndrome differentiation and treatment of spleen-stomach syndrome include spleen cold-stomach heat syndrome,which is treated with dry ginger Qinlian Ginseng Decoction,Banxia Xiexin Decoction,Shengjiang Xiexin Decoction,and Gancao Xiexin Decoction.The syndrome of spleen cold-stomach deficiency is treated with Fuzijingmi Decoction.The syndrome of spleen about intestinal dryness is treated with Maziren Pill.The syndrome of spleen deficiency and stomach inversion is treated with Xiaobanxia and Fuling Decoction.The syndrome of spleen deficiency and stomach dampness is treated with Huangqi Baishao Guizhi Kujiu Decoction.The syndrome of Shaoyang pivot is treated with Xiaochaihu Decoction.The syndrome of spleen cold-stomach deficiency is treated with Taohua Decoction.The syndrome of qi stagnation and phlegm obstruction is treated with Banxia Houpu Decoction.Syndromes and treatments of simultaneous diseases of spleen and stomach include but are not limited to : jaundice belongs to cold dampness trapped spleen treated with Yinchen Wuling powder,belongs to Yangming damp-heat yellow treated with Yinchenhao decoction,gardenia bark decoction,Mahuang Lianqiao Chixiaodou decoction.Blood syndrome was treated with Baiye Decoction or Huangtu Decoction for those without blood intake due to spleen yang deficiency,Xiexin Decoction for those with stomach fire,Didang Decoction for those with Yangming blood storage,and Chixiaodou Danggui Powder for those with damp-heat blood.6 Six special medicines commonly used by Zhang Zhongjing for treating spleen diseases include ginseng,astragalus,roasted licorice,jujube,maltose,dried ginger of warming and dispersing cold,Atractylodes macrocephala Koidz,Coix lacryma-jobi seed,Poria,Pinellia ternata of invigorating spleen and invigorating qi,and Paeonia lactiflora Pall.and Huaishan of restraining spleen and yin.Special drugs for stomach diseases include purging and purging rhubarb,clearing heat and purging gypsum,radix scutellariae,rhizoma coptidis,gardenia,douchi,bamboo ru,expelling qi and removing fullness of Magnolia officinalis,Fructus aurantii,tangerine peel,anti-stress and anti-hiccup semi-summer,ochra,xuanzhanhua,ginseng,japonica rice,ophiopogon,evodia rutaecarpa and ginger.7 The application of Zhang Zhongjing’s theory of treating the spleen and stomach separately in clinical diseases highlights ’ deficiency and cold belong to the spleen,excess and heat belong to the stomach ’,’ excess is Yangming,deficiency is Taiyin ’.Using this theory can effectively guide the diagnosis and treatment of clinical diseases.The main cause of jaundice is wet,the first treatment of jaundice Yin Huang,Yang Huang;yin and yellow spleen,belongs to cold and wet,from the spleen treatment,prescription Yinchen Wuling powder,Shufu Yinchen decoction to warm spleen wet;yanghuang treats stomach,belongs to damp heat,treats from stomach,chooses Yinchenhao decoction,Zhizibaipi decoction,Mahuang Lianqiao Chixiaodou decoction to clear heat and remove dampness.The new coronavirus pneumonia is a kind of acute infectious disease mainly caused by ’ cold-dampness epidemic ’.The pathogenic qi is initially committed in the two meridians of Taiyin and Yangming.The evolution of its syndrome type depends on the strength of spleen and stomach function.The strong stomach qi leads to Yangming,and the weak stomach qi leads to Taiyin.In the Yangming turn real,heat,dry,in the Taiyin turn cold,virtual,even internal transmission of Shaoyin,Jueyin,become dangerous.Inspired by Zhang Zhongjing ’ s theory of spleen-stomach differentiation and treatment,the tutor took ’ deficiency is three yin,and real is three yang ’ as the treatment principle of depression.’ Deficiency leads to three yin ’ refers to depression in the treatment process.If the patients show inhibitory depression mainly with negative symptoms such as unwillingness to eat,low interest,mental retardation,and decreased will activity,the treatment is to add and subtract Sini Decoction to warm and supplement Taiyin,taking into account Shaoyin and Jueyin.’Actually,three positive ’means that if the patient shows manic depression characterized by irritability,mania,fever,hyperactivity and other positive symptoms,it is advisable to clear Yangming first,and then turn to Chaihu plus Longgu Muli decoction for Shaoyang and Qingyangming.If there are symptoms,it is necessary to take into account the symptoms.Treating depression from the point of view of ’ three yangs in fact and three yins in deficiency ’is a theoretical innovation based on the theory of spleen and stomach differentiation.Conclusion: The core idea of Zhang Zhongjing’s theory of treating the spleen and stomach separately is that spleen diseases are mostly transformed from deficiency to cold,and stomach diseases are mostly transformed from excess to heat.The pathological characteristics of spleen and stomach are different,and the prescriptions are different.When treating spleen and stomach separately,spleen diseases are treated with pungent,sweet and warm herbs to warm up,and stomach diseases are treated with bitter,sweet and cold herbs to clear away.Zhang Zhongjing’s theory of treating the spleen and stomach separately is a complete theory of traditional Chinese medicine that integrates theory,method,prescription and medicine.It can effectively guide clinical treatment,enriche Zhang Zhongjing’ s theory of spleen-stomach,and provide a theoretical basis for clinical application of classical prescriptions.It is of great significance.