崔立

摘要：顽固性腹胀是指合理应用调和肝脾、理气除胀等治疗而无明显疗效之腹胀。史载祥教授认为，在肝脾不调基础上，顽固性腹胀尚存在脾阳不升、脾胃失和之病机，治宜升举清阳、补中益气、实卫固表，方选补中益气汤加减，小其制投药；对瘀血留滞、络脉瘀阻证之腹胀，宜活血化瘀、理气行滞、通利血脉，方选膈下逐瘀汤合大黄?虫丸；对肺失宣降、肃降不能之腹胀，宜宣肃肺气、润燥滑肠、行气消胀，方选温白丸加减；对沉寒痼冷、阳损寒凝之腹胀，宜温通逐寒、温补脾肾、温里助阳，可选九转玉壶丹；对奇经受累、阴阳俱损之腹胀，宜通补奇经、温补阴阳、补益肝肾，方选肉苁蓉丸加减。治疗顽固性腹胀需整体辨证、变通施治。

关键词：名医经验；史载祥；顽固性腹胀

DOI：10.3969/j.issn.1005-5304.2017.05.028

中图分类号：R259.7 文献标识码：A 文章编号：1005-5304（2017）05-0116-04

Essence Experience of Professor SHI Zai-xiang in Treatment of Intractable Abdominal Distension CUI Li1， Instructor： SHI Zai-xiang2 （1. Digestive Department， Beijing Yanhua Hospital， Beijing 102500， China； 2. China-Japan Friendship Hospital， Beijing 100029， China）

Abstract： Intractable abdominal distension refers to the reasonable application of the general dialectical therapy with no significant efficacy. Professor SHI Zai-xiang believes that on the basis of hepatosplenic disorder， there are the etiology and pathogens of spleen yang not raising and spleen and stomach in disorder in intractable abdominal distension， which should be treated with raising qing yang， tonifying qi， and consolidating the superficial resistance. Therefore， modified Buzhong Yiqi Decoction was used； as for abdominal distension with blood stasis and meridian stasis， the treatment should be motivating blood circulation and eliminating stasis， motivating qi stagnation， and making free the passage of blood in the vessels， which should be treated with Gexia Zhuyu Decoction combined with Dahuang Zhechong Pills； as for abdominal distension with lung qi stagnation， the treatment should be motivating lung qi， moisturizing dryness and laxation， promoting qi and eliminating swelling， which should be treated with modified Wenbai Pills； as for abdominal distension with cold and yang deficiency， the treatment should be warming and expelling cold， warmly tonifying spleen and kidney， which should be treated with Jiuzhuan Yuhu Pills； as for abdominal distension with extra meridians tiredness and deficiency of yin and yang， the treatment should be tonifying extra meridians， warmly tonifying yin and yang and tonifying liver and kidney， which should be treated with modified Roucongrong Pills. Intractable abdominal distension needs the overall dialectical and alternative treatment.

Key words： experience of famous doctors； SHI Zai-xiang； intractable abdominal distension

腹胀是消化系统疾病的常见症状，单以腹胀为主诉的功能性疾病亦不鲜见。其在中医学范畴可分为“痞”和“胀”，前者以胸腹痞闷、胀满不舒为主症，触之无形、压之不痛，按部位可分为胸痞及心下痞；后者指腹中有胀满之感而外有胀急之形，部位在胃脘以下。二者病因病机和临床表现多有相通，故统称为痞胀。以“腹胀”为证名出自《灵枢·水胀》“鼓胀何如？岐伯曰：腹胀身皆大，大与肤胀等也”，《諸病源候论》分“腹胀候”和“久腹胀候”阐述了腹胀的病因病机。现代中医多认为，腹胀病位在胃，其发病与脾、肝、胆等脏腑有密切关系；肝脾不调是腹胀的重要成因，故调和肝脾、理气除胀往往行之有效[1]。……