殷甜甜 武权生

【摘 要】 武权生教授基于“燮理升降”理论，总结产后便秘病位虽在大肠，却与肝、肺、脾、胃四脏腑功能密切相关，脏腑气机失调是导致产后便秘的重要病机，即肝失疏泄、肺失宣降、脾不升清、胃失和降，治疗当疏理肝气、理气通便，开降肺气、开肺通便，升健脾气、运脾通便，降逆胃气、和胃通便。创制了自拟经验方燮理升降汤，验之于临床，效如桴鼓。探讨“燮理升降”理论在产后便秘诊疗中的运用，对临床实践有所裨益。

【关键词】 “燮理升降”；气机；产后便秘；名医经验

【中图分类号】R256.35   【文献标志码】 A    【文章编号】1007-8517（2023）08-0084-03

Abstract：Professor Wu Quansheng， based on the theory of “Xieli Shengjingt”， concluded that although the disease site of postpartum constipation is in the large intestine， it is closely related to the functions of the liver， lung， spleen and stomach. The disorder of Qi mechanism of the viscera is an important pathogenesis leading to postpartum constipation， that is， liver failure. Dispelling， dispelling and descending the lungs， not raising the spleen and clearing the spleen， disharming the stomach and descending， the treatment should be soothing and regulating liver qi， regulating Qi and defecation， opening and lowering lung qi， opening lung and defecation， enhancing the spleen， invigorating the spleen and defecation， lowering the stomach Qi， and stomach laxative. To explore the application of the theory of “Xieli Shengjiang” in the diagnosis and treatment of postpartum constipation is beneficial to clinical practice.

Key words：Xieli Shengjiang;Qi Mechanism; Postpartum Constipation; Famous Doctors Experience

便秘在產后发病率较高，产后便秘又称“产后大便难”，是指产后饮食如常，大便数日不解，或艰涩难以排出者。如控制不佳，常继发肛肠疾病，严重影响着新产妇人的生活质量［1］。本病始见于《金匮要略·妇人产后病脉证并治》记载：“新产妇人有三病，一者病痉，二者病郁冒，三者大便难。”［2］中医认为该病的病机主要为血虚津亏、脾肺气虚，目前中医多治以养血润肠为主。“燮理升降”是中医气机思想的重要命题，即和调枢机，燮理阴阳，则气机和畅，脏腑合和。故武权生教授认为，脏腑气机失调是产后便秘发病之本，治疗当疏理肝气、理气通便，开降肺气、开肺通便，升健脾气、运脾通便，降逆胃气、和胃通便。阴阳舒布、气机条畅、枢机敷和，则诸症得除，疾病可瘥。

1 病因病机

1.1 “燮理升降”的内涵 “燮”，高鸿缙《中国字例二篇》认为：“原从又（手）持棍疏火使燃之形……故托以寄燮理之意。”［3］引申泛指调和、谐和；