The physiological function of the liver and gallbladder has an important position in the five internal organs, and the "Inner Classic" calls the liver "the officer of the general, plotting out of the heart", the gall as "the official of the middle righteousness, the decision to come out", and "all the eleven organs depend on the gall", which shows this. And the liver and gallbladder lesions are also many and mixed, as the "Know the Doctor Must Discern" cloud: "The disease of the five viscera, the liver qi has." Lin Peiqin said: "Most of the diseases are born from the liver." ”
The treatment of hepatobiliary diseases, since the "Inner Classics", has been discussed, such as Wang Xugao's "liver disease is the most complicated and the most extensive treatment", and the thirty methods of liver treatment are intended to be treated, which can be described as detailed. On the basis of inheriting his predecessors, Mr. Li carefully explored the physiological pathology of hepatobiliary disease, paid special attention to the interconnection between the hepatobiliary lesions, emphasized that the two were used for each other physiologically; pathologically affected each other, and the hepatobiliary symptoms were often seen; the treatment should be treated with the liver and gallbladder, and according to its symptoms, there is a distinction between primary and secondary, which reflects the high flexibility of dialectical treatment, which is introduced from three aspects as follows.
(1) Physiological characteristics and interconnection of liver and gallbladder
The liver is born in the five elements of wood, which is born of the qi of the oriental wind and wood, so it is called the dirtiness of the wind wood. The wood symbolizes the germination of its branches and leaves, thriving, and prosperous vitality, indicating the physiological characteristics of hepatic "hi-tiao-da and vicious depression".
Sex hi-yo da. It refers to the physiological ability of the liver to be unclogged, snug, hair growth and comfort. Therefore, it can promote the smooth passage of the gas machine, the operation of blood, the digestion of diet, and the infusion of jin liquid. In addition, mental activity, women's menstruation, etc. are all affected by the liver. If the liver is unable to comply with its temperament, it will be depressed and uncomfortable, or hyperactive.
Body yin with yang. The liver takes blood as the body and qi as the use, so there is a saying that the body is yin and the yang is used. Blood belongs to yin and yin, qi belongs to yang active, dynamic and static phase system, and yin and yang are also physiological characteristics of the liver. The liver hides blood to nourish the tendons, and the "Su Qing Meridian Theory" says: "Eating qi into the stomach, dispersing essence in the liver, and obscene qi in the tendons." "The claws are the tendons." Therefore, the claw armor veins are outside the liver, and the yin and yang qi and blood of the liver are harmonized, then the tendons are strong and the claws and nails are ruddy. The loss of muscles and veins, and the convulsions are often witnesses to liver disease. Born for women. In ancient times, there was a saying that "women take the liver as a congenital", because the liver is "blood sea", the relationship is chong ren; the liver and kidney ethylene decoction are homologous, and the sperm and blood are mutual. Therefore, women's menstruation depends on the regulation of the liver, and menstrual disorders are often related to the liver.
The gallbladder is attached to the liver, the semen is hidden, and the lord decides. Bile is the "house of the middle essence", and the essence stored in it comes from the liver, so the profit and loss of bile depends on the liver. "The decision of the bold master" shows that the bravery and decisiveness of people are related to the gall, in addition to maintaining the normal physiological activities of the body. For example, Cheng Xingxuan quoted the "Medical Ginseng" language: "If you are not afraid of strong winds, you are not hurt by wind." If you are not afraid of the cold, you will not be in the cold, and if you drink food not out of reluctance, you will not have the trouble of staying behind, and your qi will be swollen with courage, and evil will not be able to dry. "Even if you are bold, you can resist evil and reduce the occurrence of diseases." Spring is born of the qi, the spring qi rises, then the ten thousand peace, so the courage of the spring, then the residue from it. "It means that bile is like the spring yang qi that grows, the spring qi occurs, all things grow; the bile rises, and the function of each organ can flourish.
Wood qi flushes, bile rises, and co-owner drains. Liver wood flushing, qi machine smooth, spleen and stomach good luck. The liver is full of qi and bile, and it is released in the small intestine to promote spleen luck. The gall qi rises and promotes the release of wood qi. The mutual assistance of the liver and gallbladder, the mastermind of the liver, and the non-biliary continuously show the close relationship between the two mutual assistance. Therefore, the normal function of the liver requires the full cooperation of the gallbladder. Such as the drainage of the liver to smooth the emotions, the lack of courage to make people brave and decisive, full of spirit, the cooperation of the two, has the effect of maintaining the stability of mental and emotional activities, so it plays an important role in the defense and elimination of certain mental stimulants. Therefore, when the liver and gallbladder lesions are often accompanied by abnormalities in emotional activity.
(2) The interaction of hepatobiliary lesions
Pathologically, liver disease often involves the bile, and biliary disease often affects the liver, so the liver and gallbladder are often the same disease. Due to the different functional characteristics of the liver and gallbladder, there are different symptoms when lesions, but the two can affect each other, and the liver and gallbladder are the same disease.
Hepatic wind moves internally, associated with biliary. Liver wind internal movement is generally based on the liver's yang qi hyperactivity and reverse change of wind as the disease mechanism, so the "Inner Classic" said that "all winds and dizziness belong to the liver". However, the bile is intrinsically linked to the formation of hepatic wind. With the bile attached to the liver, the liver is the dirt of the wind wood, the bile lord spring birth less yang qi, "the fire produced by the liver wood, hidden in the gall, is called the phase fire", the wind wood is sparse, the phase fire is not excessive, the wood qi is rushed and the strip is reached, the qi and blood are smooth, and the veins are soft. If the fire is too high, it is for the sake of strengthening the fire, disturbing the liver wood, the wind and fire are inciting, the hyperactivity is reversed and the wind is turned, and the symptoms of dizziness, tremor, convulsions and shaking are born.
Liver qi is depressed, biliary loss and drainage. Liver loss of strips, stagnation of qi, drainage is not enough, it affects bile secretion and excretion, liver qi deficiency is less bile, gastrointestinal water valley does not melt; or liver qi is not sparse, bile depression is not discharged, then see rib swelling pain, bloating, anorexia. If the liver is hyperactive, it can overflow or overflow bile and see bitter mouth, jaundice and so on. On the contrary, if the medium scorch humidity and heat are depressed, affecting the excretion of bile and the accumulation of bile, the liver qi is not comfortable, the drainage is not smooth and the liver disease is caused. The liver is timid and timid, and the intention is uncertain. The Treatise on Strange Diseases says: "The liver of the husband, the general of the middle, depends on the gallbladder... This man is indecisive in his calculations, so he is emboldened and overflowing with weakness, and his mouth is bitter. "Point out the effect of liver and gallbladder on the activity of thinking. Liver disease and biliary disease, or biliary disease and liver, often have abnormal changes in consciousness. For example, liver deficiency can be seen as "unhappy" and "frightened and uneasy, as if people will catch them". Liver deficiency is timidity, and timidity, fear, sleeplessness, good sighing or sleeplessness and so on. Therefore, the treatment of the above lesions must be treated from the hepatobiliary theory.
(3) Treatment of hepatobiliary disease evidence
Hepatobiliary disease is often the same disease, and hepatobiliary disease must be treated together. Successive generations of physicians have discussed the treatment of hepatobiliary disease in detail. For example, there are three ways to cure the liver in the "Inner Classic": xin to scatter, willing to slow, and sour to receive. The three methods of slowing, xinsan and acid harvest laid the foundation for the treatment of liver disease in later generations. The "Difficult Classics" points out that "those who damage their livers are slowed down", and the "Golden Essentials" further points out that "the disease of the liver of the husband, supplement the acid, help with scorching bitterness, and use the medicine of sweet taste to adjust it", and create important formulas such as four reverse scatters, small chai hu soup, peony licorice soup and so on. On this basis, the Taiping Huimin and the Pharmacy Bureau Fang made a loose scatter, and the three methods were combined into one party, which was commonly used by posterity to treat the liver. Qing Wang Xugao believes that "liver disease is the most complicated and the most extensive treatment method", and intends to treat the liver thirty methods, divided into three categories: liver qi, liver wind and liver fire, which are different according to the main symptoms, which are quite practical.
Mr. Believes that the symptoms of hepatobiliary disease are complex and changeable, so there are "liver is a thief of the five internal organs", "liver wood is like a dragon", and among the miscellaneous diseases of internal medicine, liver disease is ten and six or seven. Therefore, the discussion of its treatment has important clinical significance. The former sages have studied the treatment of hepatobiliary disease evidence in detail, the treatment methods are complicated, and there are many prescription drugs, but there are no two ways to help the right and dispel evil.
Therefore, on the basis of inheriting the experience of his predecessors, Mr. Gu bu mud, combined with his own clinical practice, proposed that the treatment of hepatobiliary disease should pay attention to the treatment of hepatobiliary disease, and the characteristics of this mr. hepatobiliary disease should be treated. The prescription of testimony is based on the ancient formula, and the evidence-based judgment is its characteristic. Such as idle scatter, chai hu loose liver scatter, warm bile soup, etc. are commonly used in clinical practice, but with the difference between men and women, old and young, the cause of the disease is different, the evidence is different and flexible. Prescription medication, a small amount of light taste, but also reflects the characteristics of Mr. medication. Usually one party does not exceed 10 flavors, the dose is also light, 6 to 12g is constant, the evidence is judged, the change in the amount of medicine is also one of them, although the composition of the prescription has not changed, but its intention has been very different.
Drainage is not enough, the liver is not comfortable, and the treatment is soothing.
Liver qi is depressed in the beginning of the qi, followed by the blood. Liver qi is depressed and heated up day by day, consuming yin blood, and the disease is serious in the blood. Cure when the liver is soothed, the blood is nourished and the spleen is strengthened, and the party is used to disperse.
The original formula of The Loose Scatter is composed of: licorice half two, angelica, white poria, white peony, bai shu, chai hu 1 two, a total of 6 flavors, made of coarse mince, 2 dollars per serving, 1 piece of roasted ginger, a little mint, a large cup of water, fried to 7 points, go to the hot serve. In terms of its dosage, it is a "light agent", and it is only taken for 2 dollars at a time. Now the decoction is generally used, and the dosage is larger.
When Mr. Medicate, keep the original intention of the ancients, use lightly, in line with its light and cathartic purpose, its effect is better. At the same time, pay attention to the addition and subtraction of the certificate. If the liver depression is lost in drainage, the disease and the gallbladder, then the liver is also used as a choleretic, adding the yujin of the biliary meridian, taking its choleretic function; and the yujin can also enter the qi to dissolve the depression, into the blood to divide the cold blood and break the stasis, which is the qi medicine in the blood, and it is also combined with the pathological changes of the liver depression and then the blood, so it is the preferred drug. Liver depression stagnation, pain is not clear, pain is even more Kagawa neem qi to relieve pain. Liver depression stagnation, blood flow is not smooth, women menstrual abdominal pain, add incense to the liver to relieve liver rational qi, qi line is bloody, to relieve the liver to relieve the effect of depression and pain relief. If the breast is swollen even more, the king does not stay in line, take it into the liver and walk the blood, benefit the blood vein, match it with the rational qi and blood, reduce swelling and relieve pain.
Drainage is too much, the liver is hyperactive, and the treatment is soft.
Hyperinflation of liver qi, reversal of qi machine, surge of qi and blood, or transverse spleen and stomach, or bile inversion or leakage of bile, emotional performance is impatient and irritable. Fang uses chai hu to loosen the liver and regulate the liver.
See the Complete Book of Jingyue. Fangzhong chai hu, tangerine peel, citrus shell, incense with four flavors are mainly to adjust the qi, but the line of qi medicine is dry and scattered, in order to prevent injury and liver body, reuse of Sichuan root, white peony, Sichuan root for the blood of the qi medicine, the main and blood scattered; white peony yin, Wu licorice can be acid glycidated yin, and can soften the liver, feminine to make liver, prevent evacuation too much, for the treatment of liver qi overuse of the common prescription. When used, it should also be added and subtracted with the evidence. Bile overflow, bitter mouth, vomiting yellow and green water, add tulip gold, enhance the function of thinning the liver and gallbladder; chest flank, stomach, less abdominal distension and pain, kagawa neem, take its bitter cold descent, into the liver and stomach meridian, drain the liver and qi to relieve pain, where the drainage is too much, the liver qi is reversed, the stomach and spleen cause abdominal pain, which is commonly used; the liver qi is reversed, see head swelling pain, dizziness or peak pain, tinnitus, etc., add oysters, take its cold weight, can clear heat and benefit yin and yang, where liver and yang hyperactivity, or heating fire, injury and yin fluid, can be used. Both the loose scatter and the chai hu loose liver scatter are based on the legislative judgment of the four reverse scatters, which are commonly used to relieve the liver, but the main disease evidence is different.
Mr. Believes that Chai Hu Loose Liver Is Heavy in Qi, Mainly Regulating Qi, the Main Liver is used as a disease, taking into account the liver body, so it is often used to treat the symptoms of liver Qi leakage. Dispelling rumors takes into account blood. Both sides have chai hu and white peony, one is qi medicine, one is blood medicine; one is mainly xin shan, one main acid harvest; one main line qi, one main blood nourishment. Properly matched, it can adjust the liver, supplement the liver body, and make the liver body comfortable.
Mr. Li is also quite particular about the dosage and compatibility of chai hu and white peony. Although both parties use chai hu and white peony, the dosage has changed. The amount of white peony in the idle scatter is less than that of the chai hu, and the amount of white peony in the chai hu loose liver scatter is greater than that of the chai hu. Idle scattering of the main disease and blood, with white peony acid to astringent, angelica gan to warm supplement, yin to replenish blood, tonic liver body. However, liver depression can not be drained, and the liver is used to dredge the liver with chai hu, and the acid harvest is too much to hinder the liver use, so the amount of peony medicine is less than that of chai hu. Chai Hu loose liver dispersion in the adjustment of qi, the main treatment of liver drainage is too much, so the use of chai hu with citrus shell, tangerine peel, incense attached to the tone of the main, but I am afraid that its spicy nature often damages the liver body, hurt the yin blood of the liver, so it is necessary to match the white peony and other blood nourishing yin medicine to soften the liver. As Zhang Xichun said: "The liver body is wooden and hard, and it is advisable to use the method of soft liver." "It is to use more white peony than chai hu, and acid is collected to prevent evacuation from being too much." The two sides use the same two drugs, but the disease mechanism is not the same, so it can be dealt with by adjusting the proportion of the dosage of the two drugs, so that it is not scattered, the collection is not delayed, and the body is taken into account. Although the prescription is ordinary, the medicine has no major changes, and it is often won by blandness. This shows the mystery of Mr. Pro-Prescription.
Zhang Zhenyu series of articles collected by the Crescent Lake Qingnang Society from the "Zhang Zhenyu Academic Experience Summary", "Shandong University of Traditional Chinese Medicine Nine Famous Doctors Experience Record Series 丨 Zhang Zhenyu", "China's 100 Years of Traditional Chinese Medicine Clinicians Series 丨 Zhang Zhenyu", "Zhang Zhenyu Medical Case Medical Talk Collection", "Zhang Zhenyu Medical Anthology", CNKI related papers and networks, etc., if there is infringement, please inform.
