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从"肝木曲直"论治郁证

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"肝木曲直"是《黄帝内经》对于肝木生理特性的概括.郁证,是以情志异常为主要表现,以气机郁滞为病机的一类病证.然郁证当中,亦可见情志表现多样,或呈现躁郁相兼的特征,辨治困难.文章通过挖掘"肝木曲直"的内涵与作用,探讨此类郁证的辨治.《黄帝内经》论及脏腑病情志病状以心肝为主,犹以肝病的情志失常呈现躁郁兼具的特点,或与"肝木曲直"一体两面的特殊生理特性有关:肝用"曲直"以达"敷和"之态,"曲直"之用相反相成,可调控形神藏泻与张弛."曲直失用"则调控失司,情志变化失常,容易表现为躁郁对立相兼的特征.论治当参考《黄帝内经》脏腑苦欲补泻理论,借鉴《辅行诀脏腑用药法要》小补肝汤思路,辛补酸泻,相反相成,恢复肝木曲直之用,以达治疗目的.
Discussion on the treatment of depression syndrome based on the theory of'liver-wood characterized by bending and straightening'
The term of'liver-wood characterized by bending and straightening'is a summary of the physiological characteristics of liver-wood in the Huangdi Neijing.The main manifestation of the depression syndrome is the abnormality of the emotions and the stagnation of the qi flow.However,in one type of the disease,there are various manifestations of emotion,or a combination of agitation and depression,making it difficult to identify and treat.In this article,the connotation and role of'liver-wood characterized by bending and straightening'are elucidated and the treatment of these depression symptoms is discussed.In Huangdi Neijing,the heart and liver are the main subjects of the disorders of the emotions.The disorders of the liver are characterized by a combination of agitation and depression.The'bending and straightening'helps liver achieve the'harmonious'state.The contrasting features of'bending and straightening'help regulate the body and spirit,including storing-purging and stretching-loosening.If the'bending and straightening'are disabled,the control will be lost and the mood will change abnormally,easily showing the characteristics of both agitation and depression.The treatment should be based on the theory of bitterness and purging in the internal organs in the Huangdi Neijing,and on the use of Xiao Bugan Decoction from the Fuxingjue Zangfu Yongyao Fayao,acrid supplementing acid purging,opposite each other,restoring the use of liver-wood curvature and straightness,to achieve the purpose of treatment.

Liver-wood characterized by bending and straighteningHuangdi NeijingDepression syndromeA combination of agitation and depression

金珏、陈晓

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上海中医药大学中医学院,上海 201203

肝木曲直 《黄帝内经》 郁证 躁郁

上海市卫生健康委中医药传承和科技创新项目上海中医药大学中医学院攀登跋涉传承计划(第四批)

ZYCC2019001

2024

中华中医药杂志
中华中医药学会

中华中医药杂志

CSTPCD北大核心
影响因子:1.135
ISSN:1673-1727
年,卷(期):2024.39(3)
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