摘要
左进教授基于“通下”理论提出慢性便秘的核心病机为大肠传导失司,与肺、脾、肝三脏气机失调及全身津液输布障碍相关,且久病则脾肾俱损。基于此,左进教授提出慢性便秘中医治则当以“通下”为核心,实证(热结、气滞、寒凝)泻实,方选大承气汤、六磨汤、大黄附子汤等;虚证(气虚、血虚、阴虚、阳虚)补虚,主张“以补为通”,灵活选用黄芪汤、润肠丸、增液汤、济川煎等。左进教授临证注重大黄的精准运用:生大黄(8.56~10.92 g)泻实,熟大黄泻下力减适合体虚患者,配伍经典药对(如大黄-厚朴泄热导滞,黄芪-白术补气通便)。同时,强调调畅肺、脾、肝三脏气机以复肠腑通降,以通为期,兼顾滋阴润燥。该理论融合中医整体观念与辨证论治理论,结合中药现代药理学研究,实现“通而不伤,补而不滞”的诊疗思想,为慢性便秘提供了标本兼治的中医治疗方案。
Based on the"purgation"theory,Professor Zuo Jin proposed that the core pathogenesis of chronic constipation lies in the dysfunction of intestinal conveyance,associated with qi movement disorders in the lung,spleen,and liver,systemic fluid distribution disorders,and chronic spleen and kidney impairment.Accordingly,he established a therapeutic principle centered on"purgation",eliminating excess pathogens(heat accumulation,qi stagnation,and cold congealment)in excess syndromes using Da Chengqi Decoction,Liu Mo Decoction,or Dahuang Fuzi Decoction;and adopting a"tonifying to unblock"strategy for deficiency syndromes(qi deficiency,blood deficiency,yin deficiency,and yang deficiency)through Huangqi Decoction,Runchang Pill,Zengye Decoction,or Jichuan Jian.Professor Zuo emphasizes precise rhubarb application:raw rhubarb(8.56-10.92 g)for excess syndromes and processed rhubarb for constitutional weakness.Classic herb pairs are employed(e.g.,rhubarb-magnolia bark for heat clearance and astragalus-atractylodes for qi supplementation).Concurrently,he prioritizes regulating qi movement in the lung,spleen,and liver to restore intestinal peristalsis,while integrating yin-nourishing and dryness-moistening approaches.This theory integrates TCM holistic concepts and syndrome differentiation with modern pharmacological research,achieving"unblocking without damaging,tonifying without stagnation",thereby providing a comprehensive therapeutic strategy addressing both symptoms and root causes of chronic constipation.
作者
张彦成
左进
ZHANG Yancheng;ZUO Jin(Department of Proctology,Gansu Provincial Hospital of Traditional Chinese Medicine,Gansu,Lanzhou 730000,China)
出处
《中国医药科学》
2025年第23期107-111,共5页
China Medicine And Pharmacy
基金
甘肃省名中医传承工作室建设项目(甘财社〔2023〕168号)。
关键词
慢性便秘
通下
大黄
泻实补虚
Chronic constipation
Purgation
Rhubarb
Combining elimination of excess and supplementation of deficiency
