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肝胃不和性惡阻(中醫肝胃不和的治療方子)

醫案(an)日記 2023-05-07 02:13:15

肝胃不(bu)和性惡(e)阻

脈(mo)象弦滑,舌質(zhi)偏紅,苔黃膩(ni),小便醋酮試驗陽(yang)性

抑肝和胃飲

妊娠劇吐

【方名(ming)】抑(yi)(yi)肝和(he)胃飲(yin),有抑(yi)(yi)肝與和(he)胃兩種意(yi)義。抑(yi)(yi)肝者,抑(yi)(yi)制肝氣(qi)之升逆(ni)也。因為妊娠(shen)惡阻的主要(yao)(yao)病機在于(yu)沖(chong)肝之氣(qi)升逆(ni),所以抑(yi)(yi)肝是(shi)治療惡阻的主要(yao)(yao)方面。和(he)胃就是(shi)和(he)降(jiang)胃氣(qi),恢復正(zheng)常的胃降(jiang)功能。抑(yi)(yi)肝和(he)胃,意(yi)即(ji)控制嘔吐。飲(yin)者,頻飲(yin)之意(yi)也。顧名(ming)思(si)義,抑(yi)(yi)肝和(he)胃飲(yin)就意(yi)味著本(ben)方功效(xiao)為控制嘔吐,需(xu)要(yao)(yao)頻飲(yin)。

【組成(cheng)】蘇葉3~5克(ke)(ke)(ke),黃連3~6克(ke)(ke)(ke),制半夏6克(ke)(ke)(ke),廣(guang)陳皮(pi)5克(ke)(ke)(ke),姜(jiang)竹茹6~9克(ke)(ke)(ke)。嘔吐劇(ju)烈者,加(jia)炙烏(wu)梅3~5克(ke)(ke)(ke),生姜(jiang)片2~3片。

【服(fu)法】每日1~2劑,水(shui)煎頻服(fu)。

【功(gong)用】抑(yi)肝和胃,控制嘔吐。

【適應(ying)證】肝胃不和性惡阻(zu)。證見妊(ren)娠早期,惡心嘔吐(tu),飲食阻(zu)隔,吐(tu)黃苦水,甚則嘔吐(tu)綠色苦膽(dan)水,胸(xiong)悶煩躁,心中情煩不舒,脈象弦滑,舌質(zhi)偏紅,苔黃膩,小便醋酮(tong)試(shi)驗陽(yang)性。

【方(fang)(fang)解(jie)】本(ben)方(fang)(fang)是從蘇(su)(su)葉(xie)黃(huang)連(lian)湯的(de)(de)(de)基礎上(shang)加味而來的(de)(de)(de),原方(fang)(fang)出(chu)自《溫(wen)熱經緯(wei)》薛生(sheng)白(bai)方(fang)(fang)。因(yin)濕熱阻(zu)于上(shang),中(zhong)焦肺胃(wei)不和(he),嘔(ou)吐不止(zhi)(zhi),蘇(su)(su)葉(xie)黃(huang)連(lian)湯治(zhi)之,故用(yong)(yong)(yong)(yong)黃(huang)連(lian)為(wei)主(zhu)藥。黃(huang)連(lian)有(you)(you)抑肝的(de)(de)(de)作(zuo)(zuo)用(yong)(yong)(yong)(yong),朱丹溪曾單(dan)用(yong)(yong)(yong)(yong)黃(huang)連(lian)一味謂之抑青丸。加入蘇(su)(su)葉(xie)者,因(yin)其不僅有(you)(you)協(xie)助(zhu)黃(huang)連(lian)抑肝和(he)胃(wei)止(zhi)(zhi)吐的(de)(de)(de)作(zuo)(zuo)用(yong)(yong)(yong)(yong),而且蘇(su)(su)葉(xie)、蘇(su)(su)梗均有(you)(you)理氣安(an)胎的(de)(de)(de)功效。再加入陳皮、制(zhi)(zhi)半夏、姜竹茹者和(he)胃(wei)降逆,有(you)(you)助(zhu)止(zhi)(zhi)吐的(de)(de)(de)作(zuo)(zuo)用(yong)(yong)(yong)(yong)。制(zhi)(zhi)半夏在(zai)妊(ren)娠藥歌中(zhong)被列(lie)入禁品,并有(you)(you)致(zhi)畸的(de)(de)(de)報(bao)道,但止(zhi)(zhi)吐作(zuo)(zuo)用(yong)(yong)(yong)(yong)明顯,故不得不暫(zan)時(shi)用(yong)(yong)(yong)(yong)之,待嘔(ou)吐改(gai)善則停用(yong)(yong)(yong)(yong)。竹茹不僅能和(he)胃(wei)止(zhi)(zhi)吐,而且還有(you)(you)抑肝作(zuo)(zuo)用(yong)(yong)(yong)(yong),可協(xie)助(zhu)黃(huang)連(lian)。嘔(ou)吐劇(ju)烈(lie)者,尚(shang)經加入烏梅以(yi)酸斂之,生(sheng)姜以(yi)止(zhi)(zhi)嘔(ou)。總之,達到改(gai)善或控制(zhi)(zhi)嘔(ou)吐,乃本(ben)方(fang)(fang)之目的(de)(de)(de)。

【臨(lin)床運用】本(ben)方(fang)不僅適用于妊娠惡阻(zu)之屬于肝胃不和者,而且還可(ke)用于經行(xing)嘔吐(tu)及急(ji)性(xing)嘔吐(tu)等(deng)的治療(liao)。

1.經行嘔吐 每屆經前經期,惡心嘔吐,甚則不(bu)能進食,伴有胸(xiong)悶煩躁,頭昏頭痛,腰酸(suan),脘腹作脹,大(da)便(bian)艱行,月經失調(diao),后期量少(shao),色紫紅有血塊,脈象弦滑,舌質黯紅,苔黃白膩。應(ying)用本(ben)方(fang)治療時(shi),需加說(shuo)丹參、赤芍、澤蘭葉各10克(ke),制香附9克(ke)。

2.急慢性嘔(ou)吐(tu) 可見(jian)胃(wei)脘脹痛,惡心(xin)嘔(ou)吐(tu),吐(tu)出黃苦水(shui)或(huo)黏膩痰液,或(huo)伴(ban)輕度發熱,有飲食(shi)不潔(jie)或(huo)不節病(bing)史,脈象(xiang)弦(xian)滑帶數,舌苔黃膩者。用本方(fang)治療時,加黃芩(qin)10克,廣木香9克,甘松(song)10克,甚或(huo)可加大黃(后(hou)下)6克。

【按語】我們在臨床(chuang)上,凡見妊(ren)娠嘔(ou)吐劇烈(lie),吐出酸(suan)水(shui)(shui)、苦水(shui)(shui),不能(neng)進食(shi),甚則連(lian)水(shui)(shui)也不能(neng)進,常以(yi)左(zuo)金(jin)丸(wan)少量食(shi)之,有時的(de)確(que)能(neng)取效。考(kao)左(zuo)金(jin)丸(wan),系朱丹溪(xi)的(de)方劑,亦是以(yi)黃(huang)連(lian)為(wei)(wei)主藥,稍佐(zuo)吳茱萸,研末水(shui)(shui)泛為(wei)(wei)丸(wan),治(zhi)療嘔(ou)吐吞酸(suan),左(zuo)脅(xie)作痛,完(wan)全是肝(gan)木犯(fan)胃(wei),故佐(zuo)金(jin)平木,順降胃(wei)腑,確(que)能(neng)收效。為(wei)(wei)此(ci)選取蘇葉黃(huang)連(lian)飲,但必以(yi)黃(huang)連(lian)為(wei)(wei)要藥,組合順降胃(wei)腑的(de)藥物,故命之曰(yue)抑肝(gan)和(he)(he)胃(wei)飲,目的(de)就在于抑肝(gan)和(he)(he)胃(wei),降逆(ni)止吐。

肝(gan)(gan)(gan)(gan)(gan)(gan)胃(wei)(wei)(wei)(wei)(wei)不(bu)和(he)性的(de)(de)惡(e)阻(zu),在臨(lin)床上(shang)極為(wei)多(duo)見。因(yin)(yin)(yin)為(wei)妊(ren)(ren)娠(shen)之(zhi)(zhi)(zhi)后,陽(yang)氣(qi)(qi)(qi)偏(pian)旺,BBT呈(cheng)高溫相,極易激動肝(gan)(gan)(gan)(gan)(gan)(gan)經(jing)(jing)氣(qi)(qi)(qi)火(huo),肝(gan)(gan)(gan)(gan)(gan)(gan)經(jing)(jing)氣(qi)(qi)(qi)火(huo)上(shang)逆,逆犯(fan)(fan)于(yu)(yu)胃(wei)(wei)(wei)(wei)(wei),胃(wei)(wei)(wei)(wei)(wei)腑失降(jiang)(jiang)(jiang),此(ci)其一也。妊(ren)(ren)娠(shen)之(zhi)(zhi)(zhi)后,經(jing)(jing)血不(bu)再外(wai)溢(yi),壅聚以養(yang)胎兒,胎兒生長之(zhi)(zhi)(zhi)氣(qi)(qi)(qi)偏(pian)旺,通(tong)過(guo)(guo)(guo)沖(chong)脈之(zhi)(zhi)(zhi)氣(qi)(qi)(qi)而(er)上(shang)升(sheng)逆,逆犯(fan)(fan)于(yu)(yu)上(shang),胃(wei)(wei)(wei)(wei)(wei)腑失和(he)。中(zhong)焦(jiao)脾(pi)胃(wei)(wei)(wei)(wei)(wei)是升(sheng)降(jiang)(jiang)(jiang)之(zhi)(zhi)(zhi)樞紐(niu)(niu),即上(shang)下兩焦(jiao)的(de)(de)氣(qi)(qi)(qi)機升(sheng)降(jiang)(jiang)(jiang),均需(xu)經(jing)(jing)過(guo)(guo)(guo)中(zhong)焦(jiao)脾(pi)胃(wei)(wei)(wei)(wei)(wei)的(de)(de)轉輸,因(yin)(yin)(yin)此(ci)肝(gan)(gan)(gan)(gan)(gan)(gan)氣(qi)(qi)(qi)升(sheng)逆,沖(chong)氣(qi)(qi)(qi)升(sheng)逆,均犯(fan)(fan)于(yu)(yu)胃(wei)(wei)(wei)(wei)(wei),如脾(pi)胃(wei)(wei)(wei)(wei)(wei)的(de)(de)樞紐(niu)(niu)有力(li),則沖(chong)肝(gan)(gan)(gan)(gan)(gan)(gan)之(zhi)(zhi)(zhi)氣(qi)(qi)(qi)升(sheng)逆者,尚(shang)不(bu)過(guo)(guo)(guo)分劇烈,僅(jin)(jin)僅(jin)(jin)出(chu)現一些輕(qing)微的(de)(de)惡(e)心泛(fan)吐,并不(bu)能阻(zu)隔飲(yin)食(shi),因(yin)(yin)(yin)此(ci)不(bu)屬(shu)病理。若沖(chong)肝(gan)(gan)(gan)(gan)(gan)(gan)之(zhi)(zhi)(zhi)氣(qi)(qi)(qi)升(sheng)逆過(guo)(guo)(guo)甚,陽(yang)氣(qi)(qi)(qi)過(guo)(guo)(guo)旺,脾(pi)胃(wei)(wei)(wei)(wei)(wei)的(de)(de)樞紐(niu)(niu)調節功能較差,就(jiu)形成較劇的(de)(de)惡(e)心嘔吐,阻(zu)隔飲(yin)食(shi),就(jiu)將成為(wei)惡(e)阻(zu),是惡(e)阻(zu)的(de)(de)主(zhu)要病機。因(yin)(yin)(yin)此(ci),抑肝(gan)(gan)(gan)(gan)(gan)(gan)者,實(shi)際上(shang)是平降(jiang)(jiang)(jiang)沖(chong)肝(gan)(gan)(gan)(gan)(gan)(gan)之(zhi)(zhi)(zhi)氣(qi)(qi)(qi),而(er)泄過(guo)(guo)(guo)旺之(zhi)(zhi)(zhi)陽(yang)氣(qi)(qi)(qi);和(he)胃(wei)(wei)(wei)(wei)(wei)者,即調整脾(pi)胃(wei)(wei)(wei)(wei)(wei)的(de)(de)升(sheng)降(jiang)(jiang)(jiang)樞紐(niu)(niu)功能。抑肝(gan)(gan)(gan)(gan)(gan)(gan)和(he)胃(wei)(wei)(wei)(wei)(wei)飲(yin)用(yong)于(yu)(yu)妊(ren)(ren)娠(shen)惡(e)阻(zu)早期(qi)療效較好,用(yong)于(yu)(yu)惡(e)阻(zu)中(zhong)后期(qi)較差。本方中(zhong)的(de)(de)黃(huang)連、蘇(su)葉為(wei)要藥,當著重分析之(zhi)(zhi)(zhi)。

黃(huang)連(lian)(lian):味苦(ku)(ku),性寒(han)(han),入心(xin)、肝、膽、胃(wei)(wei)、大腸五經,具(ju)有清熱(re)瀉火(huo),燥濕(shi)解毒(du)的(de)作用,可治(zhi)療(liao)熱(re)病,泄(xie)瀉痢疾,心(xin)煩胸(xiong)痞(pi)嘔吐,吐血,消渴,目疾赤痛,癰(yong)腫疔(ding)毒(du),口(kou)舌(she)生瘡(chuang),濕(shi)瘡(chuang)及(ji)中(zhong)巴豆、輕(qing)粉毒(du)。李元素認為該藥(yao)能“治(zhi)郁熱(re)在(zai)中(zhong),煩躁惡心(xin),兀兀欲吐,心(xin)下痞(pi)滿(man)。”在(zai)臨床(chuang)使用中(zhong),以(yi)黃(huang)連(lian)(lian)為主的(de)方劑頗多。我們(men)認為,黃(huang)連(lian)(lian)苦(ku)(ku)寒(han)(han),其清熱(re)瀉火(huo),燥濕(shi)解毒(du)之功明顯,而(er)且善于清熱(re)清痞(pi)止嘔,凡心(xin)胃(wei)(wei)火(huo)盛者多用黃(huang)連(lian)(lian),故(gu)有黃(huang)連(lian)(lian)治(zhi)中(zhong)焦之說。但畢竟性味苦(ku)(ku)寒(han)(han),易于傷中(zhong)敗胃(wei)(wei),脾(pi)胃(wei)(wei)虛寒(han)(han)者慎用,甘苦(ku)(ku)燥傷津(jin),陰虛津(jin)枯者,亦非所宜。

蘇(su)葉(xie):味辛,性溫,入(ru)肺、脾二經(jing),功效發散(san)風(feng)(feng)寒(han)(han),理氣寬(kuan)胸,解郁化(hua)痰,安(an)胎(tai)、解魚(yu)蟹毒(du),可(ke)治(zhi)療外(wai)感(gan)風(feng)(feng)寒(han)(han),胸悶(men)嘔吐(tu),胎(tai)氣不(bu)安(an),腳氣,魚(yu)蟹毒(du)等(deng)。我們認(ren)為紫蘇(su)葉(xie)辛溫入(ru)肺脾,不(bu)但能發散(san)風(feng)(feng)寒(han)(han),且(qie)能理氣寬(kuan)中,外(wai)感(gan)表證兼(jian)見(jian)胸悶(men)嘔吐(tu)者(zhe)(zhe),用之(zhi)尤為適宜,薛生白治(zhi)濕熱證,肺胃不(bu)和,嘔惡不(bu)止,晝夜不(bu)瘥欲死者(zhe)(zhe),用連蘇(su)湯。

【加(jia)減】若肝火(huo)偏(pian)甚(shen)(shen),出現頭痛頭昏者(zhe),加(jia)入鉤藤(teng)15克(ke),苦丁茶10克(ke),白蒺藜(li)10克(ke);夾有(you)痰濕偏(pian)甚(shen)(shen),出現嘔吐黏痰甚(shen)(shen)多,胃脘痞悶,舌(she)苔白膩,加(jia)入干(gan)姜5克(ke),茯苓12克(ke),廣藿香6克(ke);若心(xin)(xin)火(huo)偏(pian)旺,心(xin)(xin)煩(fan)寐差,舌(she)尖有(you)瘡瘍(yang)者(zhe),加(jia)入蓮子心(xin)(xin)5克(ke),青龍齒(先煎)10克(ke)。

中醫(yi)肝胃不和的治療方子(zi)

我建議你用:胃康靈膠囊,一次四個,一日三次.每四至六小時服用一次.中成藥無毒副作用!!
疼痛厲害就加奧美拉唑腸溶膠囊一次一個.早晚服用一次.最好空腹服用效果更好!!
胃(wei)(wei)(wei)病的(de)(de)(de)(de)(de)(de)飲(yin)食(shi)(shi)(shi)(shi)(shi)禁忌胃(wei)(wei)(wei)痛的(de)(de)(de)(de)(de)(de)原因(yin)有多(duo)(duo)(duo)種(zhong),如進(jin)食(shi)(shi)(shi)(shi)(shi)過多(duo)(duo)(duo)涼(liang)的(de)(de)(de)(de)(de)(de)食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)容易引起(qi)胃(wei)(wei)(wei)痛,表現為(wei)胃(wei)(wei)(wei)部墜(zhui)脹(zhang)、噯氣、胃(wei)(wei)(wei)脘疼(teng)痛、腸鳴不(bu)適等(deng)。但是,得了胃(wei)(wei)(wei)病飲(yin)食(shi)(shi)(shi)(shi)(shi)上(shang)要(yao)注意以下(xia)十一條:一、少(shao)吃(chi)(chi)油炸食(shi)(shi)(shi)(shi)(shi)物(wu)(wu):因(yin)為(wei)這類食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)不(bu)容易消(xiao)(xiao)(xiao)化(hua),會加重消(xiao)(xiao)(xiao)化(hua)道負擔(dan),多(duo)(duo)(duo)吃(chi)(chi)會引起(qi)消(xiao)(xiao)(xiao)化(hua)不(bu)良,還會使血(xue)脂(zhi)增高,對(dui)健康不(bu)利。二、少(shao)吃(chi)(chi)腌制食(shi)(shi)(shi)(shi)(shi)物(wu)(wu):這些(xie)(xie)食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)中(zhong)含(han)(han)(han)有較(jiao)多(duo)(duo)(duo)的(de)(de)(de)(de)(de)(de)鹽(yan)分及某些(xie)(xie)可致(zhi)癌物(wu)(wu),不(bu)宜(yi)多(duo)(duo)(duo)吃(chi)(chi)。三、少(shao)吃(chi)(chi)生(sheng)(sheng)冷食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)刺(ci)激性(xing)食(shi)(shi)(shi)(shi)(shi)物(wu)(wu):生(sheng)(sheng)冷和刺(ci)激性(xing)強(qiang)的(de)(de)(de)(de)(de)(de)食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)對(dui)消(xiao)(xiao)(xiao)化(hua)道黏(nian)(nian)膜(mo)具有較(jiao)強(qiang)的(de)(de)(de)(de)(de)(de)刺(ci)激作用,容易引起(qi)腹(fu)瀉或消(xiao)(xiao)(xiao)化(hua)道炎癥。四、規(gui)律飲(yin)食(shi)(shi)(shi)(shi)(shi):研究表明,有規(gui)律地進(jin)餐(can)(can),定(ding)(ding)(ding)(ding)時(shi)定(ding)(ding)(ding)(ding)量,可形成條件反射(she),有助于(yu)消(xiao)(xiao)(xiao)化(hua)腺的(de)(de)(de)(de)(de)(de)分泌,更利于(yu)消(xiao)(xiao)(xiao)化(hua)。五、定(ding)(ding)(ding)(ding)時(shi)定(ding)(ding)(ding)(ding)量:要(yao)做到(dao)每餐(can)(can)食(shi)(shi)(shi)(shi)(shi)量適度,每日(ri)3餐(can)(can)定(ding)(ding)(ding)(ding)時(shi),到(dao)了規(gui)定(ding)(ding)(ding)(ding)時(shi)間(jian),不(bu)管(guan)肚子餓不(bu)餓,都應(ying)(ying)主動進(jin)食(shi)(shi)(shi)(shi)(shi),避免(mian)過饑或過飽(bao)。六、溫度適宜(yi):飲(yin)食(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)溫度應(ying)(ying)以“不(bu)燙不(bu)涼(liang)”為(wei)度。七、細嚼(jiao)慢(man)咽:以減輕胃(wei)(wei)(wei)腸負擔(dan)。對(dui)食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)充(chong)分咀嚼(jiao)次(ci)(ci)數愈多(duo)(duo)(duo),隨之分泌的(de)(de)(de)(de)(de)(de)唾液也(ye)愈多(duo)(duo)(duo),對(dui)胃(wei)(wei)(wei)黏(nian)(nian)膜(mo)有保(bao)護(hu)(hu)作用。八(ba)、飲(yin)水擇時(shi):最佳的(de)(de)(de)(de)(de)(de)飲(yin)水時(shi)間(jian)是晨起(qi)空腹(fu)時(shi)及每次(ci)(ci)進(jin)餐(can)(can)前1小時(shi),餐(can)(can)后(hou)立即飲(yin)水會稀釋胃(wei)(wei)(wei)液,用湯泡飯也(ye)會影響食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)的(de)(de)(de)(de)(de)(de)消(xiao)(xiao)(xiao)化(hua)。九、注意防(fang)寒:胃(wei)(wei)(wei)部受涼(liang)后(hou)會使胃(wei)(wei)(wei)的(de)(de)(de)(de)(de)(de)功能(neng)受損,故要(yao)注意胃(wei)(wei)(wei)部保(bao)暖不(bu)要(yao)受寒。十、避免(mian)刺(ci)激:不(bu)吸煙(yan),因(yin)為(wei)吸煙(yan)使胃(wei)(wei)(wei)部血(xue)管(guan)收縮,影響胃(wei)(wei)(wei)壁(bi)細胞的(de)(de)(de)(de)(de)(de)血(xue)液供應(ying)(ying),使胃(wei)(wei)(wei)黏(nian)(nian)膜(mo)抵抗力降(jiang)低而誘發胃(wei)(wei)(wei)病。應(ying)(ying)少(shao)飲(yin)酒(jiu),少(shao)吃(chi)(chi)辣(la)椒(jiao)、胡椒(jiao)等(deng)辛辣(la)食(shi)(shi)(shi)(shi)(shi)物(wu)(wu)。十一、補充(chong)維(wei)(wei)(wei)生(sheng)(sheng)素(su)C:維(wei)(wei)(wei)生(sheng)(sheng)素(su)c對(dui)胃(wei)(wei)(wei)有保(bao)護(hu)(hu)作用,胃(wei)(wei)(wei)液中(zhong)保(bao)持正常的(de)(de)(de)(de)(de)(de)維(wei)(wei)(wei)生(sheng)(sheng)素(su)C的(de)(de)(de)(de)(de)(de)含(han)(han)(han)量,能(neng)有效發揮胃(wei)(wei)(wei)的(de)(de)(de)(de)(de)(de)功能(neng),保(bao)護(hu)(hu)胃(wei)(wei)(wei)部和增強(qiang)胃(wei)(wei)(wei)的(de)(de)(de)(de)(de)(de)抗病能(neng)力。因(yin)此,要(yao)多(duo)(duo)(duo)吃(chi)(chi)富含(han)(han)(han)維(wei)(wei)(wei)生(sheng)(sheng)素(su)C的(de)(de)(de)(de)(de)(de)蔬菜和水果!

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