1 Interpretation of "Qing Xin"
Judging from the prescription name, the main function of Banxia Xiexin Decoction is "purging the heart". The "heart" that purges the heart does not refer to the heart organ, but refers to the lower part of the heart, that is, the upper abdomen. Clearing the heart is to remove the evil spirits in the lower part of the heart and eliminate the symptoms of fullness in the lower part of the heart. So the name "diarrhea" is actually diarrhea. Wang Youyuan said in the "Ancient and Modern Famous Doctors' Prescriptions": "However, if the stomach is under the heart, the stomach will swell. Instead of purging the stomach and the heart, I was afraid that the bitter cold would hurt my stomach and yang, and I mistakenly thought that it was introduced into Yangming to govern Yangming's rule of law. This micro-purpose of Zhongjing is also. " "Pi" means "no" and is one of the sixty-four hexagrams in Zhouyi. Negative divination means that the weather doesn't fall, the atmosphere doesn't rise, heaven and earth don't agree, the ups and downs are unbalanced, and new people don't get through. Edema is caused by abnormal lifting. Zhongjiao is the residence of the spleen and stomach and the hub of Qi. Qi deficiency of the spleen and stomach will weaken the force of ascending and descending turbidity, clear qi will not rise, turbid yin will not fall, and qi will be blocked, so it is new. The compatibility of Banxia Xiexin Decoction is to relieve bitterness and restore the normal ascending and descending function of spleen and stomach. Therefore, it is used to treat heart swelling, and the pro-drug effect is like a drum.
A brief description of the pathogenesis
Banxia Xiexin Decoction can be seen in Zhongjing's Two Books. One is article 149 of Treatise on Febrile Diseases: "Those who vomit and have fever on the fifth or sixth day of typhoid fever, but still have Chaihu syndrome after taking other drugs, should be treated with Chaihu decoction. Although this is done, it will steam and vibrate, but the fever and sweating will be solved. If the heart is full and painful, it is also a knot in the chest, mainly soup; But if it is full and painless, it is a new sensation, and Bupleurum is not in the right place. It is appropriate to use Banxia Xiexin Decoction. " 2. The article "Synopsis of the Golden Chamber: Syndrome of Heat Pulse Caused by Vomiting 17" states: "Banxia Xiexin Decoction is the main treatment for vomiting with bowel sounds and pain in the heart". Tang Sun Simiao also said in "Prepare a daughter to solve an urgent need": "Xiexin decoction can cure the old and the young to benefit, but it is not needed. There is thunder in the intestine, fullness in the heart and uneasy retching". Therefore, Banxia Xiexin Decoction has digestive system symptoms such as nausea, vomiting, bowel sounds, diarrhea, etc. Combined with clinical practice and Treatise on Febrile Diseases, it is considered that the pathogenesis of Banxia Xiexin Decoction is spleen and stomach weakness, foreign body pathogenic factors ascending and descending, and qi movement ascending and descending carelessly. In Treatise on Febrile Diseases, Jincheng Wuji annotated Banxia Xiexin Decoction as "qi deficiency of stomach, courtesy up and down". Shuo Wen Jie Zi says "Guest, send it". Kangxi Dictionary is interpreted as "all foreigners are guests" and "foreigners are also guests". It can be seen that guest evil (politeness) refers to the evil or pathological product in the body caused by abnormal rise and fall of spleen and stomach qi deficiency. Cheng Wuji also said: "Therefore, it is called purging the heart, which means that the evil under purging the heart is also ... the evil stays under the heart, so it is called purging the heart decoction to cure the new."
Treatise on Febrile Diseases (13 1) says that "the disease starts from yin, but it is because of the new person". The patient's stomach qi deficiency is caused by mistake, which not only damages the yang of the spleen and stomach, but also invades exogenous pathogens, so that although the spleen and stomach live together in Zhongzhou, they are all inherited from the soil, but their functions are different. The stomach controls the receipt and turbidity, and the spleen controls the transport and transformation and ascends the clear. The stomach likes dampness and hates dryness, while the spleen likes dryness and hates dampness. The two are integrated, dry and wet, and the ups and downs are related, especially the ups and downs. Su Wen's On Liu Weizhi said: "Rise and fall means loneliness and danger", and "If you don't rise and fall, you can't live forever". Spleen and stomach are the foundation of the day after tomorrow, and because of their specific position, they can be linked up and down and reconciled in it, which is called the hub of Qi. Therefore, the book "Medical Sage Heart Source" puts forward: "When the spleen rises, the liver and kidney also rise, so the liver is not depressed, and when the stomach falls, the heart and lungs also fall, so the golden fire does not stagnate and the middle qi is lucky." It can be seen that the spleen and stomach lifting pivot plays an important role in regulating the whole body qi. Banxia Xiexin Decoction is designed for syndrome changes caused by misuse of laxatives. If purgative drugs are used, the middle qi will be damaged, and the spleen and stomach will be deficient in cold, and its power of clearing away heat and lowering turbidity will be weakened, while that of clearing away heat and lowering turbidity will not be, so that deficiency cold will be mixed with endogenous pathological products such as damp heat and phlegm-drinking, or the heat of the sun and pathogens other than shaoyang will take advantage of it and hinder qi movement, so it is a new feeling. The position of clearing yang and turbid yin is reversed, so the upper side vomits and the lower side growls. As the great doctor specially said in the Classic, "evil spirits take advantage of the situation and enter the heart, and the middle qi is full, and the middle qi is full but not right, so the yang alone goes against it and spits, while the yin alone goes down and bowel sounds. Although Sanjiao is ill, the middle qi is the pivot of the upper and lower parts. "
Physicians of past dynasties have no objection to the pathogenesis of spleen-stomach deficiency-cold and ascending-descending disorder of Banxia Xiexin Decoction, but they have different views on guest evil. Typical examples are as follows: ① Cold-heat junction: Qing Keqin thinks that Banxia Xiexin Decoction is caused by "cold-heat junction in the heart". ② Hot drink with water: Qingcheng Yingfang thinks Banxia Xiexin Decoction is "hot drink with water, but it has not yet become a reality". ③ Phlegm and saliva are diseases: Qing and Qin Zhizhen think that all diseases of Xiexin Decoction are caused by phlegm. Liu Duzhou, a contemporary typhoid fever expert, also thinks it is "excessive phlegm and qi" [1]. ④ Stomach-heat and intestine-cold: Guo Ziguang thinks that the basic pathology of Banxia Xiexin Decoction is "stomach-heat and intestine-cold, mixed with deficiency and excess" [2]. ⑤ Damp-heat is the disease: Wang Hu, a physician in Qing Dynasty, thought Banxia Xiexin Decoction was a prescription for treating "disharmony between damp-heat and excess". Ren Yingqiu, a great contemporary Chinese doctor, also thinks it is "damp-heat deficiency" [3].
The common clinical symptoms of Banxia Xiexin Decoction are also different due to different guest pathogens, and the common cases are as follows. ① Dampness and heat: yellow fur, bitter taste, noisy and acid swallowing are the main clinical features. Qing Ye started from clearing heart to treat damp-heat in middle energizer, and put forward that "bitter cold can drive away heat and remove dampness, and pungent taste can make qi turbid". ② Partial cold and dampness: The main clinical manifestations are white fur, chills, abdominal pain and diarrhea. ③ Stomach heat and spleen cold: clinically, there are both stomach heat syndrome with yellow tongue coating and bitter and sour mouth, and spleen cold syndrome with abdominal pain, diarrhea and chills. ④ Phlegm and qi fullness: Diners or drinkers have a swollen heart, accompanied by nausea and vomiting, loose stools, white and greasy tongue coating and slippery pulse. ⑤ Another clinical symptom is neither hot nor cold, neither cold nor hot, but the stomach cavity is mainly swollen and hard, and Banxia Xiexin Decoction has a miraculous effect.
Therefore, according to the provisions of Treatise on Febrile Diseases, predecessors' viewpoints and clinical findings, the author thinks that its pathogenesis is: deficiency and cold of spleen and stomach, excessive exogenous pathogens and abnormal ascending and descending of qi, which is the syndrome of lump. As Wu Kun said, "If you don't treat the exterior syndrome, but use Chengqi decoction, it will hurt the middle qi, and the evil of Yin meridian will be taken." If you take advantage of the qi in the injury, you can't ascend turbidity and plug it in the middle. If heaven and earth don't meet, it is new. He who purifies his heart will also purify the evil under his heart. "
3 key points of syndrome differentiation
Article 149 of Treatise on Febrile Diseases discusses the prescription and syndrome of Banxia Xiexin Decoction, the causes of mistreatment and the contrast of chest obstruction, so the original text only briefly talks about the clinical characteristics of "fullness without pain". "Painless" is to distinguish it from the "full and hard" pain in the chest. "Hard and full pain" is the mutual word of "tenderness, rebound pain and abdominal pain", so the chest big knot mentioned in Treatise on Febrile Diseases is found in modern clinical acute abdomen. Even if Xiexin decoction is accompanied by pain, it is full of pain rather than abdominal pain, and there is no rebound pain. Combined with Synopsis of the Golden Chamber, "Intestinal sounds are caused by nausea, and Pinellia Xiexin Decoction is the main method for subcardiac fullness", and 157 Ginger Xiexin Decoction syndrome and 158 Glycyrrhiza Xiexin Decoction syndrome, Pinellia Xiexin Decoction syndrome includes vomiting, diarrhea, intestinal sounds, belching and so on.
Zhong Jingxian talked about tongue coating, and combined with clinical experience, "greasy coating" (whether thick or yellow) should be an important clinical indication of Banxia Xiexin decoction syndrome. Zhongjing's theory of mass formation is all due to improper treatment and damage to the spleen and stomach. Deficiency and cold of the spleen and stomach, poor qi movement, dereliction of duty in transportation and transformation, endogenous dampness stagnation and food stagnation, or invasion of the heart by pathogenic factors such as dampness and heat due to deficiency in the middle and exogenous pathogenic factors, blocking qi movement, causing swelling and hardness in the heart, so the tongue coating is often greasy. Depending on the degree of turbidity, it appears in the thickness or thinness of the tongue coating, and it is yellow or white or both yellow and white due to the degree of heat.
Therefore, although "quality" is the focus of syndrome differentiation and treatment, it is not necessary to be limited to "quality" in clinic. The key is to identify the pathogenesis. The mechanism of syndrome differentiation should focus on "spleen and stomach deficiency and cold, exogenous pathogenic factors and qi stagnation". Flexible use of Banxia Xiexin Decoction according to the nature of exogenous pathogens will often have unexpected effects.
4 Compatibility analysis
The prescription of Banxia Xiexin Decoction is a syndrome of deficiency in essence and excess in substance. The main contradiction is that external evil is better than evil, but weakness of spleen and stomach is also a factor that must be considered. From the composition and dosage of the prescription, it can be seen that the prescription is mainly to exorcise evil spirits and give consideration to strengthening the body resistance. The products that attack evil enter the stomach first, and play its role of eliminating evil by virtue of stomach qi. Ginseng, licorice and jujube in the prescription are warm in nature, benefiting qi and tonifying deficiency, while Pinellia ternata and ginger are used together with ginseng, licorice and jujube to invigorate yang, while Coptidis Rhizoma and Scutellariae Radix are used for clearing heat and removing turbidity. Especially in the "Jing" theory, it is said that "new people are full but not real." The evil invasion of the husband and guest, the sweat can not be vented, full but not real, and can not be taken down, so only the pungent smell of Pinellia ternata and dried ginger can disperse its knot. The bitter taste of coptis root and scutellaria root can relieve its fullness. However, the reason for dispersing is that although it can be used as medicine, it can also be used for stomach qi. People who use ginseng, grass and jujube can benefit qi and help them with medicine if they are weak below. "Looking at the whole prescription, on the one hand, it is based on the premise of pungent and bitter drugs to eliminate" guest evil ",on the other hand, it is based on the premise of warm drugs to strengthen the body and eliminate" guest evil ",and at the same time, the positive compound can eliminate evil. Therefore, the whole prescription plays the role of understanding depression, reinforcing diarrhea, resetting up and down, harmonizing middle qi and eliminating swelling syndrome. It can really be said that "one liter and one drop, the qi machine is harmonious; A warm and a cold, yin and yang coordination. "
5 conclusion
The treatment of Banxia Xiexin decoction has the following characteristics from the point of view of combining syndrome differentiation with disease pulse, treatment method and prescription: the disease syndrome is hard; Treatment-eliminating new things; Prescription-Banxia Xiexin Decoction; Drugs-Pinellia ternata, ginger, Scutellaria baicalensis Georgi, Coptidis Rhizoma, from which we can find that Zhongjing's original meaning is to purge the heart by inducing resuscitation, so as to remove the evil in the heart. In article 158 of Treatise on Febrile Diseases, Zhong Jing clearly pointed out that "this is not a heat binding, but a weakness in the stomach, so the courtesy is contrary, so it is hard." All kinds of drugs are related to pathogenesis, so this recipe has a miraculous effect on hypochondriac mass. However, in clinical practice, we should flexibly adjust the dosage of drugs according to the characteristics of "guest evil" and add or subtract drugs according to the nature of "guest evil" in order to get rid of diseases. Otherwise, it will easily lead to adverse reactions such as drugs not treating the symptoms, delaying the illness and increasing the economic burden of patients.
refer to
[1], Zhang. Clinical indications of typhoid fever in Liu Duzhou [M]. Beijing: Science Press, 2004.
[2] Guo Ziguang, Feng Xianxun. Treatise on febrile diseases decoction syndrome [M]. Shanghai: Shanghai Science and Technology Press, 1983.
[3] Ren Yingqiu. Clinical analysis of pathogenesis [M]. Shanghai: Shanghai Science and Technology Press, 1963.
By consulting domestic ancient and modern literature and combining with clinical practice, this paper makes a preliminary discussion on Banxia Xiexin Decoction, and holds that the name of this prescription is "Xiexin Decoction", but it actually purges the stomach. It is pointed out that the pathogenesis of this prescription is spleen and stomach deficiency and cold, exogenous pathogenic factors ascending and descending, and qi-flowing ascending and descending disorder, and the main points of clinical syndrome differentiation are swelling and pain and tongue coating, which reveals the mechanism that Zhongjing achieves "purging the heart to lower pathogenic factors" and "eliminating the heart to lower swelling" through the compatibility of bitter and bitter drugs.
Banxia Xiexin decoction, abnormal rise and fall of guest pathogens, mixed with excess and deficiency.
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