徐志华-经行头晕 – Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle

徐志华 - 经行头晕

Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle
Translated by XU Zhi-jun & J. Heaverlo

经行前后或经期,出现头目眩晕,并伴随月经周期发作者,称 “经行头晕”。徐老着重于”无痰不作眩”,施用半夏天麻自术汤而获效.

Dizziness may develop before, during or after the menstrual period.  When this occurs it is called “dizziness during menstrual cycle”.   Xu Zhi-hua emphasizes the concept “Without phlegm, there can be no dizziness”.  He achieves excellent results with the formulation ban xia tian ma bai zhu tang.

经行头晕责痰障  施用半夏天麻汤
Menstrual cycle dizziness due to phlegm – use ban xia tian ma tang

半夏天麻白术汤
组成:天麻 10g   姜夏 10g    白术10g  神曲lOg   麦芽 lOg    泽泻lOg   党参 10g   夜苓 10g   黄柏 10g   陈皮lOg 于姜 10g   生姜 3 片

Ban Xia Bai Zhu Tian Ma Tang
Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces

功用:健脾燥湿,桂痪降浊。

主治:经行头晕。

Functions:  Strengthens the Spleen and dries damp.  Expels phlegm and descends turbidity

Primary Treatment: dizziness during the menstrual cycle

方解:天麻性味辛微温,善能祛风化痰,为治疗肝风而夹痰湿之眩晕要药;二陈汤加浑泻、黄柏化湿除痰、降逆止呕;党参、白术健脾益气;神曲、麦芽健胃和中;生姜宣散水湿。

Explanation:  Tian ma is acrid and slightly warming.  It can expel wind and transform phlegm.  It serves as the chief herb when there is liver wind and phlegm damp causing dizziness.  This formula also contains er chen tang with ze xie and huang bai.  Together these herbs can transform damp and expel phlegm, descend counterflow and stop vomiting.  Dang shen and bai zhu strengthen the spleen and benefit the qi.  Shen qu and mai ya strengthen the stomach and harmonize the center.  Sheng jiang disperses water dampness.

案例:
例一:女,42岁。初诊日期: 1987 年 5 月5 日。患者近年来每至经行之时即觉头晕,后脑作胀微痛,不能见行驶车辆。发作严重时恶心呕吐,不能起坐。头重如蒙,胸闷纳少,整日昏昏欲睡。月经初潮 15 岁,3 - 5 / 2 6 - 3 0天,量中色红无块,末次月经:  1987 年 4 月 11  日,舌质淡,苔白腻,脉濡。

Case Study 1:
A 42 year old female patient reports, in the past few years, at the time of her menstrual period, she has  dizziness and occipital distention with slight pain.   She cannot even bear to see moving vehicles. When the dizziness worsens she also experiences nausea and vomiting, and cannot sit up.   The head feels heavy and foggy.  She has chest oppression and is unable to eat much.  She feels tired all day and only desires sleep.  Her menstrual cycle began when she was 15 years old.   The cycle lasts 26-30 days and the period is 3-5 days.  It is medium in amount, red in color and without clotting.   Her last menstrual period was 3 weeks prior to the time of diagnosis.   The tongue body is pale-red and the coating is white and greasy.  The pulse is soggy.

此由痰浊蒙蔽清阳,故头晕头重如蒙;痰浊中阻,浊阴不降,气机不利,故胸闷恶心,脾阳不振则少食多寐,加之经行气血下注,其气益虚,清阳不升,痰湿上扰所致。投半夏天麻白术汤。

This condition is due to phlegm turbidity obstructing the clear yang, causing dizziness and a sensation of fogginess and heaviness in the head.  When phlegm turbidity obstructs the center, the turbid yin cannot descend causing the Qi mechanism to become obstructed.  Therefore, there will be chest oppression and nausea.  The spleen yang is unable to ascend, causing diminished appetite and excessive sleepiness.   In addition, during the menstrual cycle, the Qi and blood pour downward, causing the Qi to be even more vacuous.  The clear yang is unable to ascend causing phlegm-damp to harass the upper body. Administer ban xia tian ma bai zhu tang.

天麻 10g,姜夏  10g,臼术 1 g,泽泻  10g,党参 10g夜苓lOg ,干姜 10g,陈皮 10g,黄柏 10g,麦芽10g,神曲10g,生姜 3 片。4 剂。水煎服。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, ze xie 10g, dang shen 10g, fu ling 10g, gan jiang 10g, chen pi 10g, huang bai 10g, mai ya 10g, shen qu 10g, sheng jiang 3 pieces.  4 formulas were administered for decoction.

二诊: 1987 年 5 月 10 日。此次经行已 3 天,精神明显好转,仅觉轻度头晕,尚能坚持正常教学。舌质淡,苔白微腻,脉濡滑。嘱下次经前 5天按上方再服 4 剂。3 月后随访,头晕己愈。

Follow up:  At the time of the second visit (5 days later) the patient was on day 3 of her period.  Her vitality had clearly improved.  Not only was the dizziness less intense but she was able to return to work.  The tongue body was pale-red.  The tongue coating was white and slightly greasy.  The pulse was moist and slippery.  The patient was urged, next time to start taking the herbal formulation 5 days before her menstrual cycle begins.  She was instructed to take 4 formulations at that time.  After 3 months, follow up showed that her dizziness had already recovered.

例二:付某,女,37 岁,干部,已婚。1990 年 11 月 7日初诊。患者经前头晕反复发作 2 年,头晕多在月经前 1 周发作。头晕头重如裹,胸院痞塞,恶心欲呕,纳呆,肢重乏力。末次月经,1990 年 10 月 12 日。舌质淡红,苔白腻而厚,脉滑。证属痰湿中阻,风痰上扰。方用半夏臼术天麻汤:

Case Study 2:
A 37 year old female patient reports dizziness occurring one week before her menstrual cycle begins.  This has been repeatedly occurring for 2 years.  The head feels heavy as if wrapped.  There is a sensation of chest and stomach glomus and blockage, nausea with a desire to vomit, torpid intake, and heavy limbs without strength.  Her last menstrual cycle was 3 1/2 weeks prior.  The tongue is pale-red.  The tongue coating is white, greasy and thick.  The pulse is slippery.  The diagnosis is phlegm-damp obstructing the center with wind-phlegm harassing the upper body.  Administer ban xia bai zhu tian ma tang.

天麻lOg ,姜夏 10g,自术 10g,神曲 10g,麦芽 10g,浑海  10g,党参 10g,夜苓 10g,黄柏 10g,陈皮 10g,干姜10g,生姜 3 片。5 剂。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces.  5 formulas were administered.

二诊: 1990 年 11 月 13 日。头晕减轻,纳可。现月经将至,舌脉同前,原方加泽兰叶lO g,再进 7 剂,经净晕止,一切正常,以后每临经前,继续宗方调治半年,痊愈。

Follow up:  After one month, the dizziness was mitigated and the appetite returned.  At the time of the follow up, the menstrual period was about to begin.  The pulse and the tongue were unchanged.  The same formulation was administered with the addition of ze lan ye 10g.  Seven formulations were prescribed.   After the period, the dizziness stopped and the symptoms were no longer present.  At each follow up visit, prior to the beginning of the menstrual cycle, the same formulation was prescribed.  After 6 months the patient recovered completely.

按1 经行头晕是妇科临床常见症候之一。轻者闭目即止,重者如坐舟车,旋转不定。加之经行之时,营血趋向于下,髓海空虚,肝阳偏亢,阳扰于上,则头目为之昏眩。正如《内经》云:”诸风掉眩,皆属于肝”、”上虚则眩”、”髓海不足则脑旋耳鸣”,     <金匮要略》云:”心下有痰饮,胸胁支满目眩,”刘河间认为眩晕由风火所致;朱丹溪认为”无痰不作眩”,张景岳认为”无虚不作眩”等。因此,眩晕之由,不外风、火、痰、虚。而以风阳上扰及气血亏虚者最为多见。治疗中必须首先审证求因,分清虚实,然后再确立治法。本类患者脾虚水湿失运,聚而成痰,经行痰浊上扰,蒙闭清窍,清阳被遏,故经行头晕。

Discussion:  Clinically, in gynecological medicine, dizziness during the menstrual cycle is a commonly seen condition.  In less severe cases, if the patient closes their eyes the dizziness will stop.  In more severe cases, however, it may feel as if one is riding on a boat, causing a continuous spinning sensation.  In addition, during the menstrual period, the construction blood are moving downward leaving the sea of marrow empty and depleted.  The inclination is for the  liver yang  then to ascend and harass the upper body causing dizziness.  The Nei Jing states “All wind with shaking and dizzy vision is ascribed to the liver.”“when the upper body is vacuous there will be dizziness”, “when the sea of marrow is insufficient there will be dizziness and tinnitus.”.   The Jin Gui Yao Lue states, ” when there is phlegm-rheum below the heart there will be distention in the chest and rib-side, and dizziness.”  Liu He-jian  believes dizziness is caused by wind-fire.  Zhu Dan-xi states ” without phlegm there cannot be dizziness.”  Zhang Jing-yue states “without vacuity there cannot be dizziness”.  Therefore, the causes of dizziness are nothing more than external wind, fire, phlegm and vacuity.  Among these causes the  most commonly seen are due to  the liver yang rising to harrass the upper body and qi and blood depletion and vacuity.  Treatment first must be determined by seeking the root cause and distinguishing between vacuity and repletion.  After this, the correct treatment method can be established.  Typically, these are patients with spleen vacuity and water damp causing loss of transportation.  This allows for the accumulation of phlegm.  At the time of the menstrual cycle, this phlegm turbidity will ascend and harass the upper causing fogginess and obstruction of the clear orifices.  The clear yang will be blocked leading to “dizziness during the menstrual cycle”.

徐老几十年的临床实践中,对东垣指出的”足太阴痰厥头晕非半夏不能疗,眼黑头旋,虚风内作,非天麻不除”体会尤深。遵其所论,以半夏天麻臼术汤加减屡用皆效。《本草从新》称:”天麻入肝经,通血脉,疏痰气,治诸风掉眩, 头眩眼黑”、”半夏体滑性燥,能走能散,治咳逆头眩,痰厥头痛”,浑泻利水行饮下走水道,小便一行,水湿有其出路,三焦阳气通达,表里通畅,故头晕病解。
Xu Zhi-hua has numerous years of clinical practice that has brought about a deep understanding of this condition.  As Li Dong-yuan points out ” ban xia is capable of treating foot tai-yin  phlegm-rheum causing dizziness.  When the eyes are black and the head is spinning, and there is vacuity wind internally occurring, tian ma is indispensable”.  Following this theory, the usage of modified ban xia tian ma bai zhu tang will bring results.   The Ben Cao Cong Xin states, ” tian ma enters the liver channel, opens the blood vessels, dredges the phlegm-qi and thereby treats all wind with shaking and dizzy vision, as well as, dizzy head and dim eyes.  Ban xia is slippery in body and dry in nature.  It is capable of moving and dispersing and can treat cough, counterflow, dizziness, and phlegm reversal  headaches.”  Ze xie opens waterways, moves fluids downward and promotes urination.   Once urination is unblocked,  water-damp finds a passage out and the Yang Qi of the Triple Burner becomes open and free. Thus, both the exterior and interior are open and unblocked and the dizziness can be relieved.

中医中药治疗头痛之浅谈 - Discussion on Shi Pei-qing’s Treatment of Headaches

中医中药治疗头痛之浅谈 -Discussion on Shi Pei-qing’s treatment of headaches

史培卿 张 锦

Translated by: Xu Zhi-jun & J. Heaverlo

摘要:目的:自拟中药方剂治疗头痛的有效性。方法:临床辨证论治,实际运用。结果:治疗患者159例,外感头痛一号方应用患者73例,无效 者 0 例 , 有 效 7 3 例 , 治愈 7 1 例 , 有 效 率 1 0 0 % , 治愈率 : 9 7 . 2 6 %。 内 伤 头 痛 一 号 方 应 用 患 者 8 6 例 , 无 效 者 0 例 , 有 效 8 6 例 , 治愈 8 5 例 , 有 效 率 为100 % ,治愈 率 98 . 83 % ,两则方剂总体治愈率为 98 . 05 % 以 上 。 结 论 :两 则 方 剂 均 为 治 疗头痛的 有 效 方 剂 。

Abstract: This article introduces two custom herbal formulations for the treatment of headaches: one formulation for the treatment of externally contracted headaches and one formulation for the treatment of headaches due to internal damage. Clinically, 73 patients were treated with the herbal formula for externally contracted headaches. 71 patients made a full recovery. The efficacy rate is 100% and the cure rate is 97.26%.  86 patients were treated with the herbal formula for headaches due to internal damage. 85 patients made a full recovery. The efficacy rate is 100% and the cure rate is 98.83%.  The cure rate of the two formulations is 98.05%.  Both formulations have proved to be effective within clinical practice.

关键词:中医中药 治疗头痛
Key words: Chinese medicine, Headache treatment

头痛是临床常见的症状之一。 头痛病因多端,分为外感和内伤两大 类。 头为诸阳之会,清阳之府,凡五脏精华之血,六腑清阳之气,皆上注 于 头 , 故 六 淫 之 邪 外 袭 , 上 犯 巅 顶 邪 气 稽 留 , 阻 抑 清 阳 , 或 内 伤 诸 疾 , 导 致 气 血 逆 乱 , 瘀 阻 经 络 , 脑 失 所 养 , 均 可 致 头 痛 。

Clinically, headaches are one of the most commonly seen symptoms. There are various causes for headaches. Generally, it is divided into external contraction and internal damage. The head is the confluence of  Yang Qi and the house of the clear Yang.  Essence and blood, which are derived from the five viscera, and the clear Yang Qi, which is derived from the six bowels,  ascend upward to the head. Therefore, various factors may lead to headaches. It may be due to an external evil attack of the six excesses, which invade the vertex, store the evil Qi, and obstruct the clear Yang. Or, it may be due to disease caused by internal damage, which leads to the chaotic counterflow of Qi and blood, stasis and obstruction of the channels and vessels, and therefore, causing the brain to be deprived of nourishment.

外感六淫:六淫外袭起居不慎,均可致头痛,《素问· 太阴阳明论》云:“伤于风者,上先受之,故头痛以风邪所致者最为多见。”且风为百病 之长,多夹时气为患,若风寒袭表,寒凝血涩,则头痛而恶寒战栗,风热上犯清空,则头痛而身热烦心,风湿袭表,上蒙清阳,则头痛而重,若湿邪中阻,清阳不升,浊阴不降,亦可引起头痛。

Headaches due to external contraction of the six excesses: In “Plain Questions · Treatise on Greater Yin and Yang Brightness” states, “If a person is attacked by wind, the head is the first place to be affected; therefore, most headaches are due to wind evil.” In addition, wind is the chief of the one hundred diseases, and often combines with seasonal Qi. If wind-cold assails the exterior, there will be congealed cold and inhibited blood.  This will lead to headaches and aversion to cold with shivering. If wind-heat invades the brain, headaches will present with body heat and heart vexation. If wind-damp assails the exterior and clouds the clear Yang, there will be headaches and sensations of heaviness. If damp evil obstructs the center, the clear Yang will fail to bear upward and the turbid Yin will fail to bear downward. This may also lead to headaches.

内伤不足:“脑为髓海”,主要依赖肝肾精血及脾胃运化水谷精微濡养,气血不足,失却濡养可见头痛,三脏邪盛亦可引发头痛,故其发病与 肝、脾、肾三脏有密切关系。

Headaches due to internal damage: “The brain is the sea of marrow”, which is mainly nourished by the essence blood from the liver and kidney and the essence of grain and water transformed from the spleen and stomach. If the Qi and blood is insufficient, the brain will lack nourishment and headaches will follow. Exuberant evil of the three viscera may also lead to headaches. Therefore, the pathomechanisms of headaches are closely related to the liver, spleen and kidney.

头痛的辩证,要详问病史,根据各种症状不同表现,辨别致病之因以外,尤其注意头痛之久暂,疼痛之性质,特点及部位之不同,辨别外感和内伤,以便进行论治。

While identifying the patterns for headaches, the doctor should inquire about the patient’s medical history in detail.  After doing so, the doctor can make a differential diagnosis according to the various symptoms. What is more important, in order to determine the appropriate treatment, the doctor should clearly identify if the headache is: enduring or temporary; what type of pain is present; where the pain is located; and if the headache is due to external contraction or internal damage.

另外,头痛还应根据发病部位之异,参照经络循行路线加以判断-大抵太阳经头痛多在头后部,下连于颈,阳明经头痛多在眉棱骨等处,少 阳经头痛多在头之两侧,并连接耳部;厥阴经头痛多在巅顶部位,或连于目系。 临床辨证既应注意头痛的不同特点,同时还应结合整体情况及其有关兼症全面分析以便处方用药。

In addition, headache patterns should be diagnosed according to the channel pathways. The varying types of headaches can be located within the different regions of the head: generally, the greater Yang channel headache is located at the back of the head and connects with the nape of the neck. The Yang brightness channel headache is located at or around the orbital bone. The lesser Yang channel headache is located at the parietal sides of the head and connects to the ears. The reverting Yin channel headache is located at the vertex, and/or connects with the eye. Clinically, attention should be paid not only to the different types of headaches, but also to the condition of the whole body and other concurrent patterns.

本人行医30多年,对治疗头痛有很好的经验,根据外感、内伤两大类来自拟头痛外感一号方,内伤头痛一号方,应用于临床两年来,治疗患者97例,取得了良好的效果。

Based on 30 years of medical practice,  Shi Pei-qing has acquired outstanding clinical experience in the treatment of  headaches. He has devised herbal formulations for the treatment of externally contracted headaches, and headaches due to internal damage. They have been applied clinically for two years and have achieved great results.

1 资料与方法 外感头痛一号方

1. Formula for the treatment of externally contracted headaches

组 成 : 菊花一包 (10g), 川穹一包 (6g), 羌活一包 (10g), 白芷一包 (6g), 蔓荆子一包 (10g), 甘草一 包 (3g)。
Ingredients: chrysanthemum (ju hua) 10g, chuan xiong rhizoma (chuan xiong) 6g, notopterygium (qiang huo) 10g, dahurian angelica (bai zhi) 6 g, vitex (man jin zi) 10g, licorice (gan cao) 3g

功效: 祛风,散寒,止痛。

Function: dispel wind, dissipate cold, and relieve pain

主治: 外感头痛:头痛,恶寒恶风,肢体困重,脉浮。

Indications for externally contracted headaches: headache, aversion to cold and wind, heavy and cumbersome limbs, and a floating pulse

用法:一日一剂,温开水冲服。

Directions: one dose per day, decoct in boiling water and administer warm.

方义分析:菊花散风清热, 川穹、白芷祛风止痛,羌活除湿散寒,蔓荆子清头目止痛,甘草调和诸药。

Explanation: Chrysanthemum (ju hua) dispels wind and clears heat. Chuan xiong rhizoma (chuan xiong) and dahurian angelica (bai zhi) relieve pain. Notopterygium (qiang huo) eliminates dampness and dissipates cold. Vitex (man jing zi)  clears the head and eyes and relieves pain. Licorice (gan cao) harmonizes the formula.

加减:头痛而胀,发热而加石膏一包以助清热泻火之功。

Additions and subtractions: If there is pain, distention in the head and fever , add gypsum to help clear heat and drain fire.

内伤头痛一号方

Formula for the treatment of headaches due to internal damage

组 成 : 天 麻 一 包 (10g), 钩 藤 一 包 (10g), 石 决 明 一 包 (20g), 川 穹 一 包 (6g), 菊 花 一 包 (10g), 藁本 一 包 (10g), 当 归 一 包 (10g), 茯神 一 包 (10g), 蔓荆子一包(10g),甘草一包(3g)。

Ingredients: gastrodia (tian ma) 10g, uncariae (gou teng) 10g, abalone shell (shi jue ming) 20g, chuan xiong rhizoma (chuan xiong) 6g, chrysanthemum (ju hua) 10g, Chinese lovage (gao ben) 10g, Chinese angelica (dang gui) 10g, root poria (fu shen) 10g, vitex (man jing zi) 10g, licorice (gan cao) 3g.

功效:平肝养血,祛瘀止痛。

Function: Calm the liver, nourish the blood, dispel stasis, and relieve pain.

主治:内伤头痛势弱,时发时止,倦怠乏力,舌质红,苔薄黄,脉弦细。

Indications: Intermittent headaches that are due to internal damage, fatigue and lack of strength, red tongue, thin and yellow coating, fine and stringlike pulse.

方药:石决明潜镇以定肝阳上亢。 天麻、钩藤平肝熄风,菊花、蔓荆子、藁本、川穹清头目,祛风止痛。当归养阴补血, 茯神宁心安神,甘草调和诸药,共奏平肝养血祛瘀止痛之功。

Explanation: Abalone shell (shi jue ming) subdues and settles to calm ascendant hyperactivity of the liver Yang. Gastrodia (tian ma) and uncariae (gou teng) calm the liver and extinguish wind. Chrysanthemum, vitex, Chinese lovage and Chuan xiong rhizoma clear the head and eyes, dispel wind and relieve pain. Chinese angelica (dang gui) nourishes the Yin and supplements the blood. Root poria (fu shen) quiets the mind and spirit. Licorice harmonizes the formula.  Used together, this formula can calm the liver, nourish the blood, dispel stasis and relieve pain.

加减:气虚头痛甚者加人参一包(5g), 黄芪一包(10g),血虚者加熟 地养阴补血,痰浊甚者加半夏一包,健脾化痰,瘀血甚者加红花桃仁,增强活血化瘀。

Additions and subtractions: If the patient has Qi vacuity with severe headaches, add Ginseng (ren shen) 5g, astragalus (huang qi) 10g. If the patient has blood vacuity, add cooked rehmannia (shu di) to nourish the Yin and supplement the blood. If the patient has severe phlegm turbidity, add pinellia (ban xia) to fortify the spleen and transform phlegm. If the patient has severe blood stasis, add safflower (hong hua) and peach kernel (tao ren) to quicken the blood and transform stasis.

典型病例

Exemplar case

姓名:某某 性别:男 年龄:50岁 职业:务农

Male, 50 years old

就诊时间:2011年8月2日 发病季节:立秋

First visit: August 2, 2011. Onset of the disease: the beginning of Autumn

地址:山西襄垣
主诉:头痛如裹,肢体困重,恶风,面红目赤,渴喜热饮。

Complaints: the head is heavy as if wrapped, the limbs are heavy and cumbersome.  Patient has aversion to wind, red face and eyes, and a thirst with a desire for hot drinks.

四诊得之:面色少华,精神一般,舌质红,苔薄黄,脉浮。

Symptoms:  a lusterless complexion, a moderate essence-spirit, a red tongue, thin and yellow coating, and a floating pulse.

辩证:由于气候炎热,雨水连绵,致湿热之邪较盛,湿为阴邪,其性重浊,热为阳邪,其性炎上,湿热之邪外袭,上蒙清窍,故头痛如裹,肢体困重,舌红而赤,口渴喜饮。 脾主运化,主四肢,脾为湿困,故肢体困重。 苔薄黄,脉浮,为风热之邪炽盛之象。

Pattern identification: Hot weather and continuous rain bring about exuberant damp-heat evils. Dampness is a Yin evil. By nature it is heavy and turbid. Heat is a Yang evil. By nature it flames upward. If damp-heat evils attack the outer body, it will ascend upward to cloud the clear orifices. This is why the head feels heavy, as if it was wrapped; while, the limbs are heavy and cumbersome, the tongue is red, and the patient feels thirsty with a desire for fluids. The spleen governs movement, transformation, and the limbs. When the spleen is encumbered by dampness, the limbs will become heavy and cumbersome. When there is wind-heat evils present, the tongue will have a thin and yellow coating and the pulse will be floating .

中医诊断:外感头痛。

Diagnosis by Chinese medicine: headache due to external contraction (of evils).

治法:清热,祛湿,止痛。

Method of treatment: clear heat, dispel dampness and relieve pain.

方药:外感头痛一号方。

Formula: Formula for the treatment of externally contracted headaches

用法:,开水冲服,五剂,一日一剂。

Directions: Decoct in boiling water and administer warm. Five doses altogether. One dose per day.

分析:菊花祛风清热,羌活祛风胜湿,川穹, 白芷祛风止痛,蔓荆子清头目止痛,甘草调和诸药,口服五剂后症状好转,无其他不适症状。
Explanation: Chrysanthemum (ju hua) dispels wind and clears heat. Notopterygium (qiang huo) dispels wind and overcomes dampness. Chuan xiong rhizoma (chuan xiong) and dahurian angelica (bai zhi) dispel wind and relieve pain. Vitex (man jing zi) clears the head and eyes, and relieves pain. Licorice root harmonizes the formula. After taking five doses, the condition improved and the patient had no other abnormal symptoms.

3. 讨论
依治疗原则看,外感头痛多属实证,治疗应以驱邪为主,因风者疏之,因寒者散之,因湿者化之,因热者清之。 内伤头痛,多属虚证,治疗以扶正为主。风阳侵袭则熄风潜阳,气虚则益气升清,血虚则养阴补血,肾虚则益肾填精,至于痰浊,淤血所致头痛,本虚标实,或先祛其实,或扶正驱邪兼顾。 但本人通过多年临床经验,简化了诊疗过程,把外感,内伤头痛进行综合分析,制出了外感头痛一号方、内伤头痛一号方, 以便更加方便的应用于临床实践,并且取得了良好的效果。 凡前来就诊的头痛的患者,需辨清外感,内伤,方可用上方。 请各位同仁辩证用之,有不妥之处, 请指正。

3. Discussion
Most externally contracted headaches belong to repletion patterns; therefore, the treatment should focus on expelling evils. Wind-evil should be coursed, cold-evil should be dissipated, damp-evil should be transformed, heat-evil should be cleared. Most headaches due to internal damage belong to vacuity patterns. The treatment should focus on supporting the upright Qi. If it is due to the invasion of wind Yang, extinguish the wind and subdue the Yang; if it is due to Qi vacuity, boost the Qi and upbear the clear; if it is due to blood vacuity, nourish Yin and supplement blood; if it is due to kidney vacuity, boost the kidneys and replenish the essence.  Headaches caused by phlegm turbidity and blood stasis are due to a vacuity at the root and a repletion at the branch. In treatment, the repletion should be expelled first, or simultaneously support the upright Qi and expel evil. After many years of clinical practice,  Shi Peiqing simplified the diagnostic and treatment process and created the two above-mentioned formulas. Clinically, he has achieved great results.  Before using these formulations, it is important to identify whether the headache is due to external contraction or internal damage .

中医药治疗慢性胃炎的临床体会 – Clinical Experiences Using Chinese Medicine to Treat Chronic Gastritis

中医药治疗慢性胃炎的临床体会
谢天佐 陈永祥

Clinical Experiences  Using Chinese Medicine to Treat Chronic Gastritis
Xie Tian-zuo  Chen Yong-xiang

Translated by:  XU Zhi-jun & J. Heaverlo

摘要 通过对慢性胃炎病因病机的认识及中医药治疗慢性胃炎的诊疗思路,联系临床所见病例,体会到临床运用健脾和胃,攻补兼施等综合调理方法可获良好的疗效。

Abstract: This thesis studies the disease causes and pathomechanisms of chronic gastritis.  It explores the methods of diagnosing and treating chronic gastritis with Chinese medicine, and cites clinical cases for its support. It is intended to prove that beneficial results can be achieved by using a combination of  clinical methods such as fortifying the spleen and harmonizing the stomach, and simultaneous supplementing and attacking.

关键词 胃炎,慢性;中医药;治疗

Key words: Gastritis, Chronic: Chinese medicine; Treatment

慢性胃炎是临床常见的消化系统疾病,唐晓群认为其实质是胃黏膜遭受反复损害导致固有腺体的萎缩,是由各种病因引起的慢性胃黏膜炎症。多数患者前期无症状,或仅表现为上腹痛或不适,上腹胀,嗳气,泛酸,食欲不振等消化不良症状,发病中期才会有明显的临床表现,该病的确诊有赖于胃镜检查,必要时还需进行病理活组织检查。中医学无“慢性胃炎”之病名,根据临床表现归属于中医“胃脘病”、“痞满”、“吞酸”、“呕吐”等病症范畴。

Chronic gastritis is a common disease of the digestive system. According to Tang Xiao-qun, essentially, repeated lesions of the gastric mucosa will lead to the atrophy of the glands. It can be classified as an inflammatory condition of the gastric mucosa and may be due to various causes. Many patients don’t experience early symptoms, or may present with varying symptoms of indigestion such as: epigastric pain or discomfort, abdominal distention, belching, acid regurgitation, or poor appetite. It is not until the middle stages of the disease will more obvious clinical manifestations appear. This disease has to be diagnosed by gastroscopy; and if necessary,  a biopsy will be performed. In Chinese medicine there is not a disease name for “chronic gastritis. According to its clinical manifestations, it is classified within the patterns of: “stomach duct disease”,“glomus and fullness”, “acid swallowing”, and “vomiting”.

•    病因病机的认识

慢性胃炎的临床症状表现多样,如胃痛,胀满,吞酸,痞满,嗳气等,引起这些不适的病因病
机非常复杂,发病或因情志不畅,郁怒伤肝,木不疏土;或因饮食不节,酒食过度,直伤脾胃;或因素体禀赋不足,加上外邪相干所致等,有关其病因病机的描述亦可见于历代文献,如:《灵枢·小针解》篇云:“寒温不适,饮食不洁,而病于肠胃。”《素问·六元正纪大论篇》说:“木郁之发……故民病胃脘当心而痛,上支两肋,鬲咽不通,饮食不下。”《景岳全书·心腹痛》则认识到“胃脘痛证,乃有因食、因寒、因气不顺者。”李东垣在《脾胃论》中则进一步指出“饮食不洁则胃病,形体劳役则脾病。”《杂病广要·胸痹心痛》中说:“饮食过多,不能克化,伤于胃脘,病根常在,略伤饮食则闷闷作痛。”

1.  Understanding the disease causes and pathomechanisms

The clinical manifestations of chronic gastritis may vary and they include: stomachache, distention and fullness, acid swallowing, glomus and fullness, and belching. The causes and pathomechanisms are very complicated. It may arise from: affect-mind inhibition and depressed anger damaging the liver; thereby, the liver-wood cannot freely course spleen-earth;  dietary irregularities and excessive drinking of liquor; so that the spleen and stomach are damaged directly; or from constitutional insufficiency and invasion of external evil.  Relevant descriptions can be found within the documents of past dynasties. For example, in “Magic Pivot ·Explanation of the Use of Small Needles”, it says, “Excessive cold or warmth, or unclean food may lead to the diseases of the intestines and stomach.” In “Plain Questions ·Great Treatise on the Regular Principles of the Six Origins”, it says, “Depressed wood…will lead to the disease of the stomach duct with heart pains. The throat is blocked and  unable to pass food.” In “Jing Yue’s Complete Compendium ·Heart and Abdomen Pain”, it says, “The symptoms of stomach duct pain may be due to diet irregularities, cold, or Qi stagntion.” Li dong-yuan points out in his treatise “On the Spleen and Stomach”, “unclean foods lead to stomach disease, physical taxation leads to spleen disease.” In “Miscellaneous Diseases·Chest Impediment and Heart Pain”, it says, “Excessive food intake, and the inability to digest, will harm the stomach duct. If this condition lasts for a long time, pain will arise even with a slightly irregular diet.”

尽管慢性胃炎的病因多种多样,病机复杂,但根据《内径》“正气内存,邪不可干”,“邪之所凑,
其气必虚”的发病学原理和《金匮要略》中“若五脏元真通畅,人即安和”,“四季脾旺不受邪”等理论,联系日常临床所见病例,多数学者认为慢性胃炎的病机主要以虚实夹杂,脾胃虚弱为本,邪气干胃为标。

There are various causes and complicated pathomechanisms with chronic gastritis; however, there are some basic principles of pathogenesis and treatment. For example, in “The Yellow Emperor’s Inner Classic”, it relates, “If the upright Qi is internally maintained, then evil cannot invade.” And, “if evil enters the body, the Qi must be vacuous”.  In “ Essential Prescriptions of the Golden Coffer”, it says, “If the true origin of the viscera is unobstructed, the body will be healthy and harmonious”, “evil cannot invade if the spleen is vigorous during the four seasons of the year. Based on these theories and clinical cases, most scholars believe the root cause of chronic gastritis is a vacuity-repletion complex and spleen-stomach vacuity; whereas, the branch is the evil Qi invading the stomach.

•    治疗

目前中医对慢性胃炎的治疗缺乏统一的标准,中医治疗强调审证求因,辨证论治,辨别病症之
虚实寒热。邪盛以驱邪为主,正虚以养胃为主,虚实夹杂者标本兼顾,攻补兼施。笔者结合对慢性胃炎病因病机的认识,联系临床病例认为健脾和胃,补消兼施,调畅肝气,针药结合,综合调理可取得较好的临床疗效。

•    Treatment

Up until now Chinese medicine does not have a standardized treatment for chronic gastritis. What Chinese medicine emphasizes is to assess the patterns and seek the cause to determine the treatment.  If it is due to exuberant evil Qi, the treatment should focus on dispelling evil Qi; if it is due to upright Qi vacuity, the focus will be on nourishing the stomach; if it is vacuity-repletion complex, both the root and branch should be treated by using supplementing and dispersion methods.  The writer believes that in order to achieve good clinical effects, the following combined treatment methods should be utilized: fortify the spleen and harmonize the stomach with simultaneous supplementing and dispersion methods, regulate and open the liver Qi. Treatment should be a combination of acupuncture and herbal medicine.

•    健脾和胃,补消兼施

脾胃为后天之本,脾胃的功能旺盛,则正气易于恢复,疾病易于痊愈,正如李东垣所说“善治
病者,惟在调和脾胃”。李培教授在治疗慢性胃炎方面尤重视健脾,认为健脾则胃安。《素问·阴阳应象大论篇》说:“治病必求于本”,指出治疗疾病时必须究其根本后进行治疗,而本病病久多以脾胃虚弱为主,但纯虚者极少,或多或少都有一些实邪,或气滞,或血瘀,或湿热等证型。故临床治疗本病,即应重视健脾和胃治其本,又应针对不同病邪治其标,或理气,或活血,或清热等治法,使邪去而不伤正。

2.1 Fortify the spleen and harmonize the stomach using both supplementing and dispersion methods

The spleen and stomach are the root of latter heaven. If their function is exuberant, the upright Qi is easy to recover and disease will easily be cured. As Li Dong-yuan says, “good doctors emphasize the regulation of the spleen and stomach”. Professor Li Pei attaches great importance to fortifying the spleen while treating chronic gastritis. According to him, if the spleen is fortified, the stomach will be calm. In “Plain Questions·Great Treatise on the Correspondences and Manifestations of Yin and Yang”, it says, “To treat disease, it is necessary to seek the root”.  Chronic gastritis, in most cases, is due to spleen-stomach vacuity, but very few are due to vacuity alone. More often, the symptoms are combined with some form of repletion evil. It may be Qi stagnation, blood stasis, damp-heat, etc.  Therefore, in clinical treatment, the focus should be to treat the root by fortifying the spleen and stomach. At the same time, the branches should also be treated in accordance with the presenting disease evil, such as regulating the Qi, quickening the blood, clearing the heat, etc.

案  赵某,女,56岁,退休干部,2007年7月9日初诊。患者胃脘部痞满不适,隐隐作痛3
年余,2006年11月曾作纤维胃镜检查,提示为慢性萎缩性胃炎,间断服枸橼酸铋胶囊、胃必治等药,无明显疗效。1周前因操劳过度,胃脘部痞满不适加重,时有烧灼样痛,以解痉药治疗,疼痛虽明显减轻但胃脘部痞满仍在,其他症状也无明显改善。就诊时患者胃脘部痞满不适,时轻时重,隐隐作痛,不思饮食,倦怠乏力,气短懒言,大便溏泄,舌质淡,苔薄白,脉沉弱,轻度贫血貌,心肺无异常,腹软无抵抗及压痛,肝脾未触及,肾区无叩击痛,心电图,大便常规及B型超声波检查无异常,血常规显示血红蛋白 92 g/L,白细胞 4.8×109/L,中性粒细胞 0.65,淋巴细胞 0.35,纤维胃镜检查提示慢性萎缩性胃炎。西医诊断为慢性萎缩性胃炎,中医诊断为痞证,证属脾胃气虚型。治以健脾益气,和胃消胀。方选香砂六君子汤加减。

Case study:

Female, 56 years old. Her first visit to the hospital was July 9, 2007. The patient complained of glomus, fullness, discomfort and dull pain in the stomach duct. This symptom had continued for more than 3 years. It was diagnosed as chronic atrophic gastritis after a stomach fiber endoscopy in November, 2006. She had been continuously taking potassium citrate capsules and gentamycin sulfate injections but without clear results. One week before the first visit,  her condition worsened due to overwork: she experienced increased sensations of glomus, fullness and discomfort in the stomach duct.  At times, she experienced scorching pain. After taking spasmolytics, the pain was greatly alleviated but the glomus remained. Other symptoms showed no improvement.  At the time of examination, she continued to experience intermittent feelings of glomus, fullness and discomfort, and dull pain in the stomach duct. She had no desire for food or drink. She felt tired and a lack of strength. She was short of breath and no interest in speaking. She had sloppy diarrhea. The tongue was pale and the tongue coating was thin and white. The pulses were sunken and weak. She had slight anemia. The heart and lungs were normal.  The abdomen was soft and did not feel pain under pressure. The liver and spleen were not palpated. The kidney area showed no tenderness with applied tapping.  Electrocardiogram, stool, and B-type ultrasonic examinations were all normal.   Hemoglobin was 92 g/L,  leucocyte count was  4.8×109/L,neutrophil count 0.65, and lymphocytes were 0.35.  According to western medicine, following an endoscopy, her symptoms were diagnosed as chronic gastritis. According to Chinese medicine, this was diagnosed as spleen-stomach Qi vacuity. The treatment should be to fortify the spleen, boost the Qi, harmonize the stomach and disperse distension. The formula was Costusroot and Amomum Six Gentlemen Decoction (with additions and subtractions).

处方: 党参15g, 白术15g,茯苓15g,砂仁10g,甘草6g,大枣6枚,神曲10g,麦芽10g,
山药15g,陈皮10g,蒲公英15g,佛手10g,丹参10g。水煎分早晚温服,1剂/d。嘱患者调饮食、畅情志、勿劳累。守方加减4周,患者自觉症状消失,精神饮食均佳。将上方制成胶囊,2粒/d, 3次/d,连服3个月以巩固疗效。停药后随访半年,胃病未复发。

Formula: codonopsis (dang shen) 15g, white atractylodes (bai zhu)15g, poria (fu ling) 15g, amomum (sha ren) 10g, licorice (gan cao) 6g, jujube (da zao) 6 pieces, medicated leaven (shen qu) 10g, barley sprout (mai ya) 10g, dioscorea (shan yao) 15g, tangerine peel (chen pi) 10g, dandelion (pu gong ying) 15g, Buddha’s hand (fo shou) 10g, salvia (dan shen) 10g. To be taken warm in the morning and evening. One formulation a day.

The patient was instructed to regulate food and drink, smooth the affect-mind, and not to overwork. After using a modified version of this formula for 4 weeks,  the patient felt the symptoms disappeared and reported improvement in both spirit and diet.  The patient was advised to continue taking the prescription in capsule form at a dosage of 2 capsules three times per day.  This was repeated for 3 months to secure the effect of the treatment. After 3 months the gastritis had not returned.

按   本方取四君子汤之义加减,注意补益脾胃,并配理气活血之品,诸药合用,共奏健脾益胃,
攻补兼施之效,使补而不滞,正气恢复,邪去而疾病痊愈。较好地体现了健脾和胃攻补兼施在治疗慢性胃炎中的应用。

Note: The formula utilizes a modified Four Gentlemen Decoction. The emphasis is on supplementing and boosting the spleen and stomach.  With the additional herbs, it can also regulate the Qi and quicken the blood. This formula can fortify the spleen, boost the stomach, and simultaneously supplement and attack. It supplements without causing stagnation. It recovers the upright Qi while dispelling evil in order to effectively treat the disease.

•    脏腑相关,注意调肝

慢性胃炎病位虽在中焦,但多累及肝气而成肝、脾、胃3脏之病,故临床不必见肝郁方调肝气,
治疗时可酌情加入疏肝之品,使肝气疏,中气畅,从而脾胃功能正常。刘景龙,赵瑞华等认为采用疏肝和胃法治疗慢性胃炎效果比较明显,肝属木而主疏泄条达,脾胃属土而主运化受纳,肝与脾胃为木土相克之脏,正常情况下,肝之疏泄条达,有利于脾胃消化吸收,即木能疏土。肝之疏泄条达正常,即可助脾运化,使轻阳升发,水谷精微转输上归于肺,又可助胃受纳腐熟,使浊阴之气下降,使食糜不断下达于肠。

•     Chronic gastritis and its relationship with the liver

Although chronic gastritis is located in the central burner, it’s predominant relationship is with the liver Qi.  This combination forms an imbalance of the liver, spleen and stomach. Clinically, the liver Qi should be regulated, even without the symptom of liver depression. In treatment, liver-coursing medicinals can be added to course the liver Qi, and unimpede the central Qi, in order to recover the function of the spleen-stomach . According to Liu Jing-long and Zhao Rui-hua, beneficial effects can be achieved when treating chronic gastritis with the method of coursing the spleen and harmonizing the stomach. The liver belongs to wood, which governs free coursing and orderly reaching. The spleen and stomach belong to earth, which governs movement, transformation and intake. The relationship between the liver and spleen-stomach is that of wood and earth. The normal free coursing and orderly reaching is beneficial to the absorption and digestion of the spleen-stomach. This is what is referred to as “wood courses earth”. This not only can assist the movement and transformation of the spleen, upbear clear Yang, and deliver the essence of grain and water up to the lungs; but, it also may assist the stomach decomposition intake, downbear the turbid Yin, and deliver the chyme down to the intestines.

案  袁某,女57岁,退休教师,2007年7月23日初诊。患者胃脘胀满,反复发作2年,生气及饭后尤著,伴嗳气吞酸,口苦,食欲不振,经多方治疗症状未见好转,面色萎黄,舌淡红,苔薄白,脉弦。此次就诊主因与家人生气后上述症状加重。胃镜提示:慢性浅表性胃炎,幽门螺旋杆菌阳性。中医诊断:胃脘痛,证属肝胃气滞型。治宜疏肝和胃,理气止痛。拟以柴胡舒肝散加减。

Case study:

Female, 57 years old. Her first visit to the hospital was on July 23, 2007. The patient had suffered from gastric distention and fullness repeatedly for two years. It was worsened with anger and especially after dinner. This symptom was also accompanied with belching, acid swallowing, bitter taste, and poor appetite. After multiple treatments there was no improvement in the symptoms.  The patient had a withered-yellow facial complexion; her tongue was pale red; the tongue fur was thin and white; and the pulse was stringlike.  Gastroscopy indicates that her condition is chronic superficial gastritis. Helicobacter pylori was positive. According to Chinese medicine, this was diagnosed as stomach duct pain due to liver and stomach Qi stagnation. The treatment should focus on coursing the liver, harmonizing the stomach, regulating the Qi and relieving the pain. Chai Hu Liver-Soothing Powder was adopted with abductions and subtractions.

处方: 柴胡10g,川芎10g,香附10g,白芍15g,赤芍10g,陈皮10g,枳壳6g,旋覆花10g,神曲15g,麦芽10g,半夏10g,甘草9g。水煎分服,1剂/d。嘱患者调饮食,畅情志,勿劳累。治疗3个疗程后,诸症消失,胃镜提示:未见异常, HP(-)。随访半年未见复发。

Formula: bupleurum (chai hu) 10g, chuan xiong rhizome (chuang xiong) 10g, cyperus (xiang fu) 10g, white peony (bai shao) 15g,  red peony (chi shao) 10g, tangerine peel (chen pi) 10g, bitter orange (zhi ke) 6 g, inula flower (xuan fu hua) 10g, medicated leaven (shen qu) 15g, barley sprout (mai ya) 10g, pinellia (ban xia) 10g, licorice (gan cao) 9g. Take one formula twice a day. The patient was instructed to regulate food and drink, smooth the affect-mind, and not to overwork. After three courses of treatment all of the symptoms disappeared. Gastroscopy indicated no abnormalities. HP was negative.

按  本方取柴胡舒肝散之义加减,有疏肝解郁,消食和中,理气止痛之效。充分体现了调肝可使全身气机畅达,脾胃功能如常。

Note: Chai Hu Liver-Soothing Powder can soothe the liver, resolve depression, disperse food, harmonize the center, regulate the Qi and relieve pain. This case study illustrates that by regulating the liver, the dynamic of the whole body becomes unblocked and the function of the spleen-stomach return to normal.
•    针药结合 内外同治

针灸疗法为外治法,通过腧穴经络对胃病起调节作用;而内服中药汤剂为内治法,直接对胃腑
起调节作用,两者结合运用可提高疗效,使中药治疗慢性胃炎的特色更加突出。饶燕认为采用针灸治疗慢性胃炎亦能收到良好疗效,通过调节神经通路,提高免疫功能。童春泉等认为可以通过穴位埋线治疗消化溃疡,且远期疗效和安全性较高。临床应用时应综合分析四诊材料,作出正确的诊断和辨证分析,确立正确的疗法,选择正确的方药和穴位,使针药有机结合。

•    Combination of Acupuncture and herbal medicine and the simultaneous treatment of internal and external

Acupuncture is an external method of treatment which works on stomach disease through acupoints and network vessels. Chinese herbal medicine is an internal method of treatment which regulates the stomach directly. Increased results can be achieved by combing these two methods.  However, according to Rao Yan, beneficial results may also be achieved by utilizing acupuncture as a single treatment method.  Immune functions may be improved by regulating the nervous system. According to Tong Chun-quan, in treating peptic ulcer, it is safer to utilize “threaded acupuncture”  which is capable of achieving longer lasting effects. Clinically, it is important to make the correct diagnosis and implement the appropriate method of treatment.

案  李某,女,42岁,2007年9月11日初诊。患者诉胃病史3年,3年前因饮食不节,冒雨露宿,随即脘腹胀闷,隐痛时作,大便溏薄,四肢乏力。1年前在某医院胃镜检查诊断为慢性浅表性胃炎,曾服用“雷尼替丁”、“吗丁啉”、“枸橼酸铋胶囊”、“胃必治”等西药,效果不明显。遂于2007年9月11日来我院就诊。诊见胃脘隐痛,喜按,脘胀痞闷,嗳气便溏,时欲呕恶,面色少华,自觉肢冷,舌淡苔白,脉沉细。中医诊断:胃脘痛,证属脾胃虚寒。治宜温阳祛寒,燥湿健脾。以附子理中丸内服配合针灸治疗。附子理中丸,6g/次,每日早晚饭后温开水送服。嘱患者调饮食、畅情志、勿劳累。配合针灸足三里、中脘、章门、关元等穴,以补法为主,一次/d,7次为一个疗程。治疗3个疗程后患者胃脘疼痛消失,大便正常,痞闷减轻,面色转润,精神饱满。续服上药3个疗程以巩固疗效。2008年1月6日胃镜复查显示上消化道未见明显异常。后随访3个月未见复发。

Case study:

Female, 42 years old. The patient’s initial visit was on September 11, 2007. She had suffered from stomach problems for three years. Three years prior, due to dietary irregularities and camping in the rain, she began to feel distention and oppression in the stomach duct and abdomen. She experienced frequent attacks of dull pain. She had thin stools and fatigued limbs. The previous year, her condition was diagnosed as chronic superficial gastritis with a gastroscopy exam. She took ranitidine, domperidone, potassium citrate capsules, gentamycin sulfate injections without obvious effects. The following symptoms were present at the time of examination: dull pain in the stomach duct which is improved with pressure, distention and oppression in the stomach duct, belching, sloppy stool,  frequent sensations of nausea and vomiting, lusterless facial complexion, and cold limbs.  The tongue was pale and the tongue coating was white.  The pulse was fine and sunken.  The Chinese medicine diagnois was stomach duct pain due to spleen-stomach vacuity cold. The treatment focus is to warm the Yang, dispel cold, dry dampness and fortify the spleen. Aconite Center-Rectifying Pill was prescribed, combined with acupuncture. The patient was advised to take 6g of Aconite Center-Rectifying Pill twice a day, mornings and evenings. She was further directed to regulate food and drink, smooth the affect-mind, and not to overwork.  The acupoints used were: Leg Three Miles (ST-36, Zu San Li), Central Stomach Duct (CV-12, Zhong wan), Camphorwood Gate (LV-13, Zhang men), and Pass Head (CV-4, Guan yuan). The primary method of acupuncture was supplementation, and was performed once per day.  One course of treatment consisted of seven treatments.  After three courses of treatment , the stomach duct pain disappeared, the stool was normal, the oppression in the spleen was alleviated, the facial complexion turned moist, and the patient was full of vigor. Three more courses of treatment were added to secure the treatment. On January 6, 2008, a follow up gastroscopy exam showed no abnormalities were found in the upper gastrointestinal tract.

按  附子理中丸取干姜、附子温中散寒以助阳,白术健脾燥湿,人参大补元气以助运化,甘草和中益气。此方可使中焦之寒得辛热而去,虚证得甘温而复,清阳升,浊阴降,运化健而中焦治,加之关元及元气所聚,中脘、章门乃脾胃之募穴,足三里乃足阳明合穴具较强保健之功,针药结合治疗,取其温补而不滞,行气而不散,从而脾胃阳气得复,寒湿得除,由此标本兼顾,正得复,邪得除。另外,李燕认为附子理中丸还可治疗功能性消化不良,附子理中丸对于消化不良导致的慢性胃炎亦能收到良好疗效。

Note:

In the formula of Aconite Center-Rectifying Pill, dried ginger (gan jiang)  and aconite (fu zi) can warm the center and dispel cold to assist the Yang. White atractylodes (Bai zhu) can fortify the spleen and dry dampness. Ginseng (Ren shen) can greatly supplement the original Qi of the body so as to aid movement and transformation. Licorice (Gan cao) can harmonize the center and boost the Qi. In this formula, the cold in the middle burner is dispelled by warm medicinals, the vacuity pattern is treated with warm and sweet medicinals.  When the clear Yang upbears and the turbid Yin downbears, movement and transformation is strengthened, thereby, harmonizing the middle burner. In addition, Pass Head (CV-4, Guan Yuan) is the gathering point of the original Qi, Central Stomach Duct (CV-12, Zhong wan) and Camphorwood Gate (LV-13, zhang men) are the front-mu points of the spleen and stomach,  Leg Three Miles (ST-36, Zu san li) is the uniting point of the foot Yang brightness. Needling these points will have a strong effect on the overall health of the body.  Acupuncture and herbal medicine are used in combination to warm and supplement without stagnating, and to move the Qi without dispersing; thereby, the Yang Qi of the spleen-stomach can be recovered and cold-damp can be dispelled. By treating both the root and branch, the upright Qi can be recovered and evil eliminated. Furthermore, according to Li Yan, Aconite Center-Rectifying can also treat functional indigestion leading to chronic gastritis.

•    结语

慢性胃炎按新悉尼系统的分类方法可分为浅表性、萎缩性和其他特殊类型的胃炎。目前公认的幽门螺旋杆菌感染是慢性胃炎的最主要病因,在治疗方面西医多采取三联疗法根除幽门螺旋杆菌,并配合改善消化系统的药物,如胃肠动力药、抑酸或抗酸药等,虽已取得一定临床疗效,但其服药时间长,且症状可能反复出现,很难达到理想的治疗目标。中医药在治疗慢性胃炎上有其独特优势,在中医基本理论和辨证论治思想的指导下,结合本病的病因病机和病人情况的不同,运用中医经方,以顾护胃气为本,祛除病因为标,注意肝气条达,针药结合,灵活地进行辨证论治,可取得满意的疗效。另外慢性胃炎经过治疗后,病情得以控制,若疾病处于缓解或初愈阶段,此时机体尚处于待恢复状态,胃的功能尚未健全,生活起居如有不慎,亦有复发之虞,所以预防复发也是十分重要的。
贾凤云认为慢性胃炎的发病与情志、饮食等密切相关。殷艳认为慢性胃炎愈后的饮食保健亦是非常重要的,因此预防慢性胃炎复发的措施应当是综合的,除饮食调养、起居调节、精神调摄、加强体育锻炼外,还应慎用对胃黏膜有损害的药物,并可结合药膳以继续改善和加强脾胃的功能,促进体内脏腑机能的恢复,增起御病之“正气”,以使“正气存内,邪不可干”。中医治疗有具有副作用小,疗效显著,经济实惠等优势,容易被患者接受,故具有极为广阔的临床应用前景。

•    Conclusion

According to the New Sydney System, chronic gastritis is classified as: superficial gastritis, atrophic gastritis and special type gastritis. Nowadays, it is commonly agreed that the main cause of chronic gastritis is Helicobacter pylori.  In treatment, Western medicine generally adopts a triple therapy method to root out helicobacter pylori. Other medicinals are added to improve the digestive system, such as gastrointestinal drugs and antacids. This works to some extent, but it’s hard to achieve ideal effects because the course of treatment is long, and the symptoms may relapse again and again. Chinese medicine has a unique advantage in treating chronic gastritis. Under the guidance of  basic Chinese medicine theory and the practice of identifying patterns to determine treatment, satisfactory effects can be achieved.  The root treatment is to protect the stomach Qi; and the branch treatment is to eliminate causitive disease factors. In addition, once the condition is under control, it is important to prevent relapse by keeping in mind, the patient is still in a period of recovery and the function of the stomach is still not completely recovered.

According to Jia Feng-yun, the onset of chronic gastritis is closely related with the affect-mind and diet. According to Yin Yan, it is very important to pay close attention to the diet and health care after treatment. The measures to prevent the relapse should be comprehensive: regulating diet, daily life, physical activity and the mental spirit; the patient should also be careful not to take substances that are harmful to the gastric mucosa.   Medicinal food may also beneficial to improve the function of the spleen and stomach and help recover the function of the internal organs. Chinese medicine has a significant effect in treating chronic gastritis with fewer side effects, and for some, may be economically more viable. Therefore, it is widely accepted by patients and has a broad perspective in it’s clinical application.

中医养生学的基本理论 – The Basic Theory of Life Cultivation of Chinese Medicine

Translated by XU Zhi-jun & J. Heaverlo

第三章 中医养生学的基本理

        中医养生学继承了传统中医学的理论和古代哲学思想的精华,以“天人相应”和“形神合一”的整体观为出发点.主张从综合分析的角度去看待生命和生命活动。养生方法以保持生命活动的动静互涵、平衡协调为基本准则。主张“正气为本”,提倡“预防为主”,强调辨证思想。要求人们用持之以恒的精神,自觉地、正确地运用养生保健的知识和方法,通过自养自疗,提高身体素质和抗衰防病的能力,达到延年益寿的目的。

Chapter Three:  The Basic Theory of Life Cultivation of Chinese Medicine

The Chinese Medicine study of life cultivation inherited the essence of traditional Chinese medicine theories and ancient philosophical thoughts. It originates from a holistic view that “heaven and man are mutually interactive”, and “the body and the spirit are the unity of opposites”. It holds that life and life’s activities should be treated from the perspective of a comprehensive analysis. The basic principles of life cultivation is to keep life’s activities balanced, coordinated, and in an interdependent state of movement and stillness. It takes “the upright  as the foundation”, advocates “prevention first in medical work”, and emphasizes dialectical thinking. It requests that people apply the life cultivation knowledge and methods persistently, consciously, and correctly, so as to improve their constitution and ability to defy debilitation and prevent disease, and thus, to realize the goal of prolonging life.

第一节 生命

生命是具有生长、发育活力,并按自然规律发展变化的过程。“生、长、壮、老、已”,是人类生命的自然规律。探索生命的规律,对于中医养生学来说,有着极为深远的意义。

一、生命的起源

《内经》认为,生命物质是宇宙中的“太虚元气”,在天、地、日、月、水、火相互作用下,由无生命的物质演变化生出来的。天地之间所以有品类无限多样的物种,都 是物质自己的运动和变化,在时间进行中形成的。《素问·天元纪大论》所说:“太虚廖廓,肇基化元……生生化化,品物咸章”,就是这个意思。人是最高等的动 物,但也不过是“物之一种”,是从万物群生中分化出来的。所以《素问·宝命全记沦》说:“人以天地之气生,四时之法成”。

“人以天地之气生”,是说人类生命的起源,源于天地日月,其中主要源于太阳的火和地球的水。太阳是生命能量的源泉,地球的水(凡其所溶解的各种营养物质)是生命形质的原料。有生命的万物必须依靠天上的太阳和地上的水才能生存,人类当然也不例外。

“四 时之法成”,是说人类还要适应四时阴阳变化的规律才能发育成长。因为人生天地之间,自然界中的一切运动变化、必然会直持或间接地对人体的内环境产生影响, 而人体的内环境的平衡协调和人体外界环境的整体统一,是人体得以生存的基础。在正常情况下,通过人体内部的调节可使内环境与外界自然环境为变化相适应,保 持正常的生理功能。如果人的活动违反自然变化的规律,或外界自然环境发生反常的剧变,而人体的调节功能又不能适应时,人体内、外环境的相对平衡都会遭到破 坏而产生疾病。这说明“适者生存”,仍是生物界不可逾越的客观规律。人类只有认识自然,才能更好地适应自然,改造自然,成为自然的主人。

Section One: Life

Life is a process of growing and developing according to the laws of nature. “Birth, growth, maturity, decline, and death” is the natural law of life. Thus, it is profoundly significant for the Chinese Medicine study of life cultivation to explore the law of life.

  1. The Origin of Life

According to “The Yellow Emperor’s Inner Canon”, the materials of life evolved from inert matter within the universe, under the interactions of the heavens, the earth, the sun, the moon, the water, the fire, etc. The origins of all the immeasurable and diversified species between heaven and earth are attributed to the movements and evolution of the materials themselves. They formed into their current shapes through the course of time. This accords with what was expressed in “Plain Questions: Great Treatise on the Origins and Principles of Heaven” , “The original motive power exists among The Boundless Great Void…the original  produces and evolves (all of the ten thousand things), which will naturally become prosperous.” Although human beings are the top-level animals, they are still no more than “one of the species”, and similarly, evolved from the ten thousand things. This is why “Plain Questions: Treatise on Treasuring [Heaven’s] Mandate to Preserve the Body” says, “Human beings come into existence by receiving the  between heaven and earth, and mature by following the laws of the four seasons”.

The quote, “Human beings come into existence by receiving the  between heaven and earth”, means that human life originates from the heavens, the earth, the sun and the moon.  Among these, the fire of the sun and the water of the earth are of most importance. The sun is the source of the life energy, and the earth’s water (and the various nutrients dissolved by water) is the raw materials for the matter of life. All the ten thousand living creatures must rely on the sun and the water of the earth for survival. Human beings are certainly not an exception.

The statement, “Human beings mature by following the laws of the four seasons”, means that human beings must adapt themselves to the laws of the yīn yáng changes of the four seasons in order to sustain development and growth. Because human beings exist between heaven and earth, all the movements and changes of the natural world will inevitably influence the inner environment of the human body, directly or indirectly. Therefore, the existence of the human body is based on the holistic unity of its inner and outer environment. Under normal conditions, by adjusting the human body, the inner environment can adapt to the changes of the outside natural environment, and thus to maintain normal physiological functions. If human activities go against the laws of natural change, or the outside natural environment has extreme abrupt changes, and the regulatory function of the human body cannot adjust, the relative balance of the inner and outer environment of the body will be destroyed and thus fall ill. This proves that “the survival of the fittest” is still the impassable, objective law of the natural world. Only by knowing nature can mankind better adapt to nature, transform nature, and to become the master of nature.

二、生命的运动形式

《庄 子·知北游》说:“人之生,气之聚也,聚则为生,散则为死”。这就是说,生命活动是自然界最根本的物质-—气的聚、散、离、合运动的结果,生命是物质运动 的形式。活着的人体,是一个运动变化着的人体。《素问·六微旨大论》进一步指出物质运动的基本形式是“升降出入”,“出入废则神机化灭,升降息则气立孤 危,故非出入,则无以生长壮老已;非升降,则无以生长化收藏,是以升降出入,无器不有”。这就说明,只有运动,才能化生万物,宇宙间的一切吻质,尽管有大 小和生存的时间长短不同,但运动是一致的。

升降出入运动,是人体气化功能的基本形式,也是脏腑经络、阴阳气血矛盾的基本过程。因此,在生理 上人体脏腑经络的功能活动无不依赖于气机的升降出入,如肺的宣发与肃降,脾的升清与胃的降浊,心肾的水火相济,都是气机升降出入运动的具体体现。在预防疾 病方面,同样要保持人体气机升降正常,才能抗御邪气侵犯,免生疾病。

  1. The Form of Life

In the classic“Zhuāng Zĭ:。ZhĪ Běi Yóu”it is put forth, “Human life is the gathering of . Once  gathers together, people live; once  scatters and disappears, people die”. This is to say; life’s activities result from the gathering, scattering, separation and combination of —the most fundamental substance in nature. The living human body is always changing. “Plain Questions, Great Treatise on the Subtleties of Six” further points out that the basic movement of substance is “upbearing, downbearing, inward and outward movement”, “If the inward and outward movement stops, the spirit mechanism (life) will die out; if upbearing and downbearing stops, the established  is in peril. Therefore, without inward and outward movement, there will be no birth, growth, maturity, decline, and death; without upbearing and downbearing, there will be no birth, growth, transformation, receiving, and storage. Thus, no substance is without the movements of upbearing, downbearing, inward and outward.” This is to say that only movement can give birth to the ten thousand things. The most consistent attribute of all matter in the universe, regardless of its size or time of existence, is movement.

Upbearing, downbearing, inward and outward movement is the basic function of  transformation within the human body. It is also the basic process of movement for the viscera, channels and network vessels, yīn, yáng, qì and blood. All the physiological activities of the viscera and the channels and networks vessels rely on the upbearing, downbearing, inward and outward movement of . For instance, the diffusion and downbearing of the lungs, the upbearing of the clear by the spleen, the downbearing of the turbid by the stomach, the mutual assistance between the water and fire of the heart and the kidney…all of these are specific illustrations of the upbearing, downbearing, inward and outward movement of . In terms of disease prevention, only by maintaining a normal state of the upbearing, downbearing, inward and outward movement of  can the human body resist the invasion of evil  and avert the onset of disease.

三、生命的维持和死亡

《素 问·生气通天论》里说:“生之本,本于阴阳”,这就是说,生命的根本,就是阴阳。究其原因,是由于“阳化气,阴成形”,而生命过程就是不断的化气与成形的 过程,即有机体同外界进行不断的物质交换和能量交换的过程。化气与成形,是生命本质自身中的矛盾,两个对立面是不断斗争的,又是统一的。化气与成形,互为 消长;任何一方的太过或不及,均可导致另一方受损。但二者又结合于生命的统一体内,互相依存,互相转化。阳气化为阴精,阴精又化为阳气,否则“孤阳不生, 独阴不长”。

人之所以有生命,在于构成人体的“气”具有生命力。人体生命力的强弱,生命的寿夭,就在于元气的盛衰存在;新陈代谢的生化过 程,称之谓气化生理;生命的现象,本源于气机的升降出入等等,这都反映出气既是构成人体的基本物质,又是人体的生命动力。正因为气是生命活动的根本和动 力。宋《圣济总录》提出:“万物壮老,由气盛衰”的观点,并认为“人之有是形也,因气而荣,因气而病”。张景岳则反复强调气在防病延年中的重大意义,指出 气是人体盛衰寿夭的根本。他说;“盖以大地万物皆由气化;气存数亦存,气尽数亦尽,所以生者由乎此,所以死者亦由乎此,此气不可不宝,能宝其气,则延年之 道也”。同样,精、血、津液亦是构成人体及促进人体生长发育的基本物质,如《灵枢·经脉》篇说:“人始生,先成精,精成而脑髓生,骨为十、脉为营、筋为 刚、肉为墙、皮肤坚而毛发长”,这就说明人体的产生必先从精始,由精而后生成身形五脏,皮肉筋骨脉等。不仅如此,人出生之后,犹赖阴精的充盈,从而维持人 体的正常的生命活动,故《素问·金匮真言论》说:“精者,身之本也”。若阴精充盈,则生命活动旺盛,身健少病;若阴精衰虚,则生命活动减退,早衰多病。

还 有,生命的维持还依赖于神的健康,《灵枢·天年》说:“失神者死,得神者生”。可见,神的得失关系到生命的存亡。从人体来说,神是机体生命活动的总称,整 个人体生命活动的外在表现,无不属于神的范围。它包括精神意识,运动、知觉在内,以精血为物质基础,是气血阴阳对立的两个方面共同作用的产物。

综上所述,人体的生命活动,是以体内脏腑阴阳气血为依据的。脏腑阴阳气血平衡,人体才会健康无病,不易衰老,寿命才能得以延长。这就是《素问·生气通天论》中“阴平阳秘,精神乃治;阴阳离决,精气乃绝”的理论。

但有生必有死,这是不以人们的意志为转移的客观规律。恩格斯说:“生命首先就在于:生命在每一瞬间食它自身,但却又是别的什么。所以生命也是存在于物体和过程本身中的不断自行产生和自行解决的矛盾;这一矛盾一停止,生命亦即停止,于是死就来到”。

  1. The maintenance and life and death

“Plain Questions, Treatise on Vital QÌ Connecting with Heaven” says, “Life is rooted in yīn and yáng”.  This is to say, the root of life is yīn and yáng because “yáng transforms into , yīn becomes form”. The process of life is that of constantly transforming into  and becoming form, in other words, the process in which the organism constantly exchanges matter and energy with the outside world. The transformation of  and materialization are two opposites within the nature of life.  Both are opposing as well as interdependent. Their interaction consists of waxing and waning. The excessiveness or insufficiency of any one side may lead to the injury of the other. However, the two sides combine within the body to form the unity of life, they are mutually interdependent as well as mutually transforming.  The yáng qì transforms into yīn essence and the yīn essence  transforms into yáng qì. Otherwise, “The solitary yáng cannot survive, the solitary yīn cannot grow”.

Life can exist because of the vitality of qì. The exuberance or debilitation of the original  of the human body will dictate whether one’s life is stronger or weaker, longer or shorter. is not only the essential matter constituting human body, but it is also the motive force of life. Just for this reason, “Sages’ Salvation Records” of the Sòng Dynasty puts that “The maturity and death of the ten thousand things all depends on the exuberance and debilitation of ”, and believes that “The human shape becomes healthy or ill because of .” Zhāng  Jǐngyuè repeats again and again the great significance of  in preventing diseases and prolonging life. He points out that  is the root cause of exuberance and debilitation, longer or shorter life. He says, “All the ten thousand things between the Heaven and Earth come into being from . Where there is  there is life, here there is no  there is no life. Life and death are determined by . The  must be treasured, which is the secret of prolonging life”. Similarly, essence, blood, and body fluids are also considered the essential matter that constitutes the human body and promotes its growth and development. “Magic Pivot: Channels” puts, “When a human body comes into being, first to form is the essence,  then brain-marrow develops. The skeleton is the support; the arteries and veins are the places for managing and storing  and blood; the sturdy sinews and joints work to restrain and strengthen the skeleton; the muscles and flesh are the walls to protect the internal organs, sinews, bones, and blood vessels; after the skin becomes firm and tenacious, hair will grow”. This is to say that the forming of human body starts with the essence, followed by the body frame, the five viscera, skin, flesh, sinews, bones, vessels, etc. After birth, the human body still relies on abundant yīn essence to maintain normal life activities. That’s why “Plain Questions, Treatise of the True Doctrine of the Golden Coffer” says, “essence is the root of human body”.  If the yīn essence is abundant, life activities will be vigorous, the body will be strong and healthy; if the yīn essence is feeble and weak, the life activities will decline, and the body will decay early with poor health.

The maintenance of life also relies on a sound spirit. “Magic Pivot:  Natural Life-Span” says, “Those who lose spirit die, those who gain spirit live”. It is thus clear that the gain or lose of spirit is related with life or death. In terms of the human body, spirit is the general name of the activities of all organic life. The external manifestation body belongs to the spirit, which includes spiritual awareness, movement, and consciousness. Based on the essence and the blood, it is the outcome of the interaction of yīn and yáng.

In summation, life activities of the human body are based on the viscera, yīn, yáng, and blood. Only by keeping the balance of the viscera, yīn, yáng, and blood can the human body be healthy and life be prolonged. This accords with the theory in “Plain Questions, Treatise on Vital Qì Connecting with Heaven”, “If the yīn is calm and yáng is sound, the spirit can be vigorous; if yīn and yáng are separated from each other and cannot combine, the spirit and  will be exhausted.”

第二节 天年

一、天年的概念

“天年”,是我国古代对人的寿命提出的一个有意义的命题。天年,就是天赋的年寿, 即自然寿命。人的生命是有一定期限的。古代养生家、医家认为在百岁到百二十岁之间。如《素问·上古天真论》:“尽终其天年,度百岁乃去。”;如《尚书·洪 范篇》:“寿、百二十岁也”,《养身论》亦说:“上寿百二十,古今所同”。此外,老子、王冰也都认为天年为120岁。西德著名学者H.Franke在 1971年提出:“如果一个人既未患过疾病,又未遭到外源性因素的不良作用,则单纯性高龄老衰要到120岁才出现生理性死亡”。事实上,120岁的天年期 限与一般的长寿调查资料相符,自古至今超过这一生理极限的例子,也是不少的。

Section Two:  The Natural Life Span

  1. The Concept of the Natural Life Span

The course of the natural life span is a significant proposition put forward by ancient Chinese people. It refers to the life span endowed by nature, i.e., natural life span. Human life has a time limit. Doctors and ancient experts in life cultivation believed this time limit is between one hundred and one hundred and twenty years. For example, “Plain Questions. Treatise of Heavenly Truth from Remote Antiquity” puts, “(The people from remote antiquity) lived their full span until one hundred years old”; “The Book of History. The Fundamental Laws of Government” puts, “The natural life span is one hundred and twenty years”; “Treatise of Life Cultivation” also says, “The highest life span is one hundred and twenty years. This has been a truth at all times”. Furthermore, both Lǎozǐ and Wáng Bìng believed that the natural life span was one hundred and twenty years. The German scholar, H. Franke, put forward in 1971, “If a person suffers from neither any illness nor any harmful effects by external factors, the physiological death will take place at the age of 120”. As a matter of fact, the life span of 120 conforms with corresponding research materials. From ancient times to present, there have been quite a few examples that went beyond this time limit.

二、寿命

寿命是指从出生经过发育、成长、成熟、老化以至死亡前机体生存的时间,通常以年龄作为衡量寿命长短的尺度。

一 般计算年龄的方法又可分为两种,一种是时间年龄,又称历法年龄,是指人出生以后经历多少时期的个体年龄,我国常配以生肖属性,以出生年份来计算其岁数,一 般由虚岁或足岁计算年龄。另一种是生物学年龄,是表示随着时间的推移,其脏器的结构和功能发生演变和衰老情况。在生物学上又可分为生理年龄与解剖年龄。国 外在确定退休准则时,设想应用生理年龄作为指标,可能比时间年龄更胜一筹。因为时间年龄和生物年龄是不完全相同的,前者取决于生长时期的长短,而后者取决 于脏器功能及结构的变化过程。由于每个人的先天性遗传因素与后天性环境等因素不同,因此时间年龄和生物学年龄有时不完全相同。此外,还有“心理年龄”,所 谓“心理年龄”是指由社会因素和心理因素所造成的人的主观感受的老化程度。即主观感受年龄,也称“社会心理年龄”,用以表示随着时间的推移,机体结构和功 能的衰老程度。

由于人与人之间的寿命有一定的差别,因此在比较某个时期、某个地区或某个社会的人类寿命时,通常采用平均寿命。平均寿命常用来反映一个国家或一个社会的医学发展水平。

随着时代的发展,社会的进步,人类的寿命不断增长,但人类的寿命值究竟是多少?还是一个尚未彻底解决的问题。因为它与先天禀赋的强弱,后天的给养、居住条件、社会制度、经济状况、医疗卫生条件、环境、气候、体力劳动、个人卫生等多种因素的影响有关。

  1. Life Span

Life span refers to the time period of the organic existence, which starts with birth, undergoes growth, maturity, aging, and ends with death. It is usually measured by age.

There are two common methods of counting age: one is called chronological age, or calendar age, which counts how many periods (years) a person goes through after birth. In China, this often goes together with the 12 symbolic animals. Age is counted by the year of birth. Age can be counted by nominal age (reckoned by the traditional method, i.e. considering a person one year old at birth and adding a year each lunar new year) or the actual age. The other method of counting age is called biological age, which reflects how the viscera develop and decline in the course of time. It can be further divided into physiological age and anatomical age. Some foreign countries take physiological age as the standard of retirement, which is more reasonable than chronological age. The reason is that chronological age and biological age are not completely identical with each other: the former depends on the length of life, while the latter depends on the changes of the viscera’s functions and structures. “Psychological age” is another dimension. It is the perception of how old one feels due to social and psychological elements.

Because the life span of different individuals vary, average life span is usually adopted to measure the life span during a specific period, in a specific area or society. The average life span is often used to reflect the medical development of a country or society.

With the development and progress of the times, the life span of human beings has been constantly increasing. However, the question how many years can human beings live has not yet been satisfactorily answered. An individual’s life span is influenced by various elements, such as natural endowment, provisions after birth, living conditions, social system, economic conditions, medical conditions, environment, climate, physical labor, personal hygiene, etc.

三、健康人的生理特征

迄 今为止,人们发现,影响人类尽终其天年的因素虽然很多,但有两个是非常重要的,其一是衰老;其二是疾病。那么,推迟衰老的到来,防止疾病的产生是延年益寿 的重要途径。因此,研究健康人的生理特征,就显得很有必要。一般地说,一个健康无病,没有衰老的人,应该具备下列生理特征:

  1. The Physiological Characteristics of Healthy People

Among various elements that prevent people from living their full life span, two have been found to be very important. One is aging, the other one is illness. Thus, postponing aging and preventing illness becomes important to prolonging life. It is quite necessary to study the physiological characteristics of healthy people. Generally speaking, a healthy individual should have the following physiological characteristics:

(一)生理健康特征

1、眼睛有神  眼精是脏腑精气汇集之地,眼神的有无反映了脏腑的盛衰。因此,双目炯炯有神,是一个人健康的最明显表现。

(1)   The characteristics of physiological health

  1. The eyes have spirit

The eyes are where the essence of the viscera converge. Whether the eyes are bright and with spirit is a reflection of the exuberance or debilitation of the viscera. The most evident way of determining an individual’s health is whether the eyes are bright and full of spirit.

2、呼吸微徐 微徐,是指呼吸从容不迫,不疾不徐。《难经》认为:“呼出心与肺,吸入肝与肾”,说明呼吸与人体脏腑功能密切相关。

  1. The breath is slightly unhurried.

“The Classic of Difficult Issues” holds, “Exhalation mainly depends on the heart and lungs; inhalation mainly depends on the liver and kidneys”. This points out that breath is closely related to the functions of the viscera.

3、 二便正常  《素问·五脏别论》说:“魄门亦为五脏使,水谷不得久藏”,是说经过肠胃消化后的糟粕不能藏的太久,久藏则大便秘结。而大便通畅则是健康的反 映。小便是排除水液代谢后糟粕的主要途径,与肺、肾、膀胱等脏腑的关系极为密切。小便通利与否,直接关系着人体的功能活动。

  1. The bowels and urination are normal.

“Plain Questions. A Separate Treatise on the five Viscera” says, “The gate of the corporeal soul (the anus) also functions as an excretory organ, which prevents the grain and water from remaining inside the body for prolonged periods.” This means if the waste from the digestive process remains for prolonged periods within the body, the stool will become bound. Unobstructed bowel movements are considered a reflection of one’s health. Urination is closely related with the lungs, the kidneys, the urinary bladder, plus other viscera. It is the primary route to rid the body of metabolic waste. Whether the urination is uninhibited has a direct relationship with the functions of the human body.

4、脉象缓匀  此指人的脉象要从容和缓,不疾不徐。“脉者,血之腑也”,气血在脉道内运行,所以脉象的正常与否,能够反映气血的运行。

  1. The pulse is moderate and even.

This means that the pulse should be unhurried, moderate, not too slow and not too fast. “The pulse is the house of the blood”, meaning the  and blood move through the pulse channels. Whether the pulse is normal or not, can reflect the movement of the  and blood.

5、形体壮实 指皮肤润泽,肌腠致密,体格壮实,不肥胖,亦不过瘦。因为体胖与体瘦皆为病态,常常是某些疾病带来的后果。

  1. The body is robust.

This means the skin should be moist and glowing, the interstices are fine and compact, and the body is neither too fat nor too thin. Both obesity and excessive thinness are abnormal states, which usually result from some sort of illness.

6、面色红润 面色是五脏气血的外荣,而面色红润是五脏气血旺盛的表现。

  1. The facial complexion is rosy.

The facial complexion is the outward manifestation of the  and blood of the five viscera.  A rosy complexion indicates the  and blood of the five viscera are exuberant.

7、牙齿坚固 因齿为骨之余,骨为肾所主,而肾为先天之本,所以牙齿坚固是先天之气旺盛的表现。

  1. The teeth are strong and firm.

The teeth are considered a surplus of the bones. The kidneys govern the bones.  The kidneys serve as the root of the former heaven essence. Henceforth, strong and firm teeth are a reflection the congenital essence is exuberant.

8、双耳聪敏 《灵枢·邪气脏腑病形篇》说:“十二经脉,三百六十五络……其别气走于耳而为听。”说明耳与全身组织器官有密切关系,若听力减退、迟钝、失听、是脏器功能衰退的表现。

  1. The hearing is acute.

“Magic Pivot:  Forms of Disease from Evil Qi in the Bowels and Viscera” says, “The twelve channels and three hundred and sixty five vessels…through which the  travels to the ears, which makes them able to hear.” This means that the ears are closely related to all organs throughout the body. If the hearing has been lost or is failing, it indicates the functions of the viscera are declining.

9、腰腿灵便 肝主筋、肾主骨、腰为肾之腑、四肢关节之筋皆赖肝血以养,所以腰腿灵便、步履从容,则证明肝肾功能良好。

  1. The lumbar and legs are agile.

The liver governs the sinews, and the kidneys govern the bones. The lumbar is the house of the kidneys.  The liver blood supports the sinews of the four limbs and joints. Therefore agility in the lumbar and legs plus stability in walking can prove the liver and kidneys are functioning properly.

10、声音宏亮 声由气发,《素问·五脏生成篇》说;“诸气者,皆属于肺”,声音宏亮,反映肺的功能良好。

10. The voice is resonant.

The voice comes from the qì. According to “Plain Questions: Treatise on the Engenderment of the Five Viscera”, “The  of the body belongs to the lungs.” A resonating voice indicates that the lungs are functioning well.

11、须发润泽 发的生长与血有密切关系,故称“发为血之余”。同时,又依赖肾脏精气的充养。《素问·六节胜象论》说:“肾者……其华在发”。因此,头发的脱落、过早颁白,是一种早衰之象,反映肝血不足,肾精亏损。

11. The beard and hair are moist and glowing.

The growth of hair is closely related to blood. “Hair is the surplus of the blood.” At the same time, hair relies on the support of the kidneys. “Plain Questions: Treatise on the six Periods and Visceral Manifestation” says, “the kidneys, its bloom is in the hair”. Therefore, hair loss and premature graying is the manifestation of premature debility, which reflects the insufficiency of liver blood and depletion of the kidney essence.

12、食欲正常 中医学认为,“有胃气则生,无胃气则死”,饮食的多少直接关系到脾胃的盛衰。食欲正常,则是健康的反映。

12. The appetite is normal.

According to Chinese medicine, “The body lives by the stomach , the body dies without the stomach ”. The amount of food and drink taken in directly influences the exuberance or debilitation of the stomach. Thus, a normal appetite is a reflection of health.

(二)心理健康特征

1、 精神愉快 《素问·举痛论》说:“喜则气和志达,营卫通利”,可见良好的精神状态,是健康的重要标志。七情和调、精神愉快,反映了脏腑功能良好。现代医学 亦认为,人若精神恬静,大脑皮层的兴奋与抑制作用就能保持正常状态,从而发挥对整体的主导作用,自能内外协调,疾病就不易发生。

(2)  The characteristics of psychological health.

  1. Happy state of mind

“Plain Questions: Treatise on Pain” says, “Happiness leads to harmonious , and the yíng qì and wèi qì will be unblocked”. A happy state of mind is an important sign of one’s health. When the seven affects are harmonious and the state of mind is happy it is a reflection of properly functioning viscera. Modern medicine also believes that a tranquil mind can maintain a normal state within the excitatory and inhibitory function of the cerebral cortex, which plays a leading role in the function of the whole body. Once the interior and exterior are in concert and harmony, it will difficult for the body to contract an illness.

2、记忆良好 肾藏精、精生髓,而“脑为脑之海”。髓海充盈,则精力充沛,记忆力良好;反之肾气虚弱,不能化精生髓,则记忆力减退。

  1. Good memory

The kidneys store essence. The essence produces marrow, and “the brain is the sea of marrow”. If the sea is full, a person will be full of energy and exhibit a good memory. If the kidney  is weak and cannot transform the essence into marrow, the memory will decline.

第三节 衰老

衰老是人类正常生命活动的自然规律,人类的机体在生长发育完成之后,便逐渐进入衰老(或称衰退)的过程。探讨衰老的概念、原因和衰老时的生理、病理改变,以至防止衰老的措施,是十分重要的。

衰 老可分为两类,即生理性衰老及病理性衰老。生理性衰老系指随年龄的增长到成熟期以后所出现的生理性退化,也就是人体在体质方面的年龄变化,这是一切生物的 普遍规律。另一类为病理性衰老,即由于内在的或外在的原因使人体发生病理性变化,使衰老现象提前发生,这种衰老又称为早衰。

Section Three: Aging

Aging is a normal human life activity within the laws of nature. After the human body reaches maturity, it gradually enters the process of aging. It is therefore, very important to explore the concepts and causes of aging, as well as the physiological and pathological changes, so as to prevent the process of aging.

Aging can be divided into two types: physiological and pathological. Physiological aging refers to the physiological decline that takes place after the maturity of the body, namely, the constitutional changes of the human body with age. This is common to all living creatures. Pathological aging refers to the pathological changes of the human body due to internal or external elements, which causes aging to occur earlier than normal. It is also called premature aging.

一、衰老的原因

中医学在对衰老原因的认识上,非常重视脏腑功能和精气神的作用,又很强调阴阳协调对人体健康的重要意义。兹简述如下。

1、肾阳亏虚 肾为先天之本,人的生长发育衰老与肾脏的关系极为密切。《素问·上古天真论》中“女子七七”、“丈夫八八”的一段论述,即是以肾气的自然盛衰规律,来说明人体生长、发育、衰老的过程与先天禀赋的关系,从而提示衰老的关键在于肾气的盛衰。

肾属水,主藏精,为元气之本,一身阴阳生化之根。肾的盛衰影响着元气的盛衰和生化功能的强弱,肾虚则元气衰,元气衰则生化功能弱,人的衰老就会加速到来。

  1. The reasons of aging

In terms of aging, Chinese medicine attaches great importance to the functions of the viscera and the roles of the essence, , and spirit. It also emphasizes the significance of balancing yīn and yáng for the health of human body.

  1. Kidney vacuity

The Kidneys are the root of the former heaven essence. The growth, maturity, and aging of the human body have an exceedingly close relationship with the kidneys. “Plain Questions:  Treatise of Heavenly Truth from Remote Antiquity” expounds “The essence  becomes exhausted at the age of 49 for females and 64 for males.” This tells the relationship between the process of growth, maturity, and aging of the human body and the former heaven essence through discussing the natural exuberance and debilitation of the kidney , so as to reveal that the key reason of aging lies in the exuberance and debilitation of the kidneys.

The kidney belongs to water and governs the storage of the essence. It is the root of the original , and of yīn and yáng engenderment and transformation. The exuberance or debilitation of the kidneys influences the exuberance and debilitation of the original  and its engendering and transformation functions. Thus, kidney vacuity leads to original  vacuity, which further weakens engenderment and transformation, and therefore the body experiences premature aging.

2、 脾胃虚衰 脾胃为后天之本,水谷皆入于胃,五脏六腑皆禀气于胃。若脾胃虚衰,饮食水谷不能被消化吸收,人体所需要的营养得不到及时补充,便会影响机体健 康。从而加速衰老,甚至导致死亡。《内经》明确指出阳明为多气多血之经,而“阳明脉衰,面始焦、发始堕”是衰老的开始表现。

脾胃属土,为一身气机升降之中枢,脾胃健运,能使心肺之阳降,肝肾之阴升,而成天地交泰。若脾胃虚损,五脏之间升降失常,就会产生一系列的病变,从而影响健康长寿。

  1. Spleen and Stomach vacuity debilitation

The spleen and stomach are the root of the latter heaven essence. All grains and water enter the stomach. The five viscera and six bowels receive  from the stomach. If the spleen and stomach become vacuous and debilitated, food and drink will not be properly digested, the nutrition required by the body will not be properly provided, and the health of the physical body will be affected, In this way the aging process will accelerate and may even lead to death. “The Yellow Emperor’s Inner Canon” clearly points out that the yáng brightness channel has copious  and copious blood, and “if the yáng brightness pulse becomes debilitated, the face begins to turn sallow, and the hair begins to fall”, this marks the beginning of aging.

The spleen and stomach belong to earth.  They serve as the body’s pivot for governing the upbearing and downbearing of the  mechanism throughout the body. When the spleen and stomach’s function of movement is fortified it will be able to assist the heart and lung yáng  to downbear, and the liver and kidney yīn qì to upbear.  This will promote a peaceful interaction between heaven and the earth. If the spleen and stomach vacuity-detriment leads to abnormal upbearing and downbearing of the five viscera, it will produce a series of diseases thus affecting the health and life span.

3、心脏虚衰 心藏神,主血脉,《素问·灵兰秘典论》称其为“君主之官”。心为生命活动的主宰,协调脏腑、运行血脉。心气虚弱,会影响血脉的运行及神志功能,从而加速衰老,故中医养生学尤其重视保护心脏。认为“主明则下安,以此养生则寿,……主不明则十二官危”。

  1. Heart Vacuity and Debilitation

The heart stores the spirit and governs the blood vessels. The heart is named “the office of the monarch” in “Plain Questions: Treatise of the Arcane Book of the Orchid Chamber of the Spirit Tower”. The heart governs the life activities, coordinates the viscera, and propels the blood through the vessels. Heart  vacuity affects the movement of the blood through the vessels and the spirit-mind thus accelerating the aging process. For this reason Chinese Medicine life cultivation studies pay special attention to the protection of the heart. According to Chinese Medicine, “if the monarch is sagacious, the subjects will be secure”. If one follows this principle of life cultivation the life will be long.  If the monarch is not sagacious, the twelve officials (the twelve organs) will be in danger”.

4、肝脏衰惫 肝藏血,主疏泄,在体为筋,关系到人体气机的调畅,具有贮存和调节血量的作用。如《素问·上古天真论》说:“七八,肝气衰,筋不能动”,即说明人体衰老的标志之一——活动障碍,是由肝虚而引起的。

  1. Liver Debilitation and Exhaustion

The liver stores the blood and governs free coursing. It manifest within the sinews of the body. The liver is related to the unimpeded regulation of the body’s  dynamic.  It also possesses the ability to store and regulate the blood. As “Plain Questions: Treatise of Heavenly Truth from Remote Antiquity” says, “at the age of 56, the liver  declines, and the sinews cannot move”. This illustrates that hindered movement may result from liver vacuity.

5、肺脏衰弱 肺主一身之气,《素问·六节藏象论》说:“肺者,气之本”。肺气衰,全身机能都会受到影响,出现不耐劳作,呼吸及血液循环功能逐渐减退等衰老表现。

  1. Lung Debilitation and Weakness

The lungs govern the  of the whole body. “Plain Questions: Treatise on the Six Periods and Visceral Manifestation” says, “The lungs are the root of  ”. Lung  debilitation will affect the function of the whole body, which may manifest such aging signs as decreased stamina, a gradual decline of respiration and blood circulation, etc.

6、 精气衰竭 精气是人体生命活动的基础,人的四肢、九窍和内脏的活动以及人的精神思维意识,都是以精气为源泉和动力的。因此,尽管人体衰老的因素繁多,表现 复杂,但都必然伴随着精气的病变,精气虚则邪凑之,邪势猖獗则精损之,如此恶性循环则病留之。《素问·阴阳应象大论》曰:“年四十,而阴气自半也,起居衰 矣;年五十,体重、耳目不聪明矣;年六十,阴痿、气大衰、九窍不利、下虚上实、涕泣俱出矣”。具体阐述了由于阴精阳气的亏损,人体会发生一系列衰老的变 化。

  1. Exhausted  and Essence

The  and essence are the basis of life activities. They are the motive source of the limbs, the nine orifices, the internal organs, the spirit, thoughts and consciousness. Although there are various factors for ageing, all are inevitably accompanied by a pathology of the  and essence. Where there is vacuity of the  and essence evil collects; rampant evil further depletes the essence; the disease compounds within this vicious cycle. “Plain Questions: Great Treatise on the Correspondences and Manifestations of Yīn and Yàng ” says, “at the age of 40, half of the yīn qì has waned, and the activities of daily life start to decline; at the age of 50, the body feels heavy, the ears and eyes are no longer acute and bright; at the age of 60, the yīn wilts, the kidney  greatly declines, the nine orifices are inhibited, the lower body becomes deficient and the upper body becomes replete.  There will be frequent tearing and nasal discharge”. This expounds that the body will undergo a series of changes due to the yīn essence and yàng qì depletion.

7、阴阳失调 阴阳的盛衰是决定寿命长短的关键,保持阴阳运动平衡状态是延年益寿的根本。《素问·阴阳应象大论》中就明确指出人的衰老 同阴阳失调有关,即“能知七损八益,则二者可调,不知用此,则早衰之节也”。可见,阴阳失调能导致衰老,而调节阴阳就有抗衰老的作用,人到中年以后,由于 阴阳平衡失调,机体即可受到各种致病因严的侵袭,从而疾病丛生,出现衰老。

  1. Yīn Yàng Disharmony

The exuberance or debilitation of yīn and yàng is the key to one’s life span. Maintaining a balanced state within the movements of yīn and yàng is at the root of prolonging life. “Plain Questions: Great Treatise on the Correspondences and Manifestations of Yīn and Yàng clearly points out that aging has a direct relationship with the disharmony of yīn and yàng. It states, “If the sevenfold reduction and eightfold boost is realized, yīn and yàng can be regulated; ignorance of this will lead to premature senility”. It can be seen that a yīnyàng disharmony can lead to aging, and harmony between yīn and yàng can resist aging. Because of a yīnyàng disharmony, middle-aged people are susceptible to the attack of various diseases, which further results in aging.

二、早衰的原因

(一)社会因素

《素问·疏五过论》指出:“故贵脱势,虽不中邪,精神内伤,身必败亡”。由于社会地位的急剧变化,会给人带来精神和形体的衰老。

现 代医学研究表明,很多精神疾病和躯体疾病,都与激烈的竞争,过度紧张的社会生活有直接关系,如美国综合医院门诊部对病人进行随机研究,发现65%的病人, 与社会逆境、失业、工作不顺利、家庭不和等因素有关。不合理的社会制度、恶劣的社会习俗、落后的意识形态,以及人与人之间种种斗争矛盾等,都可使人体代谢 功能紊乱,导致早衰。

II.  Reasons of early aging.

  1. Social factors

“Plain Questions: Treatise Explaining the Five Errors” points out, “When high-ranking officials lose their power, even without contraction of evil, their spirits will be internally damaged and their bodies are bound to be destroyed”. This illustrates that drastic changes within social positions can influence premature aging in both body and spirit.

Modern medical research has proved that many diseases, mentally and physically, are directly related with intense competition and excessive stress. According to the statistics by an American general hospital outpatient clinic, 65% of patients are associated with factors such as adverse social circumstances, unemployment, work conflicts, family disharmony, etc. Unreasonable social systems, contemptible social customs, regressive ideologies, and various conflicts amongst people can cause metabolic disorders that lead to premature aging.

二,自然环境

《素问·五常政大论》中指出:“高者其气寿,下者其气夭”。高,是指空气清新,气候寒冷的高山地区;下,是指平原地区。因为“高者气寒”,生物生长缓慢,生长期长,寿命也就长。而“下者气热”,生物生长较快,寿命就相应短促。

现 代研究认为,自然环境对人体健康影响很大。当有害的环境因素长期作用于人体,或者超过一定限度,就要危害健康,促进早衰。如空气污染造成空气中过氧化物增 加,衰老是和体内过氧化脂质的生成同时发展的。此外,污染的空气中可含有功多的致癌物质,如苯胼蓖、朕苯胺、α-萘胺等。有些工业废水上百万吨倾入江湖, 以致出现鱼类大量死亡;严重水污染造成人慢性铅、砷、镉中毒等。

  1. Natural environment

Plain Questions: Great Treatise on the Five Normal Rules” points out, “Those who live in high places have longer life; those who live in low places have shorter life”. High places refer to the high mountainous areas where the air is fresh and the climate is cold; low places refer to the plains. Because “it is cold in high places”, living beings will have a slower and longer growth  period, and thus will have prolonged life. Because “it is hot in low places”, living beings will mature more rapidly and thus have a shorter life span.

According to modern research, the natural environment has a tremendous influence on the health of the human body. It can be harmful to one’s health if one endures detrimental environmental factors for an extended amount of time or exceeds certain limits. For example, while air pollution increases peroxide levels, ageing takes place with the generation of lipid peroxidation. Furthermore, polluted air may contain large amounts of carcinogens, such as benzopyrene,benzidine,and α-naphthylamine。Millions of tons of industrial waste water is dumped into the rivers and lakes, which results in the death of multitudes of fishes. Serious water pollution can lead to chronic lead, arsenic and cadmium poisoning, plus others.

三,遗传因素

大量事实证明,人类的衰老和遗传有密切关系, 因遗传特点不同,衰老速度也不一样。正如王充在《论衡·气寿篇》中所说;“强寿弱夭,谓禀气渥薄也……夫禀气渥则其体强,体强则寿命长;气薄则其体弱,体 弱则命短,命短则多病寿短”,“先天责在父母”,先天禀赋强则身体壮盛,精力充沛,不易变老。反之,先天禀赋弱则身体憔悴,精神萎靡,变老就提前或加速。

  1. Hereditary factors

A host of facts indicate that aging is closely related to hereditary factors. The rate of aging varies due to different hereditary characteristics. As Wángchōng says in “Lùn Héng: Treatise on Life Span”, “If the body is strong, the life is longer; if the body is weak, the life is shorter. This depends on how much  one has been endowed …the body is strong with more , which results in a longer life; the body is weak with less , which results in a shorter life”, “all these are congenitally decided by the parents”. If the natural endowment is strong, the body is strong and energetic; if the natural endowment is weak, the body is weak and the spirit is dejected, and thus the aging process arrives early.

四,七情太过

此 指长期的精神刺激或突然受到剧烈的精神创伤,超过人体生理活动所能调节的范围,就会引起体内阴阳气血失调,脏腑经络的功能紊乱,从而导致疾病的发生,促进 衰老的来临。我国民间有“笑一笑,十年少”,“愁一愁,白了头”的谚语,就是这个道理。正如《吕氏春秋》中所说的:“年寿得长者,非短而缓之也,毕其数 也。毕数在乎去害。何谓去害?……大喜、大恐、大忧、大怒、大衰,五者损神则生害矣”。

  1. Excess of the seven affects

Long-term mental stimuli or a sudden traumatic experience, if exceeding the range the human body’s regulatory capabilities, will lead to the disharmony of yīn, yàng , , and blood, plus the functional disorder of the viscera and channels, and thus result in illness and ageing. There is a popular saying in China that “laughter can make people ten years younger”, “Worry can make people’s hair turn gray”. “Lǚ’s Spring and Autumn” says, “Long life means being able to live out one’s full span instead of trying to prolong a short life. The key to living one’s full span is to get rid of harm. How can one rid the self of harm?  Excessive joy, fear, worry, anger, and sorrow, these five can injure one’s spirit and produce harm”.

五,劳逸失度

《素问·上古天真论》曰:“以妄为常……故半百而衰也”,这里明确指出,把妄作妄为当作正常的生活规律,只活到五十岁就已显得很衰老了。所谓妄作妄为,是指错误的生活方式,它包括范围很广,如劳伤过度,房劳过度,过于安逸等等。

  1. ­Imbalance of work and rest

Plain Questions: Treatise of Heavenly Truth from Remote Antiquity” says, “Taking an irregular life as normal, that’s why the present people become old and feeble at the age of 50”. “Taking an irregular life as normal” refers to the living an improper life style, which includes many aspects, such as damage from over exertion, excessive sexual taxation, or excessively easy and comfortable living, etc.

施今墨的降血压十法 - SHI Jin-mo’s 10 methods for reducing blood pressure

Translated by XU Zhi-jun & J. Heaverlo

高血压是以特续性动脉压增高为主要表现,久而久之,可导致心,脑,肾等重要器官损害,其临床病状归于祖国医学“眩晕”,“头痛”病的范畴。其病因复杂,尤其与精神因素(忧思,恼怒等)关系密切,此外,禀赋不足,脏腑虚损,饮食劳卷等诸多因素均可引起阴阳失调,气血紊乱,络道不畅,血脉瘀滞。为了提高生活质量,健康长寿,务必降低血压,使其维持在一定的水平甚为重要。施今墨将降压之法概括为十法,分述如下.

The chief manifestation of high blood pressure is a continued elevation of arterial blood pressure.  Over time, this can lead to damage of the heart, brain, and kidneys, as well as other vital organs.  Its clinical symptoms belong to the Chinese medicine category of “dizziness” and “headache”.  The disease etiology is complex, especially when psychological factors (such as anxiety and anger) are intimately related.  In addition, natural endowment insufficiency, zàng fǔ organ vacuity and damage, exhaustion of food and drink, plus many other factors can lead to yīn yáng imbalance, qì and blood disorder, and blood stasis of the luò pathways.
In order to enhance the quality of life, health and longevity, it is necessary to lower the blood pressure and important to maintain a certain level.  Below is a summary of  SHĪ Jīnmò’s ten methods for reducing (blood) pressure.

(一)苦寒降压法
肝胆火旺,炎至于上,气血沸腾,并走于脑,遂有头疼如裂,青筋怒张,面红耳赤,烦热易怒,大便硬结,小便短赤,舌红,苔黄腻。治宜清肝泻火,苦寒折逆。方用三黄石膏汤,龙胆泻肝汤。药用黄芩,黄连,知母,生石膏,槐花, 蔚子,夏枯草,知母,黄柏等。

(1) Method of using bitter and cold medicinals to reduce pressure

Use bitter and cold medicinals when there is liver and gall bladder effulgent fire, upward flaring fire, qì and blood seething upward towards the brain.  Hence, there will be splitting headaches, sudden distention of veins, red complexion and ears, easy to anger, heat vexation, bowels which are hard and bound, urination that is short and dark colored, tongue that is red with a thin, yellow coating.
The appropriate treatment is to the drain liver and gall bladder with bitter and cold medicinals.  The exemplar formulas are sān huáng shí gāo tāng, and lóng dǎn xiè gān tāng.  The medicinals used are huáng qín, huáng lián, zhī mǔ, shēng shí gāo, huái huā, wèi zi, xià kū cǎo, zhī mǔ, huáng bǎi.

(二)调气降压法
按“气为血之师,血随气行,行有一息之不运,血有一息之不行”之理,运用降气,顺气之法亦是降压有效治法。方用旋覆花,代赭石,桔梗,枳壳,杏仁,薤白,佛手,香橼等。

(2)  Regulate the qì to reduce blood pressure

It is said that “qì is the commander of the blood, when qì moves blood moves, when qì stops  blood stops”.  To regulate the qì is an effective method for treatment.  Medicinals used are xuán fù huā, dài zhě shí, jié gěng, zhǐ ké, xìng rén, xiè bái, fó shǒu, xiāng yuán.

(三)息风降压法
适用于肝风内动,眩晕面赤,烦躁不宁,夜卧不安。治宜熄风降压。方用天麻够腾饮。药用够腾,天麻,槐花,菊花,羚羊角,水牛角等。

(3)     Extinquish wind to reduce blood pressure

This method is appropriate for use with liver wind internally stirring, with dizziness and a red complexion, vexation and agitation, restlessness, and inability to rest in the evening.
The appropriate treatment is to extinguish wind to reduce the blood pressure.  The exemplar formula is tiān má gòu téng yǐn.  Medicinals used include gòu téng, tiān má, huái huā, jú huā, líng yáng jiǎo, shuǐ niú jiǎo.

(四)镇逆降压法
适用于肝阳亢盛,血压甚高,头脑血管过于充盈诸症。治宜贝石重镇之品,以引血下行。方用镇肝熄风汤等。药用紫贝齿,紫石英,青龙齿,石决明,磁石,铁落,珍珠母,磁朱丸等。

(4) Settle counterflow to reduce blood pressure

This method is appropriate to use when there is liver yáng exuberance.  The blood pressure will be exceedingly high and the blood vessels of the head are excessively full.  The correct method of treatment is to select stones and heavy substances to settle, thereby, leading the blood downward.
The exemplar formula is zhèn gān xí fēng tāng.  Medicinals used are zǐ bèi chǐ, zǐ shí yīng, qīng lóng chǐ, shí jué míng, cí shí, tiě luò, zhēn zhū mǔ, cí zhū wán.

(五)化痰降压法
痰浊中阻,升降失常,眩晕头痛,头胀如裹,胸膈满闷,肢体麻木,言语不利,呕吐痰涎,苔白腻,脉弦滑。治宜和胃降浊,化痰降压。方用半夏白术天麻汤,十味温胆汤。药用半夏,竹茹,茯苓,白术,橘皮,远志,菖蒲,枳实,胆南星等。

(5)    Transform phlegm to reduce blood pressure

Transform phlegm to reduce blood pressure when there is turbidity obstructing the center causing abnormal upbearing and downbearing, dizziness, headaches, distention headaches as if bound, chest and diaphragm fullness and oppression, numbness of the limbs, inhibited speech, and vomiting of phlegm.  The tongue coating will be white and greasy.  The pulse will be bowstring and slippery.
The appropriate treatment is to harmonize the stomach, descend turbidity, and transform phlegm to reduce the blood pressure.  The exemplar formulas are bàn xià bái zhú tiān má tāng, and shí wèi wēn dǎn tāng.  Medicinals used are bàn xià, zhú rú, fú líng, bái zhú, jú pí, yuǎn zhì, chāng pú, zhǐ shí, dǎn nán xīng.

(六)滋阴降压法
肝肾阴虚,水不涵木,肝阳上扰,血随气升,血压增高。治宜滋阴降压。方用知柏地黄汤,杞菊地黄汤。药用枸杞子,菊花,白蒺藜,沙苑子,女贞子,旱莲草,知母,黄柏,生熟地,砂仁,杜仲,怀牛膝等。

(6) Enrich the yīn to lower blood pressure

When there is liver and kidney yīn vacuity, water will not be able to moisten wood and liver yáng will rise to harass the upper body.  The blood will follow the ascension of the qì thereby causing the blood pressure to increase.  The appropriate treatment is to enrich the yīn to decrease the blood pressure.  The exemplar formulas are zhī bǎi dì huáng tāng and qǐ jú dì huáng tāng.  Medicinals used would be gǒu qǐ zi, jú huā, bái jí lí, shā yuàn zi, nǚ zhēn zi, hàn lián cǎo, zhī mǔ, huáng bǎi, shēng shú dì, shā rén, dù zhòng, huái niú xī.

(七)通便降压法
适用于实热内积,升降失常(清阳不升,浊阴不降),腑行不畅。治宜通调腑气,泻热降压。方用承气汤。药用生川军,芒硝,瓜蒌,风化硝,枳实,厚朴,晚蚕砂,炒皂角子等。

(7) Open the bowels to reduce blood pressure

This method is appropriate for replete heat internally accumulating with abnormal upbearing and downbearing (the clear yáng will be unable to ascend while the turbid yīn will not be able to descend)  the bowels, therefore, will become blocked.
The appropriate treatment would be to open and regulate the bowel qì, drain heat to descend the blood pressure.  The exemplar formula would be chéng qì tāng.  Medicinals used are shēng chuān jūn, máng xiāo, guā lóu, fēng huà xiāo, zhǐ shí, hòu pǔ, wǎn cán shā, chǎo zào jiǎo zi.

(八)利水降压法
适用于气血紊乱,久久不愈,以致水液代谢障碍,兼见下肢水肿。治宜利水降压。方用真武汤,五苓散,二草丹。药用猪苓,冬瓜皮,冬瓜字,车前子,车前草,旱莲草,赤茯苓,赤小豆等。

(8) Disinhibit water to reduce blood pressure

This method is appropriate when the qì and blood have become chaotic with prolonged recovery.  Therefore, the water and fluids will become obstructed.  There will be concurrent lower limb swelling.  It is appropriate to disinhibit water to reduce blood pressure.  The exemplar formula is zhēn wǔ tāng, wǔ líng sàn, or èr cǎo dān.  Medicinals used are zhū líng, dōng guā pí, dōng guā zì, chē qián zi, chē qián cǎo, hàn lián cǎo, chì fú líng, and chì xiǎo dòu.

(九)通络降压法
络脉以通为顺,高血压之人,多有络脉不活之征,俗云:“久病入络”即是明证。治宜通络降压。方用六藤煎等。药用够藤,忍冬藤,海风藤,络石藤,青风藤,鸡血藤,桑寄生,桑枝,丝瓜络,炮甲珠等。

(9) Open the luò vessels to decrease blood pressure

The luò vessels can flow smoothly when they are unobstrcuted .  Among high blood pressure patients, many have improper circulation of the luò vessels.  It is said: “chronic disease enters the luò vessels”, (here) this is evident.  The appropriate treatment is to open the luò vessels to descend the (blood) pressure.  The exemplar formula is Six Vine Decoction (liù téng jiān).  The medicinals used are gòu téng, rěn dōng téng, hǎi fēng téng, luò shí téng, qīng fēng téng, jī xuè téng, sāng jì shēng, sāng zhī, sī guā luò, and pào jiǎ zhū.

(十)活血祛瘀降压法
高血压晚期多有血脉瘀滞征象,治宜活血祛瘀降压。方用血府逐淤汤等。药用桃仁,红花,当归,川芎,丹参,葛根,茺蔚子,夏枯草等。

(10) Quicken the blood and expel stasis to decrease blood pressure

In the later stages of high blood pressure many (patients) will exhibit signs of stasis in the blood vessels.  The appropriate treatment is to quicken the blood and expel stasis to reduce the blood pressure.  The exemplar formula is xuè fǔ zhú yū tāng.  The medicinals used are táo rén, hóng huā, dāng guī, chuān xiōng, dān shēn, gé gēn, chōng wèi zi, and xià kū cǎo.

加减法:眩晕加白薇汤(当归,党参,白薇,甘草);欲作中风者,加天麻,够藤,菊花,地龙;失眠,证属心肾不交者,加远志,菖蒲,酸枣仁,液交藤;心悸,心动过速者,加朱砂,琥珀,珍珠母,紫石英,仙鹤草,卧蛋草;心前区疼痛者,加檀香,降香,丹参,三七,蒲黄,五灵脂,蜈蚣,全蝎,乳香,没药等。

Methods for additions and subtractions:  If there is dizziness add bái wēi tāng (dāng guī, dǎng shēn, bái wēi, gān cǎo); if treating wind stroke add tiān má, gōu téng, jú huā, dì lóng; if there is insomnia and the pattern belongs to heart and kidney not communicating add yuǎn zhì, chāng pú, suān zǎo rén, yè jiāo téng; if there is palpitations or tachycardia, add zhū shā, hǔ pò, zhēn zhū mǔ, zǐ shí yīng, xiān hè cǎo, wò dàn cǎo; if there is precordial pain add tán xiāng, jiàng xiāng, dān shēn, sān qī, pú huáng, wǔ líng zhī, wú gōng, quán xiē, rǔ xiāng, mò yào.