尉中民应用旋覆花汤治疗内伤杂病经验

刘慧兰1，王彤 2，周刚 2，高雅2，指导：尉中民 2

1.北京中医药大学第三附属医院，北京 100029；2.北京中医药大学中医学院，北京 100029摘要：尉中民教授临证治疗内伤杂病善于妙用旋覆花汤，认为疾病久治不愈入络，导致络脉瘀阻不通之证，可用旋覆花汤以散郁行气、通络化瘀。旋覆花汤一可行气助肺、宣发肃降，二可助心行血、合脉止痹，三可疏肝健脾、和胃止痛，四可疏肝理气、化痰祛瘀。临证灵活加减用药，每于内伤杂病治疗中取得满意效果。关键词：名医经验；尉中民；旋覆花汤；行气理血

DOI：10.3969/j.issn.1005-5304.2017.11.024

中图分类号：R249.8 文献标识码：A 文章编号：1005-5304(2017)11-0101-03

Experience of Professor WEI Zhong-min in Treating Internal Diseases by Application of Xuanfuhua Decoction

LIU Hui-lan1, WANG Tong2, ZHOU Gang2, GAO Ya2, Instructor: WEI Zhong-min2 (1. The Third Affiliated Hospital to Beijing University of Chinese Medicine, Beijing 100029, China; 2. Basic Medicine College, Beijing University of Chinese Medicine, Beijing 100029, China)

Abstract: Professor WEI Zhong-min is good at the application of Xuanfuhua Decoction to cure internal diseases in the clinical treatment. She considers that refractory diseases can lead to collateral stasis or obstruction and Xuanfuhua Decoction has the efficacy of promoting qi and blood circulation and stimulating circulation to end stasis. Xuanfuhua Decoction can promote the circulation of qi by stimulating lung, activating blood circulation by tonifying heart, dispersing the stagnation of the liver and strengthening the spleen to relieve pain, regulating qi to dissipate blood stasis and phlegm. Xuanfuhua Decoction is extremely effective for internal diseases through adding or subtracting prescription in the clinical treatment.

Key words: experience of famous doctors; WEI Zhong-min; Xuanfuhua Decoction; promoting qi and blood and circulation

北京中医药大学尉中民教授是第五批国家级名老中医，尊崇经典，尤其以《金匮要略》为临床内伤杂病证治之准绳，从医 40 多年来，对心血管、消化系统、呼吸系统、妇科疾病及内伤杂病有丰富的临床经验，善用经方，疗效显著。笔者随师学习多年，受益匪浅，现将尉教授应用经方旋覆花汤治疗内伤杂病的学术经验总结如下。

1 旋覆花汤

旋覆花汤出自《金匮要略•五脏风寒积聚病脉证并治》“肝着，其人常欲蹈其胸上，先未苦时，但欲饮热，旋覆花汤主之”及《金匮要略•妇人杂病脉证并治》“寸口脉弦而大，弦则为减，大则为芤……妇人则半产漏下，旋覆花汤主之”。肝经布于两胁而络 基金项目：国家自然科学基金青年基金（81303082） 于胸，邪气入肝，气血郁滞，血着不行，由气入血，而为肝着。肝着初起时重按揉胸，借饮热水，助胸胃之阳开肝着之气，可缓胸中胀痛之感；芤脉、革脉为虚寒相搏之复合脉，虚寒导致的妇人半产漏下，半产之后有瘀滞，出现漏下不止，可用旋覆花汤化瘀散结理血以止漏下。此方以旋覆花为主药，伍新绛、葱。旋覆花咸温，虽具轻灵之性，唯其性独降，善通肝络，降胸中逆气，散结下气，散寒行水；新绛，陶弘景称为茜草，味苦辛性微温，入厥阴血分，可行血散瘀；葱辛温发散，行经络血气，通阳散结。全方具有疏肝散结、宣通络脉、痰消瘀化之功，药简力专，被后世尊为治疗络病之祖方。

尉教授认为，《金匮要略》言旋覆花汤可治肝着及妇人半产漏下之证，然此方实为针对肝络瘀滞、气机不畅之证，行气化瘀而不峻烈，作用温和而不伤正，