基于相火理論探討膽石癥發病機制及防治

姚彩娟　孫理軍　李翠娟　佟雅婧

摘要：臨床上，膽石癥多因飲食不節、情志不暢、體質差異等引起相火妄動而離位，致肝郁氣滯，濕熱蘊結，肝腎不足。其治療以實現“相火安位”為目的，以“引火歸元”為原則，本文分別從疏肝理氣、調暢情志，清利濕熱、調理肝脾，滋補肝腎、補益精血三方面論治加以闡述。相火安位，則氣機調和，臟腑功能正常。

關鍵詞：膽石癥;相火;中醫病機;辨證論治

中圖分類號：R269.574.2??? 文獻標識碼：A??? 文章編號：1005-5304（2020）01-0106-03

DOI：10.3969/j.issn.1005-5304.201810339

Discussion on Pathogenesis and Prevention and Treatment of CholelithiasisBased on Ministerial Fire Theory

YAO Caijuan， SUN Lijun， LI Cuijuan， TONG Yajing

Shaanxi University of Chinese Medicine， Xianyang 712046， China

Abstract： Clinically， cholelithiasis is often due to improper diet， bad mood， physical differences and other reasons， causing the off-position of ministerial fire. It can lead to liver-qi stagnation， dampness-heat accumulation， and liver-kidney deficiency. TCM treatment is under the principle of “igniting fire to the original place” to achieve the goal of “setting ministerial fire in the place”. This article expounded from the three aspects of soothing liver and regulating qi to regulate emotion， clearing away dampness and heat to regulate liver and spleen， and nourishing liver and kidney to tonify blood. Igniting fire to the original place would lead to the balance of qi and normal function of organs.

Keywords： cholelithiasis; ministerial fire; TCM pathogenesis; syndrome differentiation and treatment

膽石癥是由膽汁成分異常、膽道運動功能失調導致以右上腹或右脅痛、右肩部放射痛，惡心、厭油膩、納呆、口苦等為主要癥狀的臨床常見疾病，其病程較長，膽內結石長期刺激膽道和腸道，可誘發急性膽管炎、急性膽源性胰腺炎，甚至穿孔。目前，腹腔鏡膽囊切除術被認為是膽結石現代醫學治療的“金標準”，但術后有右上腹痛、餐后腹瀉、消化不良、膽道感染甚至梗阻為主癥的膽囊切除術后綜合征^[1]。本病屬中醫學“脅痛”“黃疸”“膽脹”等范疇。結石既是病理產物也是致病因素。既可以是原發性，又可繼發于肝膽疾病。高峻^[2]提出相火亢進及妄動是諸內生邪火的本質。《血證論》有“肝為風木之臟，膽寄其中，膽為相火，木生火也”，表明本病多源于火與熱，動以生熱，熱以化火。《類證治裁·肝氣篇》說：“且相火

附木，木郁化火……故諸病多自肝來，以犯中宮之土，剛性難馴。”茲以相火理論為基礎，探討膽石癥與相火關系、發病機制及相關預防，以期為臨床診療提供思路。

1? 相火致病學說