Buzhong Yiqi Decoction was first created by Li Dongyuan, and was highly praised by later doctors. Zhang Jingyue, a physician in Ming Dynasty, commented: "Buzhong Yiqi Decoction is a unique method of Li Dongyuan." Nowadays, there are fewer doctors who make good use of Buzhong Yiqi Decoction, and doctors who have just entered the clinic often feel that "failure is more than success" when using Buzhong Yiqi Decoction. Why? Re-understanding Buzhong Yiqi Decoction and re-examining Li Dongyuan's Buzhong Yiqi Decoction may be beneficial to clinic.
Syndrome differentiation and classification: the treatment of internal injury of spleen and stomach begins with light dose and little effect. It can be seen that Buzhong Yiqi decoction is a "primary syndrome" in treating internal injury of spleen and stomach after reading the theory of distinguishing confusion from internal injury and the theory of spleen and stomach, and its clinical manifestations can be similar to those of exogenous wind-cold syndrome. Its causes are "improper diet, cold and discomfort" and "anger and anxiety, overwork". The pathogenesis is "Qi deficiency of spleen and stomach, then it flows down to kidney and liver, and yin fire can occupy its soil position." The principle of treatment is that "those who work are warm and those who suffer are warm" as mentioned in Neijing, and the specific treatment method is "only using warm drugs to supplement it, yang qi can rise, and fire is cold." Astragalus membranaceus is definitely used the most in the prescription, but only five points are used, one for those who are seriously ill and three for other medicines. Converted into modern dose, the total dose of one dose is only about 10g. The administration method is "warm after breakfast".
Radix Astragali and Radix Glycyrrhizae Preparata are compatible with Cimicifuga and Bupleuri Radix.
, focusing on "real appearance", "don't sweat, damage its vitality"; Ginseng and roasted licorice focus on "strengthening the spleen and regulating the stomach"; Atractylodes macrocephala uses both its sweetness and bitterness; Orange peel "guides the air",
Angelica wine washes "blood"
Pulse condition identification: the number of right pulses is greater than that of left pulses, and it is medium.
Li Dongyuan attaches great importance to pulse diagnosis in clinic, and lists "pulse diagnosis" as the first important point to distinguish exogenous internal injuries, and thinks that pulse diagnosis is enough. "Isn't this distinction obvious?" "On Internal Injury and Trauma" lists the symptoms again because "but I'm afraid there is no doctor in Shan Ye, so why should I wait for a diagnosis? Therefore, I will repeat the symptoms to distinguish them. "
Li Dongyuan mentioned in "Analysis of Pulse Conditions" that "the pulse condition of right cunkou is twice that of human face, the pulse condition of wound is twice that of Shaoyin and three times that of Taiyin, which is the pulse condition of internal injury diet." "If you don't eat well, you are overworked ..... your mouth is sharp and your pulse is astringent" and so on. Although the description of the pulse here seems messy, there is an obvious feature, that is, the right pulse is larger than the left pulse, or the spleen pulse is larger than the pulse in other parts, so you can "count slowly" when you see the pulse. This has important clinical significance for the use of Buzhong Yiqi Decoction.
In addition, Li Dongyuan discussed from the opposite side that some pulse conditions should not be treated with Buzhong Yiqi Decoction. In the "Four Seasons of Medicine", it is mentioned in the treatment of abdominal pain that Xiaojianzhong Decoction should be used because the pulse string is impassable; The pulse is heavy and thin, so it is advisable to use Lizhong decoction; Slow pulse is not available, but Wei Ping powder should be used. It is simple and practical to identify prescriptions and syndromes from pulse conditions.
It can be seen from Li Dongyuan's works that Buzhong Yiqi Decoction has a wide range of indications, and both internal injuries and exogenous diseases can be treated. The addition and subtraction of prescription drugs (mainly adding drugs) is extremely flexible, and tonics, laxatives, cold medicines and hot medicines can be added, regardless of the pattern. However, there is a constant root in all kinds of changes, that is, the indication can only be "internal injury" (exogenous diseases are also exogenous diseases based on internal injuries), and the disease pulse mainly appears in the right pass, and the main disease position of the disease is the spleen and stomach.
Addition and subtraction: it is easy to break if you don't understand the original intention.
Zhang Rubik's Cube is "not designed to cure diseases, but to teach people more than to prove the Rubik's Cube, which is easy to be familiar with". As a disciple of Zhang, I was deeply influenced by it. All recipes are "from the right", that is, the method of teaching people cubes is emphasized, rather than teaching others the so-called effective recipes and proven recipes. There are a series of addition and subtraction methods and large-scale "four-time drug addition and subtraction" after Buzhong Yiqi Decoction, which shows that this prescription cannot be implemented and used flexibly.
According to the prescription, the syndrome of Buzhong Yiqi decoction should be neutral in the mouth, which means that it is not necessary to use Buzhong Yiqi decoction with caution because of dry mouth and throat. But Li Dongyuan's first addition and subtraction was actually "thirsty". Qi deficiency should be warmed, real fire should be bitter and diarrhea should be clear, and Li Dongyuan's second addition and subtraction turned out to be Buzhong Yiqi Decoction, Cortex Phellodendri for purging bitter and cold fire, and Radix Rehmanniae for clearing fire and Han Gan.
. Reflecting on its treatment, the original prescription of Buzhong Yiqi Decoction only contains the product of "Buzhong Shengyang" and lacks the medicine of "purging fire". It seems that adding Cortex Phellodendri and Radix Rehmanniae becomes a complete Buzhong Yiqi decoction for treating internal injuries of spleen and stomach.
Later doctors used Buzhong Yiqi Decoction to add and subtract compatibility, and the flexibility was far less than that of Li Dongyuan. On behalf of the addition and subtraction, Buzhong Yiqi Decoction plus Poria Pinellia, Buzhong Yiqi Decoction plus Liuwei Dihuang Pill. Reading Xue's medical records and Shou Shi Bao Yuan can be seen everywhere.
Deficiency of spleen and stomach, phlegm dampness and depression, Poria cocos and Pinellia ternata should be added; Buzhong Yiqi decoction treats "qi deficiency of spleen and stomach", Liuwei Dihuang pill treats "kidney water is true and yin is weak", and "both sides are beneficial, which is the agent of king harmony", and the combination seems to be extremely ingenious. However, judging from Li Dongyuan's cube origin, there are more Poria cocos and Pinellia ternata, and Liuwei Dihuang Pill falls into the lower coke, which is not conducive to "ascending its yang". It can be seen that if you don't understand Dong Yuan's original intention, it is easy to add or subtract at will.
Misuse can easily lead to bad things, so later the doctor mentioned the contraindications of Buzhong Yiqi Decoction. For example, Zhang Jingyue said: "Yuan Qi is extremely inadequate and cannot be vented; Those who exhaust yin and yang cannot rise. " Ke Qin said: "Not suitable for kidney, not suitable for yin deficiency, not suitable for yang deficiency." These expositions are extremely useful to the clinical practice of post-scholars. However, from the perspective of Li Dongyuan's "cubic reference", this is only a low-level and formal understanding.
In fact, kidney deficiency can be treated with Buzhong Yiqi decoction in spleen and stomach internal injury syndrome, but the ups and downs should be considered when taking medicine.