叶天士在《临证指南医案》中提出“通胃阳”一说，以升降为契机，燮理阴阳。叶氏继承了《黄帝内经》和《伤寒杂病论》的学术思想，在临床上主张“治胃与脾迥别”，治脾宜燥宜升，治胃宜润宜通。在用药上叶氏指出“非半夏之辛、茯苓之淡，非通剂矣”，故其常以辛味药如半夏、生姜、厚朴、枳实等，淡味药如荷叶、茯苓、竹茹等作为通阳用药。茯苓在《临证指南医案》中共出现1058次，是叶天士“通胃阳”学说中重要的一味药物，善通胃阳，引阳入阴。叶氏通过不同气味配伍，无论甘凉濡润、辛热开浊通阳，亦或温润柔剂、淡渗通阳，均配以茯苓才能达到通胃阳之功效。研究旨在对其理论内涵及临床用药规律的初步探讨，以期为临床实践提供参考。%YE Tianshi in the Medical Records for Clinical Guidance ,put forward“Tong gastric yang” ,to lift as an opportunity to yin and yang .YE inherited the Canon of Internal Medicine and Treatise on Febrile Diseases of academic ideas ,clinically advocates“cure the stomach and spleen” and treat spleen should be dry and well ,cure the stomach should be smooth and well .On medication YE pointed out that “is not the sheen of pinellia ,poria cocos light ,not through agent yi” ,it often in symplectic herbs such as pinellia ,ginger ,magnolia bark ,acid-insoluble ash ,mild drugs such as lotus leaf ,tuckahoe ,tong Yang drugs such as bamboo shavings .Poria was used 1 058 times in Medical Records for Clinical Guidance as a kind of bland traditional Chinese medicine for removing dampness by promoting diuresis .Yetianshi advanced the theory of diffusing and Obstruction-removing Gastric Yang in Medical Records for Clinical Guidance and advocated“treating stomach and spleen in different ways” .The academic idea that poria Diffuses and Obstruction-removes gastric yang is based on Ye’s theory .The study tried to introduce the background of the idea and gave readers some advice of its clinical application .
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