一个二十多岁的台湾小伙子本来是到诊所调理其他问题，但他今天来的第一句话就是：大夫，我前几天聚餐吃辣有点多，窜稀啦，老得往厕所跑。我摸完脉，问他：你是不是暴饮暴食吃多了？可不只是吃辣那么简单哦。另外，有没有胸闷或心脏不舒服。他回答说：大夫，神了啊，昨天有心脏忽然抽痛一次，胸闷倒没有。我说，你先吃一剂“泻药”，然后再跟我反馈。<\/p>\n
当天下午，就收到他的微信说：我开始胸闷了。我说：先吃药吧。过了两天再问，拉肚子好了，胸闷也没有了。<\/p>\n
我给他的“泻药”是大承气汤。大承气汤一般是用来治疗阳明腑实证，多日排不下大便的情形，攻下之力很强，为什么还可以止泻呢？伤寒论云：“阳明少阳合病，必下利…脉滑而数者，有宿食也，当下之，宜大承气汤。” 也就是说，虽然病人苦下利，但脉是滑而数的，代表肚子里面有积滞。这个时候不能光想着止泻，把宿食排下去，下利自然就止了。<\/p>\n
这个患者虽然自己说是吃辣椒导致的腹泻，但脉象右关沉滑有力，显然脉证揭示了病机，故而一投得效。至于胸闷和心脏不适，都是因为中焦瘀堵导致的气机不畅，亦从脉中显现。病机解除了，这些附带的症状也就烟消云散了。<\/p>\n
以泻止泻其实是中医的重要治疗原则之一。除了下利之外，还有其他很多场景适用这个原则。比如，妇科的崩漏如果是由瘀血导致的，也必须先用下法祛除瘀血，才能真正止血。<\/p>\n
<\/p>\n
注意：中医根据个体差异所采取的治疗手段和治疗效果亦有差异，医案分享不构成治疗建议。<\/p>\n
医案编号：088<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
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