明代醫家薛己補益脾胃相關方劑之探討

Discussion on the Prescriptions Related to the Replenishing of the Spleen and Stomach by Xue Ji, a Ming Dynasty Physician

薛己臨症用藥強調脾胃，其補益脾胃方劑中較常用的方劑分別為補中益氣湯、六君子湯、歸脾湯，本文旨在分析其用方之思路及其在中醫發展史中的繼承與發展。補中益氣湯原用於治療內傷發熱，薛己拓展補中益氣湯的應用於所有勞傷元氣的證候，以及脾胃損傷的證候。六君子湯原用於治療痰挾氣虛所致之呃逆，薛己拓展其應用於脾胃虛弱，或停食等相關證候；歸脾湯原用於治療因思慮過度，而致勞傷心脾，因而出現健忘怔忡之症狀，薛己拓展其應用範圍，只要是思慮過度所致之種種症狀皆能應用。薛己延續了金元醫家對於內傷疾病的探討，對於勞倦、飲食、情志鬱結所致之內傷，分別以前述三方作為主方。較特殊之處是薛己以「滋化源」作為核心的焦點，淡化了氣機升降之角色，脾胃為化源之基礎，故處方用藥多由補益脾胃入手。薛己消化了金元醫家的理論，並推廣應用，從「滋化源」的角度處理內傷問題。這對於後世溫補法有諸多啟發，薛己可謂在溫補學派中扮演了承上啟下的角色。

Xue Ji, a Ming dynasty physician prescribed medications that targeted symptoms that mainly occur in the spleen and stomach. Most of his spleen and stomach formulas came in the form of Center-Supplementing Qi-Boosting Decoction, followed by those in the form of Six Gentlemen Decoction and Spleen-Returning Decoction. The present study explored the rationale behind Xue’s prescriptions and how these prescriptions have been adopted and developed throughout the history of traditional Chinese medicine. Center-Supplementing Qi-Boosting Decoction is used to treat internal damage-related heat. Xue extended the application of the decoction to all patterns of taxation damage to the original qi.Six Gentlemen Decoction indicates that the decoction can be used to treat qi vacuity-induced hiccups. Building upon this application, Xue began prescribing the decoction for patterns such as spleen–stomach vacuity and stagnation of food Spleen-Returning Decoction can be used for treating forgetfulness and fearful throbbing resulting from taxation damage to the heart and spleen induced by excessive thought and preoccupation. Xue then extended the decoction’s use to treating a wide range of symptoms attributable to binding depression associated with excessive thought and preoccupation. Inspired by Jin dynasty physicians Li Gao and Zhu Zhenhen’s investigations of internal damage, Xue widened and deepened the applications of the three formulas as primary formulas for treating internal damage caused by taxation fatigue, dietary habits, and emotional binding depression. Unlike Li and Zhu, Xue shifted his focus away from the practice of upbearing and downbearing the qi dynamics. Most of Xue’s prescriptions supplemented the spleen and stomach because the spleen is underly the source of transformation. Xue heightened the importance of the spleen and stomach among the five viscera and centered his treatment around them. These contributions led to Xue becoming an essential figure in the history of traditional Chinese medicine.