基于罗天益“饮伤脾胃”论探讨酒精中毒性脑病的病机*

作者：李贞贞1，刁华琼1，张毅杰1，孙文军2

单位：1.北京中医药大学，北京 100029； 2.北京中医药大学第三附属医院，北京 100029

引用：引用：李贞贞，刁华琼，张毅杰，孙文军.基于罗天益“饮伤脾胃”论探讨酒精中毒性脑病的病机[J].中医药导报,2025,31(2):192-195.

DOI：10.13862/j.cn43-1446/r.2025.02.038

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摘要：酒为水谷之精，其性慓悍，过饮则伤人。罗天益在继承李东垣学术思想的基础上，提出“饮伤脾胃”论，详细地阐述了“酒伤脾胃”的病机。他认为酒具酷烈之性，挠扰于外，致脾胃气伤；又为沉注之体，淹滞于中，致湿浊内生；同时认为下法误治，久则阴伤，致变证百出，据此详列诸饮伤脾胃方。酒精中毒性脑病可以运用罗天益“饮伤脾胃”理论来认识。一次大量饮酒后，酒湿随辛热之性上扰脑神，出现急性酒精中毒；阴虚火旺之人，虽少量饮酒，相火、亢阳极易挟酒湿上扰脑神，致病理性醉酒；长期大量饮酒后，中焦虚衰，湿浊内生，化热生痰，肾水真阴受损，亢阳与酒气挟湿浊痰瘀壅塞脑窍，扰及心神，出现慢性酒精中毒性脑病；长期大量饮酒者突然戒酒后，人体阴虚阳亢与湿热痰浊覆压之间的病理平衡被打破，亢阳燔炽于上，出现酒精戒断综合征。治疗上，急性酒精中毒当以治湿为先，慢性酒精中毒则以消补兼施为宜，同时兼顾人的体质强弱及疾病的发展阶段。

关键词：酒精中毒性脑病；饮伤脾胃；罗天益；病机

Abstract：

Alcohol is the essence of grains and water, with a pungent and forceful nature. Excessive consumption of it can harm the body. Based on inheriting LI Dongyuan's academic thoughts, LUO Tianyi put forward the theory of "drinking injuring the spleen and stomach", elaborating in detail on the pathogenesis of "alcohol harms the spleen and stomach". He believed that alcohol, with its intense and fierce nature, disturbs the exterior, resulting in injury to the Qi of the spleen and stomach. Also, due to its heavy and stagnant nature, it accumulates in the middle, giving rise to the internal generation of damp and turbidity. Meanwhile, he considered that inappropriate purgation treatment, over time, would lead to Yin injury, causing various complicated symptoms. Accordingly, he listed in detail various prescriptions for treating the impairment of the spleen and stomach caused by alcohol. The theory of "drinking injuring the spleen and stomach" proposed by LUO Tianyi can be used to understand alcoholic encephalopathy. After drinking a large amount of alcohol at once, the alcohol dampness will go up with the pungent and hot nature disturbing the mind and causing acute alcohol poisoning. For people with Yin deficiency and hyperactivity of fire, even if they drink a small amount, the phase fire and hyperactivity of Yang are very likely to carry alcohol dampness upward and causing pathological drunkenness. After long-term heavy drinking, the middle jiao is weak, dampness and turbidity are generated internally, heat turns into phlegm, the true Yin of kidney water is damaged, hyperactivity of Yang and alcohol with dampness and turbidity phlegm and blood stasis block the brain and disturb the mind, causing chronic alcoholic encephalopathy. After long-term heavy drinkers suddenly quit drinking, the pathological balance between Yin deficiency and Yang hyperactivity in the human body and dampness heat and phlegm stagnation pressure is disrupted, and the Yang hyperactivity burns on top, resulting in alcohol withdrawal syndrome. In terms of treatment, acute alcohol poisoning should be treated with dampness first, while chronic alcohol poisoning should be treated with both elimination and tonic, while taking into account the strength of the person's constitution and the stage of development of the disease.

Key words：alcoholic encephalopathy; drinking injury the spleen and stomach; LUO Tianyi; pathogenesis

发布时间：2025-12-13

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