Appetizer and Jiao Sanxian

• Post By: 汉青
• Date: 2019-09-18
• Category: Clinical Reflections

Clinically, it is common for some patients to complain that their food is tasteless from time to time, or they may express it as a loss of appetite, or they may express that they do not want to eat and that nothing they eat tastes good. Regarding this kind of situation, I have encountered some misunderstandings in treatment. I talked about this in a recent chat, which was quite enlightening.

Generally speaking, a lack of appetite, food that doesn’t taste good, and food that tastes tasteless are basically symptoms of spleen malfunction. It may be due to insufficient spleen, or it may be due to abnormal spleen operation caused by various circumstances. In terms of treatment, the medicine for spleen deficiency can strengthen the spleen and replenish qi. If the spleen is abnormal, various reasons must be found. If these reasons are solved, the appetite problem will naturally be solved.

However, for patients with spleen deficiency, my use of Sijunzi Decoction is almost ineffective, and my use of Buzhong Yiqi Decoction is half and half, while Shenling Baizhu Powder and the like have a very slow effect. I don’t understand what is going on.

It wasn’t until Brother Zhao Shitong mentioned Erchen Tang that I suddenly felt enlightened.

As a famous prescription for resolving phlegm, Erchen Decoction is active in many disease spectrums. A very important feature of its formula compatibility is that it opens and closes. The use of this pungent medicine is very critical. Reminiscent of the famous Jiao Sanxian, its essence is to use the pungent flavor of this burnt aroma to transport the spleen and resolve stagnation. If used properly, the effect of Jiao Sanxian is very fast and significant. In my clinical practice, whenever I see yellow greasy coating and excessive or insufficient Guan pulse, it generally points to abnormal spleen and spleen functioning. At this time, using Jiao Sanxian, the symptoms will improve quickly and the tongue coating will soon recede.

It can be seen that the important factor in appetizing is to open up the appetite. No matter whether it is empty or real, you must choose the right pungent medicine to open up the path of the spleen, which is the right way.

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临床上常见一些患者，主诉或间或有饮食无味的症状，或者表达为没有食欲，也可能表达为不想吃饭，吃什么都不香。针对这类情况，我在治疗上曾走过一些误区，近日聊天时谈及此事，颇有些启发。

一般来讲，没有食欲、吃饭不香、吃什么都没味在根本上属于脾失健运，可能是由于脾气不足，也可能是因为各种情况引起的脾气运行失常，在治疗上，脾气不足的药健脾益气，运行失常的要找到各种原因，把这些原因解决了，食欲问题自然就解决了。

然而，针对脾虚的患者，我使用四君子汤几乎是无效的，使用补中益气汤也是一半一半，而参苓白术散之类，疗效甚慢，我很不明白这到底是怎么回事。

直到赵世同兄提到了二陈汤，我突然感到茅塞顿开。

二陈汤作为化痰名方，活跃在许多疾病谱中，其组方配伍中非常重要的特点是有开有收，这个辛味药的使用非常关键。联想到著名的焦三仙，其本质也是利用这种焦香的辛味运脾化滞，若运用得当，焦三仙的效果非常快速且显著。我在临床中，只要看到黄腻苔，关脉太过或不及的，一般都指向脾气运行失常，此时用焦三仙，症状改善很快，舌苔很快就会退下去。

由此可知，开胃的重要因素在于开，无论虚与实，都要选用合适的辛味药，将脾气的运行道路打开，方为正道。