《脾胃论》“苦甘”配伍思想发微  

Explanation of the compatibility thought of ‘bitter and sweet’ in Piwei Lun

作　　者：王一婷 冯全生[1] 刘文平 王也民 WANG Yi-ting;FENG Quan-sheng;LIU Wen-ping;WANG Ye-min(Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China)

机构地区：[1]成都中医药大学,成都610075

出　　处：《中华中医药杂志》2022年第8期4610-4613,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家中医药管理局中医药传承与创新“百千万”人才工程——张之文全国名老中医药专家传承工作室建设项目(No.003109011004);国家重点研发计划(No.2018YFC1704104);四川省苗子工程项目(No.2020093)。

摘　　要：李东垣继承并发展先师张元素升降浮沉和脏气法时的用药思想,在疾病治疗中大量运用“苦甘”类药物,然后世对此举挖掘不深,尚有未逮。笔者通过分析其用药思想,进一步挖掘“苦甘”配伍运用的内涵。李东垣十分重视体内气机升降,认为大多数疾病是由于脾胃的升降失常所致,故在治疗上首重脾胃。他立“甘补苦泻”法为脾胃病的主要治疗原则,以甘补脾气,以苦泻胃火。春升之令,肝气主时,以甘缓肝升发之急;夏浮之令,心气主时,以甘寒泻心浮之火;秋降之令,肺气主时,以酸甘助肺肃降之功;冬藏之令,肾气主时,以苦寒滋其肾阴。通过恢复人体自身内部气机的升降出入,以及与外界四时节气相协调的平衡状态,实现人体内环境与外环境的整体和谐。LI Dong-yuan inherited and developed the thought of drug use in the method of ascending-descendingfloating-sinking of ZHANG Yuan-su and the time of visceral qi,and applied a large number of ‘bitter and sweet’ drugs in the treatment of diseases.However,the world did not have a deep understanding of this practice.The author further excavates the connotation of ‘bitter and sweet’ compatibility and application by analyzing his medication thought.LI Dong-yuan attached great importance to the rise and fall of qi in the body,and believed that most diseases were caused by the abnormal rise and fall of the spleen and stomach.Therefore,he first focused on the spleen and stomach in treatment.He established the ‘sweet tonic-bitter diarrhea’ method as the main treatment principle for the spleen and stomach.He uses sweet to nourish the spleen qi,and bitter to relieve stomach fire.Order of spring rising,when liver qi dominates,use sweetness to slow down the urgency of liver ascension.Order of summer floating,when the heart qi dominates,the heart fire is purged with sweet and cold.Order of autumn descending,when the lung qi dominates,use acid and sweet to help the lungs to suppress descending.Order of winter hiding,when the kidney qi dominates,the kidney yin is nourished by bitter cold.By restoring the ascendingdescending-in-out of the human body’s own internal qi,as well as the balanced state of coordination with the four seasons of the outside world,the overall harmony between the internal environment and the external environment of the human body is realized.

关 键 词：苦甘 脾胃论 脏气法时 升降浮沉 李东垣 

分 类 号：R289.1[医药卫生—方剂学]