五运六气理论与《临证指南医案》中风证治  

The Theory of Five Circuits and Six Qi and the Syndrome and Treatment of Apoplexy in the Case Records as a Guide to Clinical Practice(Lin Zheng Zhi Nan Yi An)

作　　者：张玉鑫 刘晓燕[1] 崔亚东 张文静 梁羽茜 裴枫 邰雪莉 黄雪杰 ZHANG Yuxin;LIU Xiaoyan;CUI Yadong;ZHANG Wenjing;LIANG Yuxi;PEI Feng;TAI Xueli;HUANG Xuejie(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029

出　　处：《世界中医药》2024年第6期818-821,825,共5页World Chinese Medicine

基　　金：国家重点研发计划中医药现代化研究专项(2019YFC1711905)--中医时空理论指导下低辐射太赫兹治疗设备智能化模式构建;北京市中医药科技发展资金项目(JJ-2020-35)--基于五运六气理论建立运气-气象-体质相关的流感发病预测模型。

摘　　要：五运六气学说是《黄帝内经》天人合一思想的重要组成部分,也是中医思维的一大特色,更是中医科学性的重要体现。叶桂承经旨而博采众长,在《临证指南医案》中记载了诊疗中风的宝贵经验,其中蕴含着五运六气理论的应用经验,叶氏认为,风木司天容易出现气火上亢,脾土受克又兼气机上下滞塞,而天符岁会年气候变化剧烈,阳气开泄,阴不内守而中风。中风发病特点与时令之气有关,厥阴风木主时与火热之气当令,耗气伤津,气津输布异常致络脉空虚而中风;冬令天反暖失于封藏,多肾阴暗耗而动风。针对上述病机,其中厥阴风木当令,脾胃受邪,故治以培补中气,同时兼以敛降之品调节人体升而不降的气机状态;火热当令,阳气发泄,致络脉空虚而中风者,补益脾胃以实卫气;冬令当寒反暖,致肾精不固而中风者,则以滋水涵木为法。叶氏重视外界环境因素对病机的影响,将天人相应的思想运用于中风的辨证论治中,示人以法,值得学习和借鉴。The theory of five circuits and six qi is an important thought of the unity of man and nature in the Huangdi′s Internal Classic(Huang Di Nei Jing),as well as a major feature of TCM thinking and an important embodiment of the scientific nature of TCM.The Case Records as a Guide to Clinical Practice(Lin Zheng Zhi Nan Yi An)encompasses the valuable experience of Ye Tianshi in the diagnosis and treatment of apoplexy and his experience in the application of the theory of five circuits and six qi.Ye believes that when wind-wood dominates the heavens,qi and fire are easily hyperactive,which will restrain the spleen and soil and obstruct qi movement,while in the year of celestial correspondence when the climate changes dramatically,apoplexy occurs due to the release of yang qi and failure of keeping yin in interior.The occurrence of apoplexy is related to seasonal qi.The overlapping of the time dominated by Jueyin wind-wood and heat-fire qi will consume qi and fluid.The abnormal distribution of qi and fluid empties collaterals,resulting in apoplexy.The abnormal warm days in winter will lead to the failure of kidney in storing and consume kidney yin,leading to the symptoms of apoplexy.In view of the above pathogenesis,middle qi should be replenished when Jueyin is dominant and the spleen and stomach are affected by pathogen,and at the same time,the astringent and descending medicinals should be used to regulate the ascending but not descending qi in the human body.In the season when heat-fire is dominant and yang qi is released,spleen and stomach should be tonified to strengthen the defense qi for those who suffer from apoplexy due to empty collaterals.In winter with abnormal warm days,those who suffer from apoplexy due to insecurity of kidney essence could be treated by nourishing water and wood.Ye attached great importance to the influence of external environmental factors on pathogenesis and adopted the idea of correspondence between man and nature to diagnose and treat apoplexy,which is worth research and learning.

关 键 词：五运六气 《临证指南医案》 中风 证治规律 叶桂 天人相应 时令 病机 

分 类 号：R255.2[医药卫生—中医内科学]