叶天士“人在气交,法乎天地”补法微探  

Analysis on therapy for invigoration binding YE Tianshi‘in the Qi Jiao,follow the example of Tian Di'

作　　者：蒋啸 李鑫辉 李彩云 夏旭婷 王慧 JIANG Xiao;LI Xinhui;LI Caiyun;XIA Xuting;WANG Hui(College of Traditional Chinese Medicine,Hunan University of Chinese Medicine,Changsha 410208,China)

机构地区：[1]湖南中医药大学中医学院,长沙410208

出　　处：《中华中医药杂志》2024年第5期2592-2595,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.82074392);湖南省中医药管理局重点课题(No.A2023013);湖南省自然科学基金区域联合项目(No.2023JJ50036);湖南省教育厅重点项目(No.23A0283)。

摘　　要：“天人合一”是中医学的重要认识,强调人与自然顺应和谐。叶天士由此论提出“人在气交,法乎天地,兼参体质施治”的立法原则。叶天士此论是考量不同时序阴阳消长、气机升降、脏腑荣衰三者变化,对治法确立的精辟总结。可惜叶天士思想多散金碎玉的湮没于零散医案中,学界虽有争鸣,但尚需系统阐述、提炼科学内涵。文章基于《素问·脉要精微论》所提,将四时年节律细分,以冬至、夏至为矩,讨论年节律影响下阴阳消长、气机升降、脏腑荣衰与补法关系。从择时用药上看,阳气微上,阴气微下时,人身气机顺应天时变化,多处“一阳始生、胆气春升”状态,此时立法当注意顾护胆气升发,宜宣畅少阳佐以健运中宫,方剂多选择瓜蒌栀子汤、玉竹麦冬汤合用。阴气微上,阳气微下时,下元亏损、化津无源,又兼燥邪当令,立法则多从肺肾论治,治此当分缕层次,补益阴精,方剂多选择六味二至丸佐以沙参麦冬汤。最后,文章以案释法,爬梳叶天士此论要点,认为“顺势思维”与“机法相参”是叶天士临证思维特点,希冀御简执繁,丰富临证思路,提高诊疗精度。'The unity of man and nature'is an important understanding of traditional Chinese medicine,which emphasizes the harmony between man and nature.YE Tianshi thus put forward the legislative principle of'in the QiJiao,follow the example of TianDi,and participate in the constitution'.YEs'theory is a penetrating summary of the establishment of the treatment method by considering the rise and fall of yin and yang,the rise and fall of qi,and the rise and decline of zang-fu organs.Unfortunately,there is the disappearance of YEs'thoughts in scattered medical cases.Although there is a debate in the academic circle,it still needs to systematically elaborate and refine the scientific connotation.This paper is based on the'inside meridians to fine micro',the four years of festival law subdivided,to the winter solstice,summer solstice as the moment,discuss the relationship between yin and yang under the influence of the festival law,the qi rise,the spirit,yang micro,yin qi,the change of time,gardenia soup,jade bamboo wheat winter soup together.Yin qi micro,yang micro,under the next yuan loss,passive,and dry evil when the order,legislation is more from the lung and kidney treatment,the treatment of this when the level,tonic yin essence,prescription more choose six taste two to pills with sand ginseng wheat winter soup.This paper interprets the law by the case,climbs the main points of YEs'theory,hoping to simplify and complicated,enrich the idea of evidence,and improve the accuracy of diagnosis and treatment.

关 键 词：时间医学 气交之变 阴阳消长 气机升降 叶天士 举案释法 

分 类 号：R249[医药卫生—中医临床基础]