李东垣“补泻在味,随时换气”用药思想探赜  

Exploring LI Dong-yuan′s Medication Ideology of"Tonification and Purgation Based on the Five Tastes and Adjusting the Four Properties According to Seasonal Changes"

作　　者：涂家惠 唐逸 刘金涛 TU Jiahui;TANG Yi;LIU Jintao(Beijing University of Chinese Medicine,Beijing,China,100029;Dongfang Hospital,Beijing University of Traditional Chinese Medicine,Beijing,China,100078)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院,北京100078

出　　处：《河南中医》2025年第3期385-389,共5页Henan Traditional Chinese Medicine

基　　金：国家重点研发计划项目(2018YFC1704105);科学技术部科技基础资源调查专项项目(2022FY102002);中央高校基本科研业务费专项项目(2022-JYB-JBRW-002)。

摘　　要：“补泻在味,随时换气”是指基于人身中类似自然界四时的气机变化,借助药物气味厚薄和五行生克之理,调和五脏升降浮沉的气机,强调随天地四时气候的变化,调整药物寒温属性,包含补泻之法和随时用药两个层面。补泻之道为借助气味厚薄,调节五脏气机,将肝、心、肺、肾四脏与四时气机相应,分别赋予升、浮、降、沉之性,借助药物气味来补泻五脏,气味作用顺脏性者为补,逆之为泻。随时用药为照应四时五脏,重视四气加减,当人体气机升浮有余、沉降不足时,类似四时春夏之令太过而秋冬之令不行,当以寒凉酸苦之药沉降气机。李东垣将二者灵活结合,基于天地四时与人体的气机变化,以药物气味厚薄和五行生克调节五脏气机,并尤为注意顺应四时寒温进行加减。其对于药物气味和五脏补泻的深入研究,促使后世医家进一步探讨五脏补泻治法和药物气味应用,为脏腑阴阳学说的兴起和温病学派用药法式的确立奠定了基础。"Tonification and purgation based on the five tastes,and adjusting the four properties according to seasonal changes"refers to harmonizing the qi movement(ascending,descending,floating,and sinking)of the five zang organs by leveraging medicinal substances′thickness or thinness of qi-flavor and the principles of mutual generation and restraint in the five phases.It emphasizes adapting the cold or warm properties of medicines to align with climatic shifts in the natural world′s four seasons,encompassing two dimensions:(1)The principle of tonification and purgation involves utilizing the thickness or thinness of medicinal flavors and properties to regulate the qi movement of the five zang organs.The liver,heart,lung,and kidney are aligned with the seasonal qi dynamics of the four seasons,each assigned ascending,floating,descending,and sinking properties.By leveraging the flavors and properties of medicines to tonify or purge the zang organs,actions that align with the organ′s inherent nature are considered tonification,while those opposing it are purgation.(2)Using medicine according to the time aligns with the dynamic interplay of the four seasons and five zang-organs,emphasizing adjustments based on the four medicinal properties.When the ascending-floating qi movement dominates while descending-sinking is insufficient-akin to excessive spring-summer qi and deficient autumn-winter qi in nature,so cold-cool,sour,or bitter medicines should be applied to descend pathological qi excess.Li Dongyuan flexibly combined the two,based on the changes of qi movement in the universe and the human body in the four seasons,regulating the qi movement of the five zang organs with the thickness and thinness of the medicinal properties and the mutual generation and restraint of the five phases,and paid particular attention to modification according to the cold and warm of the four seasons.His in-depth research on the flavors of medicines and the tonification and purgation of the five zang organs prompts later medical practition

关 键 词：“补泻在味 随时换气” 补法 泻法 随时用药 李东垣 

分 类 号：R242[医药卫生—中医临床基础]