从“土枢四象,一气周流”论治视网膜静脉阻塞性黄斑水肿  

Treatment of Macular Edema Secondary to Retinal Vein Occlusion Based on Theory of“One Qi Circulation,Earth as Pivot with Four Elements”

作　　者：陈惠媚 李江伟 姚小磊[1,2,3] CHEN Huimei;LI Jiangwei;YAO Xiaolei(The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410208,Hunan,China;Hunan University of Chinese Medicine,Changsha 410208,Hunan,China;Hunan Provincial Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Eye,Ear,Nose and Throat Diseases,Changsha 410208,Hunan,China)

机构地区：[1]湖南中医药大学第一附属医院,湖南长沙410208 [2]湖南中医药大学,湖南长沙410208 [3]中医药防治眼耳鼻咽喉疾病湖南省重点实验室,湖南长沙410208

出　　处：《辽宁中医杂志》2025年第4期32-35,I0002,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82174443,81860870);湖南省科技厅临床创新引导项目(2021SK51407);白求恩·朗沐中青年眼科科研基金(BJ-LM2021009J);湖南省中医药科研计划项目重点项目(A2024022);湖南中医药大学“揭榜挂帅”项目(22JBZ029);湖南中医药大学研究生创新课题项目(2023CX11)。

摘　　要：黄元御提出“土枢四象,一气周流”理论,强调中气的升降出入在疾病发生发展中的作用。脾胃居中焦,斡旋气机,助龙虎回环,水火互济,如此则全身气机调畅,机体康健。脾胃功能失调,则中气不足,导致肝失条达,肾水乏源,全身气机循环紊乱,瘀血、痰湿等病理产物堆积,壅滞于目络,引发视网膜静脉阻塞性黄斑水肿。因此在该病中,中气不足,失于斡旋,痰水瘀结是其病机关键。从脾论治,宜补中气,利升降,助中焦之气协调;从肝论治,宜疏肝气,助肝气升发;从肾论治,宜暖肾水,济阴阳。此则中气升降相因,全身气机有序运行,一身之气循环周流,病理产物得以消除,脏腑和目窍功能恢复正常。The theory of“one Qi circulation,earth as pivot with four elements”is proposed by HUANG Yuanyu,which lays great emphasis on the role of the ascending,descending,entering and exiting of middle Qi in the development of diseases.Spleen and stomach are located in the middle Jiao,mediating Qi movement,and integrating fire and water,so that the Qi movement of the whole body is regulating and the body is healthy.If spleen and stomach are dysfunctional,middle Qi is insufficient,leading to the stagnation of liver Qi and deficiency of kidney essence.Meanwhile,the Qi movement of the whole body is disturbed,and phlegm-dampness,blood stasis and other pathological products block the eyes,causing the macular edema secondary to retinal vein occlusion.So the deficiency of middle Qi and the Qi movement disturbance are key pathogenesis.The treatment from spleen is to supplement the middle Qi and help spleen and stomach to coordinate the middle Qi.The treatment from liver is to smooth and disperse the liver Qi.The treatment from kidney is to warm kidney water,so that Yin and Yang of the whole body is balanced.There is interdependence between the ascending and descending of the middle Qi,and the Qi movement of the whole body is ordered,which will contribute to circular flow of the Qi of the whole body and the elimination of pathological products.The function of the Zang-Fu organs and eye will be normal.

关 键 词：视网膜中央静脉阻塞性黄斑水肿 土枢四象 一气周流 黄元御 气机升降 

分 类 号：R276[医药卫生—中医五官科学]