基于“一气周流”理论探讨内伤发热

中土平和是气机升降有序的关键,脾胃调和,则痰湿无以生,气血充沛,肝木不郁,肾水得滋,则内伤发热可愈。黄元御提出“一气周流”理论,健脾和胃善用黄芽汤,肝气升发无力加桂枝、牡丹皮以疏肝,肺气不降则加陈皮、杏仁以理肺。内伤发热为肝郁所致者,应当健脾、疏肝、温肾并举,治以疏肝调畅气机,同时健脾益肾,采用柴胡芍药汤加减,肝肾功能失调者加生地黄,阳虚甚者加干姜、附子以温肾水。肾阳虚则肝木郁,肝木郁则克脾土,脾土虚则易生痰浊水湿。中土虚,一气运化无力而百病乃生,治以温肾通阳,以天魂汤健脾温肾,水不涵木,肝气瘀滞而血瘀者,可加牡丹皮、赤芍、桃仁、红花等。

Discussion About Internal Damage Fever Based on the Theory of"Circumfluence at a Stretch"

Mild middle earth is the key to the orderly ascending and descending of the qi movement,and is the basis of the change of the body's qi movement.If the spleen and stomach are harmonious,phlegm dampness cannot be produced,qi and blood will be abundant,liver wood will not be depressed,kidney water will be nourished,and internal damage fever can be cured.Huang Yuanyu put forward the theory of"circumfluence at a stretch",was good at invigorating the spleen and harmonizing stomach with Soybean Sprout Decoction.He often added Guizhi(Ramulus Cinnamomi)and Mudanpi(Cortex Moutan)to soothe the liver if the liver qi is weak in ascending.He used Chenpi(Pericarpium Citri Reticulatae)and Xingren(Semen Armeniacae Amarum)to regulate the lung if lung qi failing to descend.Internal damage fever is due to liver injury.The treatment should focus on strengthening the spleen,soothing the liver,and warming the kidney together to dredge qi movement.For strengthening the spleen and nourishing the kidney,Modified Bupleurum and Peony Decoction can be adopted.For liver and kidney dysfunction,Shengdihuang(Radix Rehmanniae)is often added.For severe yang deficiency,Ganjiang(Rhizoma Zingiberis)and Fuzi(Radix Aconiti Lateralis Preparata)are added to warm kidney water.Deficiency of kidney yang leads to stagnation of liver,and stagnation of liver suppresses spleen.Deficiency of spleen leads to turbid phlegm and water dampness,and deficiency of middle soil leads to weakness of one qi movement.All kinds of diseases will be caused,so the treatment should focus on warming kidney and activating yang.Tianhun Decoction(天魂汤,THD)is often used to invigorate the spleen and warm the kidney.For water failing to nourish wood leading to qi stagnation and blood stasis,Mudanpi(Cortex Moutan),Chishao(Radix Paeoniae Rubra),Taoren(Semen Persicae),Honghua(Flos Carthami),etc.can be added.