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基于《四圣心源》探讨消渴、瘿病的治疗策略
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Abstract:
《四圣心源》作为清代著名医家黄元御的代表作,其主要的学术理论便是“一气周流,土枢四象”,对消渴、瘿病的治疗具有较大的指导和参考价值。基于《四圣心源》可知,消渴与瘿病病机均有升降反作,戊土上逆,带动甲木胆火上逆而致相火上炎,下不温癸水而致肾寒;但二者病机之本的侧重点不同,消渴病机之本为水寒土湿木郁,重点在于己土下陷,乙木不达,其气遏抑而生风,故而为厥阴病。瘿病病机之本为土虚胆逆,劳伤中气,少阳相火被戊土带动上逆,产生病理产物,壅滞经脉为瘰疠,故为足少阳病。由此可知,消渴与瘿病的治法也以恢复中气运行为主,消渴为泻湿燥土,清风疏木,瘿病为培补中气;同时对衍生出来的病机立法,如清降胆火、活血化瘀。
Four Sacred Heart Source is the representative work of Huang Yuanyu, a famous doctor in Qing dynasty, its main academic theory is “One Qi Circulation and Tu regulating the four phases”, for the treatment of diabetes, Gall disease has greater guidance and reference value. Based on the Four Sacred Heart Source can be known, diabetes and gall disease pathogenesis have ascending and descending converse, then with the upward rebellion of Wutu, driven Jiamu and gallbladder fire upward reversal and lead to ministerial fire upward inflammation, the lukewarm Guishui causes the kidney cold; however, the focus of the pathogenesis of the two is different, the pathogenesis of diabetes is originally cold Shui, damp Tu and stagnated Mu, the point is that Jitu sinks, Yimu does not reach, and its qi suppresses and generates weakness, so it is Jueyin disease. Gall disease mechanism of the root of the Tu deficiency led to Gallbladder Fire inverse, labor injuries to the Middle Qi, Shaoyang ministerial fire was driven upward inversion by Wutu, resulting in pathological products, congestion of the meridians for scrofula, so for the foot Shaoyang disease. Therefore, the treatment of diabetes is to recover the Middle Qi, reduce dampness and dry Tu, clear Feng and sparse Mu, while the treatment of gall disease is to cultivate and replenish the Middle Qi; meanwhile, the pathogenesis of derived legislation, such as clearing down gallbladder fire and blood stasis.
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