从《内外伤辨惑论》阴火理论探讨疫病的防治

Probing into the Prevention and Treatment of Epidemic Diseases from the Theory of Yinhuo

《内外伤辨惑论》是李东垣为1232年汴京大疫所作,其对阴火所致“内伤病”的描述与疫病在症状上有共通之处。故本文从《内外伤辨惑论》出发,梳理归纳阴火的含义、病机、症状和治疗宜忌,并根据阴火理论来探讨对疫病的认识与防治。李东垣认为阴火的核心病机为脾胃亏虚,中气不足,气与火的关系失常,他认为脾胃亏虚后易内生火热、易外感湿热、严重者可虚阳浮越。阴火的临床症状复杂多样,涉及多个病位,但其核心病位在脾胃,李东垣强调了脾胃在整个发病过程中的重要性。在治疗上,李东垣强调需辨证论治、方证对应,提倡用药需平和、动态观察,忌用药猛烈和一成不变。结合阴火理论,笔者认为疫病当属“内伤病”之一,脾胃亏虚是疫病发病的重要原因之一。在治疗方面,需以调理脾胃贯穿始终,寒性疫病可用补中益气汤等来调理脾胃;畅通气机以消内生之阴火,热性疫病可用李氏清暑益气汤等来调理脾胃,化湿解毒以散外来之阴火;疫病重症当重视人参的使用。防护方面,需重视脾胃的重要性,如饮食衣物寒温适中,忌饮酒等。脾胃正常,则正气充足,从而达到预防疫病的目的。

“Nei wai shang bian huo lun”was written by Li Dongyuan for the Bianjing epidemic in 1232.His description of“internal injury disease”caused by Yinhuo has something in common with the symptoms of the epidemic.Therefore,this article starts from“Nei wai shang bian huo lun”,sorts out and summarizes the meaning,pathogenesis,symptoms and treatment of Yinhuo,and discusses the understanding and prevention of epidemic diseases according to the theory of Yinhuo.Li Dongyuan believes that the core pathogenesis of Yinhuo is the deficiency of the spleen and stomach,the deficiency of qi in the middle,and the abnormal relationship between qi and fire.The clinical symptoms of Yinhuo are complex and diverse,involving multiple disease sites,but the core disease site is the spleen and stomach.Li Dongyuan emphasized the importance of the spleen and stomach in the entire pathogenesis.In terms of treatment,Li Dongyuan emphasized the need for treatment based on syndrome differentiation and corresponding prescriptions and syndromes.Combined with the theory of Yinhuo,the author believes that epidemic disease is one of the“internal injuries disease”,and deficiency of the spleen and stomach is one of the important reasons for the incidence of epidemic disease.In terms of treatment,it is necessary to regulate the spleen and stomach throughout.For cold diseases,Buzhong Yiqi Decoction can be used to regulate the spleen and stomach.adjusting qi,remove dampness and detoxify to disperse external Yinhuo;severe disease should pay attention to the use of ginseng.In terms of protection,it is necessary to pay attention to the importance of the spleen and stomach,such as eating and clothing with moderate cold and temperature,and avoid drinking alcohol.When the spleen and stomach are normal,there will be sufficient positive energy,thus achieving the purpose of preventing epidemics.