论《内外伤辨惑论》辨虚实本质及内外伤的相关性

Statement on the Essence of Identification on the Deficiency and Excess Patterns from Nei Wai Shang Bian Huo Lun and the Relativity between Internal Damage and Exogenous Diseases

[目的]探讨金元医家李东垣的奠基之作《内外伤辨惑论》的辨惑本质以及内伤与外感病的相关性。[方法]通过对《内外伤辨惑论》立论背景的研究,分析该论中主要的十三辨,进而思考辨惑的本质;同时联系李氏代表著作《脾胃论》中对解表药(风药)升发阳气作用机理的阐发,并与张仲景《伤寒论》等学术思想相比较,讨论外感风寒与内伤脾胃的对立与转化关系。[结果]发现《内外伤辨惑论》的辨惑实质并非在于病位之表里,而在于病证之虚实;从风药的作用机理以及表证、风药与脾胃的关系等分析,提出了内伤与外感病存在相关性。[结论]对《内外伤辨惑论》辨虚实本质的揭示及对解表药作用本质、内伤和外感相关性的认识,可以为临床辨证用药打开一些思路。

[Objective]To explore the essence of doubts differentiation from ＇Neiwaishangbianhuolun＇,the monumental work of the medical practitioner Dongyuan Li in Jin and Yuan Dynasties, and relativity between internal damage and exogenous diseases.[Methods] By means of researching the background of ＇Neiwaishangbianhuolun＇, analyzing the 13 main differentiations, think about the essence of doubts differentiation; meanwhile, by connecting to the explicate of mechanism of ascending yangqi belonging to exterior-releasing medicine（wind-expelling drugs） in his representative work ＇Piweihin＇, discuss the contrary and transforming relationships between exogenous wind-cold and internal damage of the stomach and spleen, comparing to academic thoughts of Zhongjing Zhang＇s ＇Shanghanlun＇. [Results]Realize essence of doubts differentiation from ＇Neiwaishangbianhuohin＇ is not exterior or interior of disease location,but deficiency and excess of disease character.By analyzing the functional mechanism of wind-expelling drags and relationship among exogenous diseases,wind-expelling drugs and the stomach and spleen, raise the relativity between internal damage and exogenous diseases. [Conclusions] The revealing of the essence of deficiency and excess differentiations from ＇Neiwaishangbianhuolun＇, together with knowledge of the functional essence of wind-expelling drugs and the relevance of internal damage and exogenous diseases, may open the mind partly for syndrome differentiation and medications in the chinic.