陈士铎“水升火降”治疗消渴理论探讨

Theory of ‘water-ascending and fire-descending' in treating wasting-thirst from CHEN Shi-duo

清代以后,由于温病学的发展,医者偏执"阴虚燥热"是消渴的病机,治疗上多用养阴清热之法。然单纯的"阴虚燥热"不会导致三消并见,且验之于临床,养阴清热之法有效者虽多,罔效者亦不少。消渴患者整体呈现的是"火炎于上,阴亏于下,水火不相既济"的病态,故水火升降失常可能是消渴发病之根本。著名医家陈士铎在其所著《石室秘录》一书中创立"引火升阴汤""合沉汤",并指出"消证非火不成也",但火有虚实之分,主张治疗虚火当"引火",实火要"泻"火。提倡实现体内"水升火降"是治疗消渴的关键。

Since the development of school of warm diseases from the Qing dynasty,the dryness-heat due to yin deficiency was considered as the only reason forwasting-thirst,the method of nourishing yin and clearing heat was used in the treatment,but it could not cure and explain all the symptoms of wasting-thirst.The patients with wasting-thirst always had the pathogenesis of ‘fire being flaring up,yin deficiencyin the lower part,anddisharmony between heart and kidney＇,so the disorder of ascending and descending was the root cause of wasting-thirst.CHEN Shi-duo created Yinhuo Shengyin Decoction and Hechen Decoction in the Shishi Milu.He pointed out that wasting-thirst was closed related with fire,and fire could be divided into excessive fire and deficient fire,‘conducting fire＇ should be used in treating deficient fire while ‘purging fire＇ should be used in treating excessive fire.He also advocated that ‘water-ascending and fire-descending＇ in the body was the key to treat wasting-thirst.