《黄帝内经》“心欲软”涵义及其补泻理论应用解析

Connotation of heart desiring soft and application of supplementation-draining theory in Huangdi Neijing(Yellow Emperor's Internal Classic)

载于《素问·脏气法时论篇》的五脏苦欲补泻理论是指导脏腑用药的重要理论基础,尤其是五脏所欲及其补泻用药法度。在五脏所欲中,相比其他四脏之"所欲","心欲软"的涵义较难理解,因心类火,其生理之性理应炎上而升散,而经中却言"心欲软",且历代医家并未对此有明确的注解,致使后人对此困惑不解。通过从"心主神明,心君以柔和宽厚为贵";"心主血脉,血脉以柔软畅达为要"和"心开窍于舌,舌体以柔软灵活为用"3个方面对"心欲软"的涵义进行阐释。并对"心欲软,急食咸以补之,以咸补之,以甘泻之"的用药法度进行深入解读,提出了咸味药物可以抑制心阳的亢盛,名为"补"实为"泻";甘味药物可以振奋衰微之心阳,名为"泻"实为"补"的观点。

The theory of supplementation and draining according to desire of five viscera, from Suwen . Zangqi Fashi Lun （Plain Questions . On Visceral Qi and Seasons）, is an important theoretical base for guiding visceral medication, in particular for desire of five viscera and medication laws. In desire of five viscera, the connotation of heart desiring soft is hard to understand compared with desire of other 4 viscera. Heart is characterized by fire and has physical characteristics of heating the superior and flaring up. But Suwen said heart desiring soft, and physicians of all dynasties had no clear comments on this, and later generations feel puzzled. In this paper, the connotation of heart desiring soft is explained from 3 aspects, heart controlling mental activities （characterized by soft and lenience ） , heart controlling blood vessels （characterized by soft and fluent ） and heart opening into tongue （characterized by soft and flexible）. The medication laws for heart desiring soft with salty supplementation and sweet draining are interpreted, and viewpoints are promoted, including salty medicinal can impair hyperactive heart yang, which is called supplementation and actually is draining, and sweet medicinal can inspire declined heart yang, which is called draining and actually is supplementation