运气大司天与叶天士脾胃学说的建构

Yun Qi Da Si Tian Theory and Construction of Ye Tianshi′s Spleen and Stomach Theory

叶天士学术思想成型的时代处于第74个甲子的后30年。据运气大司天理论,该时期为阳明燥金大在泉。阳明病早期从热化则气血弛张;中期从寒化则气血乏源,聚痰湿、水饮阻脉入络。因阳明为三阳"阖",厥阴为三阴"阖",两者同气相求,在生理、病理上相互影响。叶天士结合运气大司天的特点,提出了独重阳明病的学术观点。阳明从热化,肺胃之阴液不足,不能濡养阳明。叶天士多以甘寒、辛润、苦温之品以轻宣肺气、濡养胃阴,以促进肺胃津液输布阳明。阳明从寒化,痰湿内生而渐成癥瘕积聚之变,治疗关键仍以调治中焦脾胃为主,培补胃气、通降阳明以恢复阳明系统的平衡,使阳气重新输布中焦;若阳明病转化为厥阴病,叶天士提出"阳明胃土,独当厥阴风木"的观点,通过调治阳明以恢复厥阴;若阳明与太阴同病,则采用甘平之法以健脾养胃。由此可知,叶天士脾胃学说的建构与运气大司天关系密切。

The establishment of Ye Tianshi’s academic thought is in the last thirty years of the 74 thJiazi Year. According to the theory of Tun Qi,it is the period when the Yangming dry gold is Zai Quan. In the early stage of Yangming disease,the disease comes from the Heat and that would lead to Qi and Blood growing;in the middle stage,the disease comes from the Cold and that would lead to the Qi and Blood decreasing. The the Phlegm and Wetness would be caused and the retained fluid would block the collaterals. Yangming is the close of Sanyang and Jueyin is the close of Sanyin,and both of which are affecting each other physiologically and pathologically. In combination with the characteristics of Yun Qi Da Si Tian,Ye Tianshi put forward the academic viewpoint of paying greatest attention to Yangming disease. When Yangming disease comes from the Heat,the Yin of Lung and Stomach is insufficient,which cannot support Yangming normally. Ye Shi mostly used Gan Han,Xin Run,and Ku Wen drugs to lightly disperse the Lung Qi and nurish the Stomach Yin,to promote the transmission of body fluid going to Yangming. When Yangming disease comes from the Cold,endogenous Phlegm and Wetness would gradually accumulate,and the key to treatment is still to treat Spleen and Stomach,to replenish the stomach Qi,to down lead the Yangming Qi and to help restore the balance of the Yangming system,so that the Yang Qi can be redistributed to the middle Burner. If Yangming disease is converted into Jueyin disease,Ye Tianshi puts forward the viewpoint of " Yangming Stomach alone can help Jueyin Liver",and restores the normal function of Jueyin by regulating Yangming function. If Yangming and Taiyin are sick at the same time,the method of using Gan Ping drugs to strengthen the Spleen and nourish the Stomach. It can be seen that the construction of Ye Tianshi’s Spleen and Dtomach theory is closely related to the Yun Qi Da Si Tian Theory.