薛己朝夕互补法治疗虚损病浅析

An Analysis of Xue Ji's Morning and Evening Complementary Method in the Treatment of Consumption Disease

明代医家薛己首创朝夕互补法治疗虚损病,依据脏腑的气机升降规律选择朝夕分服不同的补益剂。对于临床虚证显实象,内伤似外感的病证,薛己常以温补脾肾之法治疗虚损病。元气亏损证朝服补中益气汤以补气升阳,夕用六味地黄丸加黄柏、知母补肾水以滋化源;脾胃亏损、肝脾不和证朝用六味地黄丸以滋养肝体,夕用六君子补气健脾、培土生金,佐以当归、芍药补肝体,敛肝用;肾虚火不归经证朝用四君子汤补气升阳,佐以熟地黄、当归以滋阴养血,气血双补,夕用加减八味丸阴阳互补;脾肺亏损证朝服六君子加减,夕服八味丸;脾肾亏损证朝服补中益气汤加生姜、附子补脾升阳,夕服金匮肾气丸加补骨脂、肉豆蔻补命门之火;肝肺肾亏损证朝用六味丸滋补肝肾,夕服逍遥散疏肝行气,借助外界阳气降敛的力量助阳气潜藏,阴覆阳降。

Xue Ji,a physician in the Ming Dynasty,first created the morning and evening complementary method to treat consumption disease.Different tonifying formulas were taken day or night according to the ascending-descending law of qi movement of zang-fu organs.For the clinical deficiency syndrome manifested as excess symptoms,and internal injury which is like external contraction,Xue Ji often used the method of warming and tonifying the spleen and kidney to treat consumption disease.For original qi deficiency syndrome,Center-Supplementing and Qi-Boosting Decoction was used to tonify qi and raise yang in the morning,while Rehmannia Pills plus Huangbai(Cortex Phellodendri Chinensis)and Zhimu(Rhizoma Anemarrhenae)was used in the evening to supplement kidney water.For syndrome of disharmony between the liver and spleen due to deficiency of the spleen and stomach,Six-Ingredient Rehmannia Pill was used to nourish the liver body in the morning,while Six Gentlemen Decoction was used in the evening to replenish qi and activate the spleen,bank up earth to benefit metal,and Danggui(Radix Angelicae Sinensis)and Shaoyao(Radix Paeoniae Alba seu Rubra)were added to replenish the liver body and astringe the liver.For syndrome of fire failing to return to meridian due to kidney deficiency,Four Gentlemen Decoction was used in the morning to tonify qi and raise yang,and Shudihuang(Radix Rehmanniae Praeparata)and Danggui(Radix Angelicae Sinensis)were added to nourish yin and blood for replenishing both qi and blood.Modified Eight-Ingredient Pill was used in the evening to complement yin and yang.For syndrome of spleen-lung deficiency,Modified Six Gentlemen Decoction was used in the morning,and Eight-Ingredient Pill was used in the evening.For syndrome of spleen-kidney deficiency,Center-Supplementing and Qi-Boosting Decoction plus Shengjiang(Rhizoma Zingiveris Recens)and Fuzi(Radix Aconiti Lateralis Preparata)was used in the morning to tonify the spleen and raise yang.Golden Cabinet's Kidney Qi Pill plus Buguzhi(Fructus Psoraleae)and Roudoukou(Semen Myristicae)in the evening to nourish life gate fire.For syndrome of liver-lung-kidney deficiency,Six-Ingredient Pill was used in the morning to nourish the liver and kidney,while Free Wanderer Powder was used in the evening to soothe the liver and move qi,and with the help of the external yang qi reducing power,yang qi was hidden,resulting yin dominated and yang descending.