《黄帝内经》标本中气理论通析

Analysis of the theory of incidental, fundamental and middle-qi in Huangdi Neijing

文章探析标本中气的脏腑基础,阐明标本中气的生理病理实质,对“从本”的少阳太阴、“从中气”的阳明厥阴、“从本从标”的太阳少阴进行生理病理系统诠释。标本中气理论从脏腑基础说,根源于脾胃土类,而非纯粹思辩的结果。其中,从本的少阳太阴最为重要,少阳太阴火湿保证了人体的基本温度和湿度,太阴脾湿在少阳三焦相火的主导下主肠胃饮食,生化营卫血气神,是人体生命的根本;其生理功能是主气和饮食的开阖出入以及神的升降出入;在病理上主要为内伤火湿病,以李东垣《脾胃论》“阳虚三联证”为特征。厥阴从中气少阳,风火相值,生发阳气主升,并把少阳太阴土类化生的营卫气血等营养物质从门静脉上奉肝心肺,然后输布全身。阳明从中气太阴,燥湿相济,生发阴气主降;其生理功能是通过天地合气化生胃气、神气和真气;若燥湿互济功能失调,可形成“胃家实”“脾约”以及内伤燥病等。从中的厥阴阳明主左右阴阳升降,体现了“阳生阴长,阳杀阴藏”的自然规律,在病理上则为阴阳反作和阴阳更胜。太阳少阴从本从标,寒热互调,主阴阳盛极转化,不转化则亢害;在生理上阴阳转化,即左阳从春厥阴肝木上升,至夏天太阳心火盛极而转化,右阴从秋阳明肺金下降,至冬天少阴肾水盛极而转化;在病理上可形成二至病,太阳少阴从本从标有寒热之病。

This article analyzed the visceral foundation of incidental, fundamental and middle-Qi, clarified physiological and pathological essence of incidental, fundamental and middle-qi in the three aspects: Shaoyang and Taiyin from the root cause,Jueyin and Yangming from middle-qi, Taiyang and Shaoyin from both the symptoms and the root cause. The theory of incidental,fundamental and middle-qi was originated from the spleen and stomach which was not the pure speculative results. Shaoyang and Taiyin from the root cause was the most important part. Fire and moisture in Shaoyang and Taiyin ensured the basic temperature and humidity of human body. Moisture in Taiyin spleen supported by Shaoyang Sanjiao assitant fire promoted the digestive function of the spleen and stomach, generated Ying-wei, qi-blood and spirit which were the root of life. The physiologic function of Shaoyang and Taiyin was important for food absorption and digestion, the normal movement of qi, and spirit activity. Internal injury of fire and moisture was commonly occurred pathologically in which yang deficiency of triad manifestations in the theory of Piwei Lun by LI Dong-yuan. Jueyin and Yangming from middle-qi, wind and fire ascended yang qi, and ascended the Yingwei, qi-blood to heart and lungs to nourish the whole body. Jueyin and Yangming from middle-qi, interdependence between drying and moistening, descended the yin qi. The physiologic function of Jueyin and Yangming from middle-qi was to generate stomach qi, spirit qi and inborn vitality. The disfunction between drying and moistening caused stomach excess, spleen limitation,and internal dryness. The promotion and demotion of Jueyin and Yangming represented ‘yin growing while yang generating’and yin conceals when yang is restrained’. ‘Reverse action of yin and yang’ and ‘alternate preponderance of yin and yang’ were occurred pathologically. Taiyang and Shaoyin from both the symptoms and the root cause, cold heat intermodulation, regulated the transformation between yin and yang. Physiologically, the transformation between yin and yang was described: Jueyin liver ascended, Taiyang heart excessive fire transformed, Yangming lungs descended, Shaoyin kidney excessive water transformed.Erzhi Disease occurred pathologically. Taiyang and Shaoyin from both the symptoms and the root cause also had disease related to cold and heat.