析论《黄帝内经》之“痿”

Analysis of“flaccidity syndrome”in Huangdi Neijing

传统医学对痿病的系统认识,肇始于《黄帝内经》,立论之详,可称诸病之首。本文以文字溯源为基础,结合医理阐述与临床思维,进一步对“痿”释义及演变进行考辨,笔者通过对《黄帝内经》痿病源流的梳理,结合文献古籍考究本病义理,指出痿之生,启于肺,关乎胃,源于肺热叶焦;痿之因,伤于热,关乎湿,成于百脉干竭;痿之变,始于上,关乎下,终于久伤成劳。痿病之辨治,当在“独取阳明”的基础之上,参以泻南补北之法,临证亦需兼治兼挟标症,后期当观权达变,灵活施以“痿痹合治”,以期厘正痿之病、因、证、治,临证可资借鉴。

Systematic understanding of“flaccidity syndrome”disease in traditional Chinese medicine began with the Huangdi Neijing,which explains very detailedly compared with other diseases.Based on text tracing,combined with medical explanation and clinical thinking,this paper further summarizes the definition and development of“flaccidity syndrome”.By combining the origin and flow of flaccidity syndrome in Huangdi Neijing with related descriptions in ancient literature,we point out that the occurrence of“flaccidity syndrome”starts from the lung,is related to the stomach,and is caused by the lung scorched by heart.The etiology of“flaccidity syndrome”,which is injured by heat,is closely related to dampness,and the onset is mainly due to the dryness of meridians.The change in flaccidity syndrome,starting from the upper body,is related to the lower body,and eventually leads to exhaustion if not treated.Syndrome differentiation and treatment of flaccidity is based on“taking Yangming alone”with the method of“clearing heart fire and nourishing kidney water”.Clinical syndromes also need to be treated by targeting“flaccidity syndrome with symptoms”,or later flexible“flaccidity syndrome with arthralgia”,in order to correct the causes and symptoms of flaccidity.