基于文献探讨不同时代阳明病的概念演变

Exploring the conceptual evolution of Yangming disease in different eras based on literature

历代医家立足于《黄帝内经》的学术思想,对阳明病的理论来源及其治疗方法进行进一步的传承与演变。《黄帝内经》从阴阳气血盛衰、气机开阖、经脉主病、标本从化等方面论述阳明之生理、病理,认为其具有捍卫诸阳、维络阴阳、多气多血、主阖、本燥标阳从中化等特点。《难经》拓展对于阳明经脉的论述,提出“冲脉并行阳明经脉,阳明脉浮大而短,手阳明属下部,足阳明属中部”等观点。《伤寒论》六经辨证理论体现阳明与其他五个界面生理病理相互作用和影响的关联性,对同时立足于阳明合病去解释和治疗相应疾病进行了延伸,如太阳阳明合病宜透邪;正阳阳明多见火热燥实,久则津液不足;阳明少阳合病则少阳枢机不利,阳明失阖;太阴阳明合病,虚寒治之太阴,湿热治之阳明;少阴阳明合病,注意顾护元气;厥阴阳明合病,土虚木乘,注意顾护中土。温病学医家关于阳明病进一步拓展了“承气法”,并更注重固护阴津,明确卫气营血辨证,提出阳明温病热邪深入营血分的治法。后世医家还提出了“膈阳明分上热中寒,宜上下分消”“阳明之降乃人身最大降机”等观点。

Based on the academic thoughts of Inner Canon of Yellow Emperor,physicians of the past dynasties further inherited and evolved the theoretical source of Yangming disease and its treatment methods.Inner Canon of Yellow Emperor discussed the physiology and pathology of Yangming from the aspects of the rise and fall of yin and yang,qi and blood,the opening and closing of qi,the main diseases indicated by meridians,and the congruence of specimens,which had the characteristics of defending all yang,maintaining yin and yang,more qi and more blood,controlling the closing,and neutralizing the dry standard yang.Classic of Questioning expanded the Yangming meridian,and put forward the view that“the Chong meridian was parallel to the Yangming meridian,the Yangming meridian was floating,large and short;the branches of large intestine meridian were at the bottom,and branches of stomach meridian were at the middle”.The six meridian syndrome differentiation theory in Treatise on Febrile and Miscellaneous Diseases reflected the correlation between Yangming and the other five interfaces of physiological and pathological interaction and influence,and extended the explanation and treatment of corresponding diseases based on the combination of Yangming at the same time,such as“Diseases should be cleared of pathogens.”Zhengyang and Yangming were more likely to be hot and dry,and the body fluid would be insufficient for a long time.If Yangming and Shaoyang were combined with diseases,the Shaoyang cardinal would be unfavorable,and Yangming could not close.The combination of Taiyin and Yangming was used to treat the symptoms of deficiency and cold through Taiyin and damp and heat through Yangming.Shaoyin and Yangming combined disease,paid attention to protect the vitality.Jueyin Yangming combined disease,soil deficiency and wood multiply,paid attention to protect the middle earth.Yangming for warm diseases further expanded the“Qi-holding method”,and paid more attention to consolidating and protecting Yin and Jin.Physicians of later generations put forward the viewpoints that“the upper part of the Yangming was divided into the upper part of the heat and the middle part of the cold,and it should be divided into the upper part and the lower part of the body”“the descending of the Yangming was the greatest descending opportunity of the human body”and so on.