温通与温补理论探析

Differentiation and Analysis of Theory of Warming-Dredging and Warming-Tonifying

温法有温通与温补之别,温通是温以促通,温补是温以达补。首先,从三个代表性时期论述温法中“通”与“补”的历史脉络:仲景时期,治阳重在温通,甘草干姜汤演化为四逆汤类方,温通思想贯穿始终;金元时期,李东垣在升降思想下创制补中益气汤,其以象春生夏长之令以升补清阳;明清时期,温补学派在东垣脾胃学说的基础上,进一步强调了温阳补虚基础上填补阴精的重要性。其次,基于《伤寒论》太阳病篇、张景岳右归丸,分别探讨温通与温补的不同特点,同时从病因、病位、病机、药物组成等方面阐述温通与温补的应用鉴别。最后,从胸痹与久泻举例论证温通与温补的不同应用场景。

There are two different warming methods,warming-dredging and warming-tonifying.The former is to promote circulation by warming whereas the latter is to tonify by warming.Firstly,the historical context of“dredging”and“tonifying”in warming method was analyzed from three representative periods:①In the Zhongjing period,warming-dredging was the key to treating yang.Gancao Ganjiang Decoction(甘草干姜汤)evolved into associated formulas of Sini Decoction(四逆汤),with warming-dredging thought throughout.②In the Jin and Yuan periods,LI Dongyuan created Buzhong Yiqi Decoction(补中益气汤)under the ascending and descending thought to lift and tonify the lucid yang,following the order of sprouting in spring and growing in summer.③In the Ming and Qing periods,the school of warming-tonifying further emphasized the importance of supplementing yin essence based on warming yang and tonifying deficiency according to Dongyuan’s theory of spleen and stomach.Secondly,the different characteristics of warming-dredging and warming-tonifying were analyzed respectively based on Taiyang disease of Treatise on Cold Damage and Yougui Pills(右归丸)of ZHANG Jingyue,and the application identification of warming-dredging and warming-tonifying was described from etiology,disease location,pathogenesis and medication.Finally,the different application scenarios of warming-dredging and warming-tonifying were demonstrated by examples of chest impediment and chronic diarrhea.