秦裕辉教授运用“土枢四象、一气周流”理论论治年龄相关性黄斑变性的经验

Professor QIN Yuhui's experience in treating age-related macular degeneration based on the theory of"earth as the pivot of the four organs,unified qi in circular flow"

黄元御,清代著名医家,其代表性著作《四圣心源》的主要学术理论可概括为“土枢四象、一气周流”,强调中气之升降浮沉是维持五脏六腑生理功能的基础,以脾土之气为轴,心、肺、肝、肾为轮,轴运轮转,推动心、肺、肝、肾四象互生互化互制,生生不息。基于“土枢四象、一气周流”理论结合秦裕辉教授临床实践探析年龄相关性黄斑变性,将其病因病机概括为“脾土衰败、湿浊困脾;肝木不足、癸水亏虚;木气郁滞、脾土壅塞”,依“运轴行轮、运轮复轴、轴轮并运”之法,行“健土祛湿以复中焦,滋补乙木、润养癸水,疏达乙木、健运己土”之法,为年龄相关性黄斑变性的辨证论治扩展思路。

HUANG Yuanyu,a renowned physician of the Qing Dynasty,is best known for his seminal work Si Sheng Xin Yuan(Four Sages'Study).The main academic theory applied in this book can be summarized as"earth as the pivot of the four organs,unified qi in circular flow".The theory emphasizes the importance of the ascending,descending,floating,and sinking movements of the central qi in maintaining the physiological functions of the five zang and six fu organs.With the qi of the spleen earth as the axis and the heart,lung,liver,and kidney as the wheels,the axis operates the wheels,promoting the intergeneration,intertransformation,and mutual restraint among the four organs in an endless cycle.Based on the theory of"earth as the pivot of the four organs,unified qi in circular flow",this paper combines with QIN Yuhui's clinical practice,analyzes and studies the age-related macular degeneration,summarizing its pathogenesis as"deficiency of spleen earth and spleen encumbered by dampness and turbidity;insufficiency of liver wood and kidney water;stagnation of liver qi,obstruction of spleen earth."Following the principle of"operating the axis to move the wheels,moving the wheels to return to the axis,and the simultaneous operation of axis and wheels,"the method of"strengthening the earth to eliminate dampness and restore the middle jiao;nourishing liver wood and moistening kidney water;unblocking liver wood,and promoting the movement of earth"is employed,expanding the treatment based on pattern identification approaches for age-related macular degeneration.