从相火“体”“用”探讨内伤热病的病机与辨治

Pathogenesis and Treatment of Internal Fever Injury From Perspective of"Ti"and"Yong"of Xiang Fire

“相火”是内伤热病辨治的关键,相火的本质是元阳元气,位置在肾间命门,各脏腑皆有,是生命活动的基础能源。“体用之辨”是中国哲学的常用范畴,“体”为根本、本体;“用”为实体发挥的作用。相火的“体”与“用”关系对认识内伤热病的病机与辨治有重要的指导作用。内伤热病发病之本在于相火之“体”元气虚损,相火异常是内伤热病的核心致病因素,各种发热的表现都是相火之“用”。内伤热病的病机主要包括元气虚损,气火之变;阴精虚损,水不制火;元阳虚损,相火离位等3个方面。内伤热病的诊疗应注重调中宫而除热、益精血以制火、温肾命而摄火,重视甘温、甘寒类药物和温补扶阳类方剂的使用,灵活运用滋补方药。

"Xiang Fire"is the key to the diagnosis and treatment of internal fever injury.The essence of the Xiang Fire is Yuan yang and Yuan Qi.The location of Xiang Fire is between the two kidneys as well as in each Fu and Zang,and it is the basis of energy for life activities.The"Ti-Yong discrimination"is a common category in Chinese philosophy,in which"Ti"means the fundamental,the noumenon while"Yong"means the role played by the noumenon.The relationship between"Ti"and"Yong"of Xiang Fire is an important guide to understanding the pathogenesis and treatment of internal fever injury.The root pathogenesis of internal heat disease lies in the Yuan Qi deficiency in"Ti"of Xiang Fire,in other word,abnormal Xiang Fire is the core pathogenic factor of internal fever injury,and all kinds of fever manifestations are the"Yong"of Xiang Fire.The pathogenesis of internal fever injury mainly includes three aspects:deficiency of Yuan Qi and change of Qi Fire,deficiency of Yin Essence and the Fire being out of the control of Water as well as the deficiency of Yuan Yang and the Xiang Fire going away from the normal position.The diagnosis and treatment of internal fever injury should focus on regulating the Middle Jiao to remove Heat,benefiting the Essence and blood to control Fire,warming the Kidney to take in Fire.In clinical practice,sweet-warm and sweet-cold drugs as well as warming and Yang-supporting formulas should be used,with flexible using of tonic formulas and medicines.