基于肝藏象理论探讨补中益气汤甘温除热的机理

摘要

补中益气汤是金元医家李东垣运用甘温除热法治疗气虚发热的代表方剂.李东垣注重调补脾胃,以脾胃立论,并首倡阴火论.理解阴火产生的病机对于掌握气虚发热的本质,正确运用补中益气汤进行临床施治起到至关重要的作用.但是历代医家对于阴火产生的机理认识不一,各执一言.分析了当前对阴火病机的不同认识,从中医肝藏象理论出发,结合气机升降理论、阴阳五行理论深入剖析,提出阴火病机为脾气亏虚,清阳下陷,阳入于阴,肝阴阳失衡,肝阳上扰,阴火自生.用甘温之剂补脾气,升发少阳之气,则阴火自除.此理论不仅有助于解释气虚发热及补中益气汤甘温除热机理,而且对于指导临床具有重要意义.%Buzhong Yiqi Tang is a representative formula used by LI Dong-yuan,a physician in the Jin and Yuan Dynasties,for treating qi deficiency fever with the therapy of relieving fever with sweet-warm Chinese medicinals.LI Dong-yuan stressed regulating spleen and stomach,made a point based on spleen and stomach and initiated the theory of yin fire.To understanding the pathogenesis of yin fire is very important for grasping the essence of qi deficiency fever and correctly applying Buzhong Yiqi Tang for clinical treatment.But generations of physicians have different opinions and words on the pathogenesis of yin fire.The paper analyzed current different perceptions on the pathogenesis of yin fire,and proposed,based on TCM theory of liver visceral manifestation,qi movement theory,yin-yang theory and five phase theory,that the pathogenesis is spleen qi deficiency,clear yang sinking,yang entering yin,disorder of liver-yin and liver-yang,liver-yang harassing up and yin fire producing.The formulas with sweet-warm Chinese medicinals can tonify spleen qi,ascend Shaoyang qi and removing yin fire.This opinion is help to explain qi deficiency fever and mechanism of Buzhong Yiqi Tang for relieving fever with sweet-warm Chinese medicinals as well as guide clinical practice.