“营卫”理论的临床发微

摘要

Objective]To explore the relationship between Yin-wei theory and clinical practice ,and to discuss how to apply Yin-wei theory to solve practical problems in clinical situation.[Methods]We start from the Traditional Chinese Medicine(TCM) classics Nei Jing(the Canon of Internal Medicine) and Nan Jing(Canon On Eighty-One Difficult Issues),combined with Zhang Zhongjing’s application of Guizhi decoction in his book“Treatise on Febrile and Miscellaneous Diseases”to explore the cause and effect of Yin-wei theory and to comprehensively analyze its underlying thought .[Results]We found that Guizhi decoction in the“Treatise on Febrile Diseases”was not only applied in the chapter Taiyang disease,but also involved in other four chapters of Shaoyin disease and the chapter of cholera disease.In“Synopsis of Golden Chamber”,Guizhi decoction was used to treat vomitus gravidarum and affection by cold after delivery,while in Zhongjing’s practice,Guizhi decoction derived formula was widely used in the treatment of consumptive internal injuries miscellaneous disease,indicating that many internal injuries miscellaneous diseases were closely related to external infection .Tonic medicines were rarely seen alone in classical consumptive disease treatment.[Conclusion]Practice has proven that deep learning and understanding of Yin-wei theory has great guiding significance for us to put knowledge in TCM classic theories into clinical practice .Yin-wei theory opens an important window to learn“Treatise on Febrile and Miscellaneous Diseases”and trains clinical thinking,which is worth further discussion.%[目的]研究营卫理论和临床的关系，探讨在临床中如何运用营卫理论解决实际问题。[方法]从中医经典书籍《黄帝内经》和《难经》入手，结合张仲景在《伤寒杂病论》中对桂枝汤的运用，阐述“营卫理论”的来龙去脉，并综合分析其背后揭示的思想。[结果]《伤寒论》中运用桂枝汤不单是在太阳病篇，还涉及除少阴病的其他四篇和霍乱病篇；《金匮要略》中桂枝汤用于治疗妊娠呕吐、妇人产后中风，而桂枝汤衍生出来的方剂广泛地治疗虚劳内伤杂病，提示很多内伤杂病的来源与外感密不可分，经方治疗虚劳中很少见到单用补益药物。[结论]实践证明，深刻学习并且理解营卫理论对于学习中医经典及应用于临床实践有着极大的指导意义。营卫理论实为学习《伤寒杂病论》开启临床思维之重要法门，值得深入探讨。