阴火论探微及临证应用

研读李杲《脾胃论》等著作,认为其所论阴火为脾胃气机升降失常,太阴脾虚(湿盛)不能升清,阳明胃火不降所致。阴火异于阳热实火和阴虚虚火。本文考镜源流,认为阴火之论根于《黄帝内经》,其病因病机为饮食劳倦,损伤脾胃,致脾虚或脾虚生湿,不能升清,则胃土不能降浊,阳明不降而出现一派热象,此热中兼有脾虚中气不足之证,实为内伤虚火。其临床表现以热或在颜面,或在九窍,或在四肢,其热势或高或低,但均有气短声低、倦怠乏力中焦气虚表现,或肢体沉重、四肢不收、大便溏泄等湿盛之象。治以辛甘温之剂补其中而升其阳,苦寒以泻其火。用药为人参、黄芪、羌活、陈皮、茯苓、猪苓、柴胡、升麻、黄芩、黄连等。方如补中益气汤、补脾胃泻阴火升阳汤、升阳散火汤、升阳除湿防风汤等。临证以补脾胃泻阴火升阳汤治疗寒热错杂、虚实相兼一患者。

Clinical Application of Yin Fire Theory

After studying the classics like Treatise on the spleen and stomach,it is proposed that the "Yin fire" is caused by the disorder of the qi activity,deficiency in the spleen(excessive dampness) leading to failure of elevating lucid yang and descending of stomach fire. Yin fire is different excessive fire caused by excessive yang and deficient fire caused by yin deficiency. The theory of yin fire is based on The Yellow Emperor's Inner Classic. The cause and mechanism are that improper diet and fatigue damage spleen and stomach,leading to deficiency of spleen,and deficiency of spleen results into dampness and spleen failing to lift the clear and stomach failing to lowering the turid,manifesting as heat. This heat is mingled with deficiency of middle- energizer qi,and therefore essentially it is deficient fire by internal injury. The clinical manifestations include heat on the face,in nine orifices,in the limbs,and the heat is high or low,but all with shortness of breath,low voice,lassitude and weakness,or physically heavy,loose stool and so on. The therapeutic principle should be tonifying middle- energizer qi to lift yang,and purging heat by bitter and cold herbs. The medicines mainly include Renshen,Huangqi,Qianghuo,Chenpi,Fuling,Zhuling,Chaihu,Huangqin,Huanglian and so on. The formulas include Buzhong Yiqi decoction,Bupiwei Xieyinhuo Shengyang decoction,Shengyang San Huo decoction,Shenyang Chushi Fangfeng decoction and so on. In clinic,Bupipei Xieyinhuo Shengyang decoction was applied to treat a patient with syndrome of simultaneous occurrence of the cold and heat and deficiency and excess.