主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2021, Vol. 44 ›› Issue (5): 392-398.doi: 10.3969/j.issn.1006-2157.2021.05.002

• 名家论坛 • 上一篇    下一篇

《黄帝内经》论“暑”及“暑证”论治刍议*

黄俊伟, 刘金涛, 史延昊, 王伟航, 王维广, 陈子杰, 翟双庆#   

  1. 北京中医药大学中医学院 北京 100029
  • 收稿日期:2020-11-03 出版日期:2021-05-30 发布日期:2021-06-01
  • 通讯作者: #翟双庆,男,博士,教授,博士生导师,主要研究方向:黄帝内经研究,E-mail:zsq2098@163.com
  • 作者简介:黄俊伟,男,在读博士生
  • 基金资助:
    *国家重点研发计划项目(No.2019YFC1709202)

Huangdi Neijing's theory on Shu and the treatment of Shu Pattern*

Huang Junwei, Liu Jintao, Shi Yanhao, Wang Weihang, Wang Weiguang, Chen Zijie, Zhai Shuangqing#   

  1. School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029,China
  • Received:2020-11-03 Online:2021-05-30 Published:2021-06-01
  • Contact: Prof. Zhai Shuangqing, Ph. D., Doctoral Supervisor. Beijing University of Chinese Medicine, No.11, Beisanhuan East Road, Chaoyang District, Beijing 100029. E-mail: zsq2098@163.com
  • Supported by:
    National Key R&D Program (No.2019YFC1709202)

摘要: 暑,在《黄帝内经》中的论述是多方位的。首先,从阴阳而言,它是与“寒”相对立又统一的一个概念,即以寒暑别阴阳。其次,从四时而言,温、暑、凉、寒则分别对应于春、夏、秋、冬。从五脏而言,风、暑、湿、燥、寒分别对应于肝、心、脾、肺、肾,统归天之气,在五行则分别对应木、火、土、金、水。此外,暑作为“六气”之一,在三阴三阳理论中,暑为“少阴”,其性蒸腾。基于暑的这些属性,相应地,在致病方面,逆于夏长之气,主要表现为“伤心”,或说“太阳不长,心气内洞”。作为致病因素,夏伤于暑,主要特点是“热气盛,藏于皮肤之内,肠胃之外”及“其汗大出,腠理开发”。从“六气”角度而言,主要是“六气”间的淫、胜与复,其核心病机均是“火淫金病”。而《黄帝内经》关于“暑”这一概念的多元化论述,在后世造成了概念上的混淆,主要表现在“暑”与“热”“火”“湿”之间。“暑”“热”在古代为同一概念的不同说法,“暑”为“热”之性,《黄帝内经》常通用,后人区别之,“火”为五行之一,与“暑”相对应,即在天为“暑”,在地为“火”,“暑(热)”为“火”之化气;关于“暑”与“湿”的关系,统言“暑必兼湿”必然不妥,“暑”的兼“湿”与否,必须结合不同的历史时期与地域环境而论,但“暑”与“湿”别为二气,不可浑而言之。在论治方面,《黄帝内经》关于暑证的论治,从阴阳角度而言,是以调和阴阳升降为本;从五行与六气的角度而言,主要依五行间的生、克、制、化为准。这种论治思想,为李东垣清暑益气汤所继承,临证可根据患者的基本病情,或加减此方论治、或权衡各组药物比重随证施治,来解决大部分“暑证”;而王孟英所创同名方剂,基本是取法于《伤寒论》的“白虎加人参汤”,其所举病证,属于暑热伤津耗气的范畴。

关键词: 暑, 黄帝内经, 阴阳, 病证, 清暑益气汤

Abstract: The term of Shu (commonly known as summerheat) has multi-faceted connotationsin Huangdi Neijing(Huangdi's Internal Classic).Firstly, from the perspective of yin and yang, Shu is a both opposite and unified concept of cold; that is, Shu and cold are the criteria for the differentiation of yin and yang.Besides, warm, Shu, cool and cold correspond to the spring, summer, autumn and winter respectively.What's more, wind, Shu, dampness, dryness and cold correspond to the liver, heart, spleen, lung and kidney respectively in terms of the five organs, and wood, fire, earth, metal and water in terms of the five elements. In addition, in the three-yin three-yang theory, Shu corresponds to less yin, pertains to shaoyin, and is characterized by steaming. Based on these properties of Shu, correspondingly, disorders of Shu are mainly manifested as sadness.As a cause of disease, Shu is mainly “hidden beneath the skin and outside the stomach and intestines”, causing “profuse sweating with opening of the interstitial spaces”; or “metal (lung) disorder” according to the six-qi theory. The diversified discussion of the concept of Shu in Huangdi Neijing has caused conceptual confusion in later generations, mainly among the concepts of Shu, heat, fire and dampness. Shu and heat are two terms referring to the same concept, which are used alternately in Huangdi Neijing. Fire, as one of the five elements, corresponds to Shu. While Shu and dampness are two separate qi which can be seen together in historical periods and regional environment. In terms of treatment of Shu pattern in Huangdi Neijing, it's mainly through regulating the up-bearing and down-bearing of yin and yang, or by following the generating, restraining, counter-restraining, and transforming rules among the five elements. Such a therapeutic thinking pattern is inherited by Li Dongyuan in Qingshu Yiqi Decoction (Summerheat-resolving and Qi-boosting Decoction). In clinical application of the formula to treat most Shu patterns, modifications can be made in accordance to the patient's basic condition. Besides, the Qingshu Yiqi Decoction (Summerheat-resolving and Qi-boosting Decoction) established by Wang Mengying is based on the Baihu Jia Renshen Decoction (White Tiger Decoction Plus Ginseng) in Shang Han Lun (Treatise on Cold Damage) for the treatment of fluid damage and qi consumption due to Shu.

Key words: Shu (summerheat), Huangdi Neijing, yin and yang, disease syndrome, Qingshu Yiqi Decoction (Summerheat-resolving and Qi-boosting Decoction)

中图分类号: 

  • R221.09