| 秦雨筱,李想,谷建军.基于张景岳“相火有形有位”理论探讨内伤热病的辨治[J].浙江中医药大学学报,2025,49(1):59-64. |
| 基于张景岳“相火有形有位”理论探讨内伤热病的辨治 |
| Treatment Based on Syndrome Differentiation in Internal Injury Fever Based on ZHANG Jingyue ’s Theory of “Ministerial Fire Has Tangible Position” |
| DOI：10.16466/j.issn1005-5509.2025.01.010 |
| 中文关键词: 张景岳 内伤热病 相火 元气 肾阳 火非土不荣 虚损发热 命门 |
| 英文关键词: ZHANG Jingyue internal injury fever ministerial fire original Qi kidney-Yang fire does not flourish without soil deficiency fever Mingmen |
| 基金项目:国家社科基金项目冷门绝学研究专项(22VJXG041)；北京市社科基金项目(20ZXB002)；北京中医药大学揭榜挂帅项目(2023-JYB-JBZD-067) |
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| 中文摘要: |
| [目的] 基于张景岳“相火有位有形”理论，探究内伤热病的辨证思路与治疗方案，以期为内伤热病如虚损发热、遗精、血证、消渴证等的临床辨治提供新思路。 [方法] 通过研习张景岳的相关著作《景岳全书》《类经》，结合其他医家如刘完素、朱丹溪、李东垣等的著作，讨论相火理论在内伤热病辨证治疗中的应用方法。结合医案，总结归纳内伤热病的辨治思路，讨论张景岳的相火理论在虚损发热、遗精、血证、消渴证等具体热病治疗中的作用。 [结果] 张景岳认为相火“有位”，其生于命门，遍布各个脏腑之中，人体一切内生热病都与之息息相关。内伤热病发病多以虚为主，相火“有形”，可依据相火“必著于”血气、脏腑等“确有证据”之物的损伤来展开辨治。其病机主要有脾元虚、阴精虚、元阳虚三个方面，诊疗应注重调中宫而除热、益精血以制火、温肾命而摄火，据辨证情况用药上重视甘温、甘凉类药物和温补扶阳类方剂的使用，灵活运用滋补方药。 [结论] 张景岳对相火理论有极为深刻的认识，在汲取前人思想精华的基础上，常有自己的新见解。其“相火有位有形”理论对讨论内伤热病的病机、辨治有重要价值，值得后世借鉴与参考。 |
| 英文摘要: |
| [Objective] Based on ZHANG Jingyue’s theory of “ministerial fire has a place and is visible”， to explore the syndrome differentiation thinking and treatment plan about injury fever syndrome differentiation， in order to provide new ideas for the clinical treatment of internal injury fever such as deficiency fever， spermatorrhea， blood syndrome， diabetes syndrome and so on. [Methods] By studying the relevant works of ZHANG Jingyue ’s Jingyue Encyclopedia and Classified Classic， combined with the works of other doctors such as LIU Wansu， ZHU Danxi， LI Dongyuan， etc.， it discussed the application of ministerial fire thought in the syndrome differentiation and treatment of internal injury fever. Combined with medical records， three ideas of syndrome differentiation and treatment of internal injury fever were summarized: spleen-Qi deficiency， Yin essence deficiency and original Yang deficiency， corresponding to three treatment methods of regulating middle-Jiao， benefiting essence and blood， and warming body origin. Combined with clinical practice， it summarized the diagnostic and treatment thought of internal injury fever， and discussed the role of ZHANG Jingyue ’s ministerial fire theory in the treatment of specific febrile diseases such as deficiency fever， spermatorrhea， blood syndrome and diabetes syndrome. [Results] ZHANG Jingyue believed that ministerial fire “has a place”， which was born in Mingmen and all over the viscera. All endogenous fevers in the human body were related to it. And ZHANG proposed that the incidence of internal injury fever was mainly deficiency， and ministerial fire was “tangible”， which could be differentiated and treated according to the fact that ministerial fire must be damaged by “blood Qi， viscera and other evidence ”. Its pathogenesis mainly included three aspects: spleen-Qi deficiency， Yin essence deficiency and original Yang deficiency. The diagnosis and treatment should pay attention to regulating the middle palace and heat， benefiting essence and blood to make fire， warming kidney and life to absorb fire.According to the syndrome differentiation situation， in terms of medication， it should pay attention to the use of sweet and warm， sweet and cold drugs also warming and tonifying Yang prescriptions flexibly. [Conclusion] ZHANG Jingyue had a very profound understanding of the theory of ministerial fire. On the basis of absorbing the essence of predecessor’s thoughts， he often had his own new insights. His theory of ministerial fire had important value in discussing the pathogenesis and treatment of internal injury fever， which was worthy of reference for the later generations. |
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