论丹溪治痿与痹南泻补北的浅析.docVIP

论丹溪治痿与痹南泻补北的浅析 浙江省义乌市新法风湿病医院 贝新法 江凤鸣 贝芹 【摘要】朱丹溪在治疗痿证从中医五行生克制化中提出南方属心火，北方属水，东方属肝木，西方属肺金，脾土性温属中。若嗜欲无节，则水失所养，火寡于畏，而侮所胜，肺得火邪而热矣。木性刚急，肺受热则金失所养，木寡于畏而侮所胜，脾得木邪而伤矣。肺热则不能管摄一身，脾伤则四肢不能为用，而诸痿之病作。泻了南方补了北方是治该病指导思想。在后世医家中得到长足发展。为此对他的病证原文、病证分析、典型医案，结合现代治萎的理论进行讨论。有肺痿及肢痿，痿与痹之别，以助医者借鉴。 Zhu Dan-xi in the treatment of atrophy permit from the Health and restraint in the five elements of Chinese medicine made in the South are Firelight, the North is water, is a liver restricting the East, the West is a lung payments, Pitu and warm the genus. If thnve appetite-free section, then the water loss by cultivation, fire widowed in fear, but be insulted by the wins, the lung was evil and hot carry on the fire. Wood of just acute pulmonary heat loss has raised the gold, wood widowed and humiliated by Yu Wei-sheng, the spleen was evil and injury carry on wood. Hyperactivity can not control photo 1, spleen injuries were the limbs can not be used, but Zhu atrophy as the disease. Xie added the South in the North is the guiding ideology of governance of the disease. In the later medical home by leaps and bounds. This card to his original illness, the sick forensic analysis, the typical medical case, combined with the theory of modern governance wilt be discussed. There Fei Wei and limb atrophy, atrophy and paralysis of difference, to help the medical reference. 【关键词】朱丹溪 泻南补北 痿证 痹证 痿证是指肢体筋脉弛缓、软弱无力，日久因不能随意运动而致肌肉萎缩的一种症证。《内经》对痿证的记载颇详，在《素问·痿论篇》中作为专题论述，指出本病主要病理为“肺热叶焦”，肺燥不能输精于五脏，因而五体失养，产生痿软证候。朱丹溪则更加深入研究，纠正“风痿混同”之弊，提出“泻南方、补北方”的治痿指导思想①。在辩证施治方面又分为湿热、湿痰、气虚瘀血之别。许多学者曾沿用该理论来治疗痿痹，收到了明显的效果。 1、病证原文 诸痿生于肺热，只此一句，便见治法大意。《经》曰东方实西方虚，泻南方补北方。此固是就生克言补泻，而大经大法不外于此。东方，木肝也；西方，金肺也；南方，火心也；北方，水肾也。五行之中，惟火有二，肾虽有二，水居其一。阳常有余，阴常不足。故《经》曰一水不胜二火，理之必然。肺金体燥而居上，主气畏火者也；脾土性湿而居中，主四肢畏木者也。火性炎上，若嗜欲无节，则水失所养，火寡于畏，而侮所胜，肺得火邪而热矣。木性刚急，肺受热则金失所养，木寡于畏而侮所胜，脾得木邪而伤矣。肺热则不能管摄一身，脾伤则四肢不能为用，而诸痿之病作。泻南方，则肺金清而东方不实，何脾伤之有？补北方，则心火降而西方不虚，何肺热之有？故阳明实则宗筋润，能束骨而利机关矣。治痿之法，无出于此。骆隆吉亦曰：风火既炽，当滋肾水。东垣先生取黄柏为君，黄芪等补药之辅佐，以治诸痿，而无一定之方。有兼痰积者，有湿多者，有热多者，有湿热相半者，有挟气者，临病制方，其善于治瘘者乎。（《局方发挥》）