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“阴中求阳”配伍研究
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摘要
“阴中求阳”是补肾阳方剂的重要配伍方法,是基于中医学整体观念的阴阳互根学说在肾阳虚证治疗实践中的具体应用。本文全面阐述了“阴中求阳”理论的起源与发展过程及其不同历史阶段的方剂应用特点,并收集古今文献记载的549首补肾阳方剂,应用Access表建立补肾阳方剂数据库。通过系统整理和深入分析,揭示了补肾阳方剂中配伍补阴药物以“阴中求阳”的部分应用规律。
     1.临床应用指征古代“阴中求阳”之剂,主要用于阳气不足、肾精亏虚者,以神疲乏力、腰膝酸软、阳痿为主要临床特点;而“纯阳益火”之剂,主要用于命门火衰、虚寒较著者,以小便频数、不思饮食、畏寒肢冷为主要临床特点。现代医家则不论寒之微甚,精亏与否,大凡肾阳不足之证,皆以“阴中求阳”之剂治之。
     2.补肾药物选择古今“阴中求阳”剂中之补肾阴药,皆以温润补肾填精之熟地黄(干地黄)、山药、山茱萸、枸杞子等为常用,意在既可滋阴补虚、填精益髓,又无寒凉伤阳之弊。古今“阴中求阳”剂中之补肾阳药,皆以附子、肉桂、菟丝子、巴戟天、肉苁蓉等为常用。其中附子、肉桂温阳之力峻,用以迅速恢复已失之肾阳;菟丝子、巴戟天、肉苁蓉温补肾阳之中兼可补肾益精,既可助附、桂温阳之功,亦寓“阴中求阳”之道。
     3.补阴药物比重现代治疗肾阳亏虚之证,应用“阴中求阳”之法者达90%以上,远远超过以往任何时代,方中补阴药的比重也由古方的20.50%提高至27.91%,剂量由24.40%提高到32.47%,反映了现代中医对于阴阳相生互化关系的高度重视。
     4.“阴中求阳”作用内涵肾阳是对肾中精气的热、升、动等属阳性功能之概括,肾阳亏虚的物质基础包含肾中精气的不足。因而治疗肾阳虚损之剂,在以辛热入肾之药物为主以补充加强其热、升、动之效能的同时,配入滋肾填精之品则更有助于肾中阳气的恢复以提高疗效。
     5.与“阴阳并补”之别“阴中求阳”与“阴阳并补”之剂皆以补阳药配伍补阴药为主组成,但方中药物的应用尤其是补阴药的选择有所区别。前者常用熟地黄、山药、山茱萸等甘温甘平之味,适宜于肾阳虚弱兼肾精亏虚或肾气不足者,以腰膝酸软、神疲乏力、阳痿、畏寒肢冷等为主要临床表现,代表方如右归丸;后者适宜于既有腰膝酸软、阳痿遗精、畏寒肢冷等肾阳虚征象,又有盗汗、午后潮热等肾阴虚表现的阴阳两虚证,故方中所用补阴药既有甘温益精之品,也常配伍甘寒滋润兼清虚热之味,代表方如地黄饮子。
"Reinforcing Yang from Yin" is an important compatibility method in tonifying kidney Yang prescriptions,which is based on the overall concept of Yin and Yang of Chinese medicine interaction root of the theory in the practice treating kidney deficiency syndrome specific application. This thesis expatiate "reinforcing Yang from Yin" theory of the origin and development of its different historical stages and the prescription application characteristics, collecting 549 ancient and modern literature tonifying kidney Yang prescriptions, applying access table to set up tonifying kidney tonifying Yang prescriptions database. Sorting through the system and in-depth analysis reveals tonic Yin drugs in tonifying kidney Yang prescription with "reinforcing Yang from Yin" part of the application of the law.
     1. Clinical indications Ancient " reinforcing Yang from Yin " prescriptions, mainly for lack of kidney Yang, deficiency of kidney essence leading to fatigue, lassitude and knees, impotence as the main clinical features; and The agent of pure Yang benefiting fire ", mainly used for the patients of Mingmen Huoshuai and cold,frequent urination, no appetite, aversion to cold for the main clinical features. Modern physician, regardless of the micro very cold, sperm loss or not, in almost all kidney deficiency with " reinforcing Yang from Yin "prescriptions to treat.
     2. Selecting of invigorating kidney Tonic kidney Yin drugs in ancient and modern " reinforcing Yang from Yin "prescriptions are warm moist Bushentianjing of cooked Rehmannia (dry Rehmannia) yam, Cornus, Lycium, etc. for the common intention of tonic Yin, filled marrow, nor cold injury Yang. Agent of tonic kidney Yang medicine in ancient and modern "reinforcing Yang from Yin"prescriptions are aconite, cinnamon, dodder seed, Morinda officinalis how, Cistanche, etc. as common. Which aconite, cinnamon are powerful tonic yang of force for the rapid restoration of the lost kidney yang; dodder seed, Morinda officinalis how, among Cistanche can warming kidney and may get Bushenyijing, can help aconite, cinnamon to warm, also including "reinforcing Yang from Yin" way.
     3.The proportion of tonic Yin The proportion of application "reinforcing Yang from Yin" rule for treating kidney Yang deficiency at present is more than 90%, far more than any previous era, the proportion of tonic yin drugs in prescriptions is from the ancient 20.50% increased to modern 27.91%, the dose increase from the 24.40% to 32.47%, reflecting the modern TCM doctors appreciate the relationship of Yin and Yang each other.
     4. "Reinforcing Yang from Yin" connotation kidney Yang is the general positive function summarization to a kidney essence gas heat, rise, move and so, the material basis of kidney Yang deficiency include renal refined gas deficiency. Prescriptions to treat kidney Yang deficiency select pungent warm drugs into kidney, in order to supply and reinforce heating rising moving into the kidney,meanwhile with tonic kidney and elite t is more helpful recovery of kidney Yang
     5. Difference with " Yin and Yang supplement together " The prescriptions of "reinforcing Yang from Yin" and " Yin and Yang supplement together " are composed chiefly of tonic Yin and Yang drugs, but the application of drugs in prescription and choice especially differ. The former as cooked rehmannia, yam, Cornus etc, is sweet warm suitable for deficiency of kidney Yang deficiency and kidney elite weak or insufficient kidney Qi, fatigue, impotence, aversion to cold, as the main clinical manifestations, on behalf of Yougui Pill; the later is suitable for both weak waist, impotence emission, aversion to cold and other signs of kidney Yang deficiency, but also sweating, hot flashes afternoon etc. kidney Yin deficiency manifestations of both Yin and Yang deficiency, so drugs of tonic Yin in the prescription are both sweet warm tonic elite products, often combined with sweet cool moist and clear adynamic fever, on behalf of precriptions such as Di Huang Yin Zi.
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