金元时期易水学派的脏腑病机理论研究
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摘要
金元时期是中国医学学术思想繁荣兴盛的年代。金元医学,被称为上承秦汉晋唐宋,下启明清两代的重要历史阶段,各医家皆有丰富的创造发明,形成各具特色的医学理论,中国医学史上所称的“易水学派”就是在这个时期出现的一个主要医学流派。脏腑病机理论是中医基础理论里面一个核心组成部份,其中易水学派在脏腑病机理论的逐渐完备,起着承先启后的地位,在中国医学史上作出重要的贡献。
目前尚未有文献对易水学派的脏腑病机、脏腑辨证学说,以及对后世影响的全面研究。易水学派本身的医学内容非常丰富,全面整理、展示其医学内容,既可丰富中医学的理论体系,又可成为中医理论继续向前发展的基本素材,同时,易水学派的医学理论与临床实践紧密给合,有丰富的临床治疗经验可供给我们借镜,在今天仍然具有重要的指导意义。
研究范围以易水学派四大家：张元素、李东垣、王好古、罗天益等医家的著作为主要研究村料,并且搜寻与此相关的资料,包括医学典籍、医家著作、历代的文献等。本文在借鉴前贤的研究成果和研究方法的基础上,应用文献学和医学史的研究方法,从原文分析、阐述、整理他们著作的脏腑病机理论相关的内容,考查其医学内容的发生与演变的脉络,阐释其学说的具体内容。
易水学派是以研究脏腑病机理论为其主要学术内容。现代中医学把“病机”定义为疾病的发生及其发展变化的机理。本文追本溯源,从首载“病机”一词的《素问·至真要大论》开始,说明病机在《内经》中的意义,是指疾病最重要的,关键之处,更同时具有病因的含义,说明了掌握病机是治疗疾病的关键,所以中医学从其奠基的《内经》开始,便积极寻找疾病发生的根源。文中同时指出病机十九条实际上是提出了掌握病机的方法,即审证求因,为从证测病机,树立了典范,开辨证论治的先河,成为中医病机学的纲领性文献,奠定了中医病机学的基础。
《内经》以降,包括《内经》本身,对于病机意义的理解,除了指疾病的关键处之外,也有对疾病的发生过程、变化、转归、生死逆顺等,当中为何如此,其中推动其变化的机理等,有丰富的解释,这是对病机意义的扩展。文中同时提出,中医学对病机的机理解释,是基于从中医学对人体生理病理,包括对人体脏腑、气血津液的特有看法,应用阴阳五行理论作为推理工具,其中的理论前设、方法论等,与现代医学的病理学明显不同,研究两者的病机时应注意到这方面的差别。
本文用了主要的篇幅,从易水四大家的原文著作中,发掘他们在脏腑病机理论方面的内容,特别是易水学派的始创人张元素,因为现有文献对张元素的研究不足,深入研究他的医学主张别具意义。研究结果显示,张元素的脏腑病机理论是一个以五脏六腑为主体,以虚实寒热为纲,以脉证判断疾病情况、论述当中的病理变化、生死逆顺,理、法、方、药齐备的脏腑病机辨证论治体系。并且张元素进一步将六腑、经脉从属于五脏,构成一个以五脏为中心的脏腑病机理论。在标本问题上,经过分析论证,认为张元素所谓的“本病”是指脏腑之病,“标病”是经络之病。对于张元素来说,所谓治病求本,就是辨别出疾病是归属于五脏的那一脏,这便是找到了疾病的根源,就是病机所在。受刘完素的影响,张元素吸收了刘完素六气病机理论,成为他的脏腑病机理论的一部分。本文指出张元素在构建其脏腑病机理论的主体内容时,尝试将七篇大论与《内经》的病机内容作出整合。
张元素建造了一个比较平衡,同时又较为全面的脏腑病机理论,给后来者在一个稳固的基础之上漆砖筑瓦。李东垣在五脏之中,独重脾胃,认定脾胃就是疾病的关键所在,提出著名的“内伤脾胃,百病由生”之说,从“脾胃内伤”的角度深刻地剖析了外感热病与内伤发热的病因病机,并且提供了详细的症状鉴别的方法。李东垣在解释内伤发热产生的原因,断言是因为脾胃虚弱,对于当中病变的机理,李东垣提出了“阴火”概念,本文认为李东垣所谓的“阴火”是由于脾胃虚衰,元气不足,脾气不升反下流于肾,引致源于肾间的相火妄动,导致身体产生发热症状的一种不正常的火。
至于王好古,主要讨论了他所提出的阴证学说和三焦分证辨治体系。王好古论阴证,对于所有发热,烦燥,口渴欲饮冷水,出血…等等阳性的病征,王好古都认为是标证,甚至是假象,阴证的本是寒,根源在于脾肾虚损。他同时指出倘若患者是肾阳虚的话,是不宜再用升发阳气的方法,这和李东垣主张用升发阳气的方法治疗脾胃病有所不同,提出要分辨清楚根源在肾还是在脾胃,开宽了辨证的思路。三焦由于没有具体的解剖形状与位置,“有名而无形”,历代对此引起不少的争论,但是对于三焦的生理功能的认识则较为一致,认为三焦的主要生理功能是主持诸气以及是水谷之道路。王好古将三焦一腑分成上焦、中焦、下焦三个独立不同的部位来考虑病因病机,是对张元素的三焦寒热虚实病机的进一步发展,配合三焦寒热用药体例,形成稍具雏型的三焦分证辨治体系。
罗天益在脏腑病机理论方面,主要发挥了李东垣的脾胃学说,和确立了三焦辨证论治体系。对于导致脾胃损伤的原因,离不开李东垣所言,皆因被饮食与劳倦所伤,但是罗天益进一步认为饮与食应该分开处理,因为饮伤与食伤的病机与治疗方法皆有不同。他重视脾胃之余,同时注意到三焦与脾胃的关系密切。罗天益对于三焦的论述,在张元素、王好古的基础之上再有发展,所列出三焦的症状,明显己经函盖了五脏六腑,其中辨证上焦病包括了心肺的病变,中焦病包括了脾胃,下焦病包括了肝肾。罗天益进一步对三焦的分证论治,实际上已经把三焦的辨证应用到全身,具备一个独立的辨证体系的雏型。
易水学派的脏腑病机理论对后世影响较大的主要有三方面,就是脾胃学说、肾命学说和三焦辨证。脾胃学说方面,介绍了缪希雍的脾阴之说和叶天士的胃阴之说,薛己遥承易水诸家,在脾胃与肾命都有所发展；肾命学说介绍了孙一奎、张介宾和赵献可；易水各家对三焦的论述,促成三焦辨证体系的建立。
The Jin-Yuan era is a period of prosperity for the development of Chinese medicine scholastic thoughts. Jin-Yuan medicine is thought to be an important historical stage of inheriting the legacy of Qin, Han, Jin, Tang, Song dynasties, while ushering in the two later dynasties of Ming and Qing. All doctors have their inventive discoveries, forming various schools of medical theories with unique characteristics. What is known as "Yishui school" in Chinese medical history is one such major school that emerges during this era. Pathogenesis theory is a core component of basic theory of Chinese medicine. Yishui school gradually perfected their theory of pathogenesis which assumes the role of inheriting the past and ushering in the future. It is an important contribution in the history of Chinese medicine.
At present, there is no literature of comprehensive study on the Yishui school pathogenesis theory and theory of syndrome differentiation of zang-fu viscera, as well as their impact on the later generations. The content of medical theory in Yishui school is very rich. A comprehensive study and display of its medical contents will not only enrich the theoretical system of Chinese medicine but also serve as basic material for further development of Chinese medicine. At the same time the Yishui school medical theories are closely related with clinical practice. The Yishui doctors provide rich clinical experience for our reference. They are still important in providing guidance for clinical practice today.
This research uses the major writings of the four most important doctors, Zhang Yuansu, Li Dongyuan, Wang Haogu, Luo Tianyi of Yishui school as main research material. At the same time it is supplemented with other related material including medical records, writings of doctors and related literature throughout the generations. While relying on the research result and research methods of predecessors, this thesis also analyzes, expounds and reorganizes the original texts on pathogenesis theory related content using methods of philology and medical history research. It seeks to investigate on the genesis and development of its medical content and explain the content of the theory.
The main scholastic content of Yishui school is the study on zang-fu pathogenesis theory. Modern Chinese medicine defines pathogenesis as mechanism of genesis and development of disease. Tracing its origin the term "pathogenesis" is first found in "Theory of Vital Importance" of Suwen which defines its meaning. This shows the meaning of pathogenesis in Nei jing refers to the most important point or key point of disease. At the same time it implies the etiology of disease. Therefore, a good understanding of pathogenesis is the key to effective treatment. That is why starting from the foundational classic text of Neijing, Chinese medicine always seeks to find out the root cause of disease. The nineteen items of pathogenesis actually propose a method for grasping pathogenesis. It is a method of examining the symptoms in order to find the root cause, meaning arriving at a theory of pathogenesis by detailed observation of symptoms. A model is established for syndrome differentiation since then. It has become the guiding principle of pathogenesis in Chinese medicine, and serves as its foundational theory.
The understanding of pathogenesis from Neijing onward, including Neijing, aside from referring to the critical point of disease, it also includes the process of genesis, development, life and death reversal, and the reason of change in the process of disease. There are very specific explanations on the meaning of pathogenesis. The understanding of pathogenesis in Chinese medicine is based on its understanding of human pathology, including its peculiar view of human zang-fu viscera and qi-blood body fluid. It uses the Yin-yang theory and theory of five elements and its logical tool. Its premises and methodology are sharply differently from that of modern medicine. Any study on pathogenesis should notice their differences.
The main body of this thesis seeks to discover the specific content of theory of pathogenesis from the original writings of the four main doctors of Yishui school. Special attention is put on the founder of Yishui school Zhang Yuansu. Since current literature is very deficient on the study of Zhang Yuansu, in-depth research on his medical propositions is especially meaningful. The research shows the pathogenesis theory of Zhang Yuansu is a system of zang-fu viscera pathogenesis syndrome differentiation based on the five Zang-organs and six Fu-organs as focal point, trying to differentiate cold, heat, deficiency or excess, and using pulse symptom to judge disease condition. The theory is a complete system covering pathological change, life and death reversal, clinical principles, methods, prescriptions and medicine. In the matter of manifestation and root cause, after thorough analysis it is found that what Zhang Yuansu means disease of root cause refers to zang-fu viscera disease, while manifestation disease refers to meridian disease. For Zhang Yuansu,. treating disease at its root cause means identifying which of the five zang-fu viscera is responsible for the disease. This is the root cause of the disease and also where pathogenesis arises. Having been influenced by Liu Wansu, Zhang Yuansu assimilated Liu Wansu's six climatic factors pathogenesis theory to become part of his zang-fu pathogenesis theory. In constructing the main body of his zang-fu pathogenesis theory Zhang Yuansu attempts to incorporate the "Seven major chapters" with the pathogenesis content of Neijing.
Zhang Yuansu formulated a more balanced and comprehensive zang-fu pathogenesis theory. This provides a solid foundation for later generation to continue adding more details on top of it. On the other hand, Li Dongyuan emphasizes more on the spleen-stomach system among the five zang-fu viscera. He thinks the spleen-stomach system is critical in the genesis of disease. He proposed the very famous slogan of "various diseases arise after the spleen-stomach is hurt". He provides in-depth analysis of the etiology and pathogenesis of exogenous febrile diseases and endogenous febrile diseases from the point of view of spleen-stomach internal disorder. He also describes in detail the method of symptom differentiation. Li Dongyuan asserts that the reason for endogenous febrile disease is the weakness of spleen-stomach. As for the pathological mechanism, Li Dongyuan proposes the concept of "yin fire". The so-called "yin fire" proposed by Li Dongyuan is due to weakness in spleen-stomach, causing deficiency of primordial qi. Instead of going upward the spleen qi reverses downward towards kidney, causing the hyperactivity of ministerial fire. This causes the body to generate heat as a symptom of abnormal fire.
As for Wang Haogu he proposes the yin syndrome theory and three-burner syndrome differentiation system. In his yin syndrome theory Wang Haogu considers the yang disease symptoms such as fever, dysphoria, thirst desiring to drink cold water, etc as manifestation symptoms only, or even as fake phenomena. The root of yin syndrome is coldness. The cause is rooted in the degradation of spleen and kidney functionality. He also pointed out that if the patient suffers from kidney yang deficiency, it is inappropriate to use elevating and dispersing yang qi. This is sharply different from Li Dongyuan's proposal of using method of elevating and dispersing yang qi to treat spleen-stomach diseases. Wang suggests one must differentiate whether the root cause is in the kidney or spleen-stomach system. This widens the thinking for syndrome differentiation. Since the three-burner system has no specific anatomical shape and position, being the so-called "one with name but without shape", it has caused much debate over the generations. However, the understanding of the functionality of three-burner system is quite unanimous. Most think that the main function of the three-burner system is the path of qi as well as path of food. Wang Haogu separates three-burner system into upper burner, middle burner and lower burner in consideration for their disease etiology and pathogenesis. This is a further development on top of Zhang Yuansu's three-burner cold-heat-deficiency-excess pathogenesis. This theory coupled with the clinical practice of treating the three-burner cold and heat with specific medicine, it forms the preliminary three-burner syndrome differentiation and treatment system.
In terms of zang-fu viscera pathogenesis theory Luo Tianyi mainly elaborates the spleen-stomach theory of Li Dongyuan, and establishes the three-burner syndrome differentiation system. As for the cause of spleen-stomach impairment, he does not differ from what Li Dongyuan says, being mainly due to inappropriate food consumption and over-fatigue. However, Luo Tianyi further theorizes that drink and food should be treated separately, since injury due to drink and injury due to food are different both in terms of pathogenesis and method of treatment. While putting emphasis on spleen-stomach, he also notices that three-burner is closely related to the spleen-stomach. The description of Luo Tianyi on three-burner has further development from that of Zhang Yuansu and Wang Haogu. The symptoms he mentions about the three burners obviously cover the five Zang-organs and six Fu-organs. His upper burner diseases include heart and lung diseases. His middle burner diseases include spleen-stomach diseases. His lower burner diseases include liver and kidney diseases. The way Luo Tianyi treats three burners as three separate systems for treatment actually applies three-burner syndrome differentiation to the whole body, forming the preliminary model of an independent syndrome differentiation system.
The influence of zang-fu viscera pathogenesis theory of Yishui school on later generations is mainly on three aspects. Namely, spleen-stomach theory, kidney-vitalgate theory and three-burner syndrome differentiation theory. In terms of spleen-stomach theory, the spleen-yin theory of Miao Xiyong and the stomach-yin theory of Ye Tianshi are also discussed. Xue Ji inherits various sects of the Yishui school and further develops on both the spleen-stomach and kidney-vitalgate. For kidney-vitalgate the contributions of Sun Yikui, Zhang Jiebin and Zhao Xianke are also discussed. The descriptions of three-burner system of various sects of Yishui school finally bring about the establishment of a three-burner system syndrome differentiation.
目前尚未有文献对易水学派的脏腑病机、脏腑辨证学说,以及对后世影响的全面研究。易水学派本身的医学内容非常丰富,全面整理、展示其医学内容,既可丰富中医学的理论体系,又可成为中医理论继续向前发展的基本素材,同时,易水学派的医学理论与临床实践紧密给合,有丰富的临床治疗经验可供给我们借镜,在今天仍然具有重要的指导意义。
研究范围以易水学派四大家：张元素、李东垣、王好古、罗天益等医家的著作为主要研究村料,并且搜寻与此相关的资料,包括医学典籍、医家著作、历代的文献等。本文在借鉴前贤的研究成果和研究方法的基础上,应用文献学和医学史的研究方法,从原文分析、阐述、整理他们著作的脏腑病机理论相关的内容,考查其医学内容的发生与演变的脉络,阐释其学说的具体内容。
易水学派是以研究脏腑病机理论为其主要学术内容。现代中医学把“病机”定义为疾病的发生及其发展变化的机理。本文追本溯源,从首载“病机”一词的《素问·至真要大论》开始,说明病机在《内经》中的意义,是指疾病最重要的,关键之处,更同时具有病因的含义,说明了掌握病机是治疗疾病的关键,所以中医学从其奠基的《内经》开始,便积极寻找疾病发生的根源。文中同时指出病机十九条实际上是提出了掌握病机的方法,即审证求因,为从证测病机,树立了典范,开辨证论治的先河,成为中医病机学的纲领性文献,奠定了中医病机学的基础。
《内经》以降,包括《内经》本身,对于病机意义的理解,除了指疾病的关键处之外,也有对疾病的发生过程、变化、转归、生死逆顺等,当中为何如此,其中推动其变化的机理等,有丰富的解释,这是对病机意义的扩展。文中同时提出,中医学对病机的机理解释,是基于从中医学对人体生理病理,包括对人体脏腑、气血津液的特有看法,应用阴阳五行理论作为推理工具,其中的理论前设、方法论等,与现代医学的病理学明显不同,研究两者的病机时应注意到这方面的差别。
本文用了主要的篇幅,从易水四大家的原文著作中,发掘他们在脏腑病机理论方面的内容,特别是易水学派的始创人张元素,因为现有文献对张元素的研究不足,深入研究他的医学主张别具意义。研究结果显示,张元素的脏腑病机理论是一个以五脏六腑为主体,以虚实寒热为纲,以脉证判断疾病情况、论述当中的病理变化、生死逆顺,理、法、方、药齐备的脏腑病机辨证论治体系。并且张元素进一步将六腑、经脉从属于五脏,构成一个以五脏为中心的脏腑病机理论。在标本问题上,经过分析论证,认为张元素所谓的“本病”是指脏腑之病,“标病”是经络之病。对于张元素来说,所谓治病求本,就是辨别出疾病是归属于五脏的那一脏,这便是找到了疾病的根源,就是病机所在。受刘完素的影响,张元素吸收了刘完素六气病机理论,成为他的脏腑病机理论的一部分。本文指出张元素在构建其脏腑病机理论的主体内容时,尝试将七篇大论与《内经》的病机内容作出整合。
张元素建造了一个比较平衡,同时又较为全面的脏腑病机理论,给后来者在一个稳固的基础之上漆砖筑瓦。李东垣在五脏之中,独重脾胃,认定脾胃就是疾病的关键所在,提出著名的“内伤脾胃,百病由生”之说,从“脾胃内伤”的角度深刻地剖析了外感热病与内伤发热的病因病机,并且提供了详细的症状鉴别的方法。李东垣在解释内伤发热产生的原因,断言是因为脾胃虚弱,对于当中病变的机理,李东垣提出了“阴火”概念,本文认为李东垣所谓的“阴火”是由于脾胃虚衰,元气不足,脾气不升反下流于肾,引致源于肾间的相火妄动,导致身体产生发热症状的一种不正常的火。
至于王好古,主要讨论了他所提出的阴证学说和三焦分证辨治体系。王好古论阴证,对于所有发热,烦燥,口渴欲饮冷水,出血…等等阳性的病征,王好古都认为是标证,甚至是假象,阴证的本是寒,根源在于脾肾虚损。他同时指出倘若患者是肾阳虚的话,是不宜再用升发阳气的方法,这和李东垣主张用升发阳气的方法治疗脾胃病有所不同,提出要分辨清楚根源在肾还是在脾胃,开宽了辨证的思路。三焦由于没有具体的解剖形状与位置,“有名而无形”,历代对此引起不少的争论,但是对于三焦的生理功能的认识则较为一致,认为三焦的主要生理功能是主持诸气以及是水谷之道路。王好古将三焦一腑分成上焦、中焦、下焦三个独立不同的部位来考虑病因病机,是对张元素的三焦寒热虚实病机的进一步发展,配合三焦寒热用药体例,形成稍具雏型的三焦分证辨治体系。
罗天益在脏腑病机理论方面,主要发挥了李东垣的脾胃学说,和确立了三焦辨证论治体系。对于导致脾胃损伤的原因,离不开李东垣所言,皆因被饮食与劳倦所伤,但是罗天益进一步认为饮与食应该分开处理,因为饮伤与食伤的病机与治疗方法皆有不同。他重视脾胃之余,同时注意到三焦与脾胃的关系密切。罗天益对于三焦的论述,在张元素、王好古的基础之上再有发展,所列出三焦的症状,明显己经函盖了五脏六腑,其中辨证上焦病包括了心肺的病变,中焦病包括了脾胃,下焦病包括了肝肾。罗天益进一步对三焦的分证论治,实际上已经把三焦的辨证应用到全身,具备一个独立的辨证体系的雏型。
易水学派的脏腑病机理论对后世影响较大的主要有三方面,就是脾胃学说、肾命学说和三焦辨证。脾胃学说方面,介绍了缪希雍的脾阴之说和叶天士的胃阴之说,薛己遥承易水诸家,在脾胃与肾命都有所发展；肾命学说介绍了孙一奎、张介宾和赵献可；易水各家对三焦的论述,促成三焦辨证体系的建立。
The Jin-Yuan era is a period of prosperity for the development of Chinese medicine scholastic thoughts. Jin-Yuan medicine is thought to be an important historical stage of inheriting the legacy of Qin, Han, Jin, Tang, Song dynasties, while ushering in the two later dynasties of Ming and Qing. All doctors have their inventive discoveries, forming various schools of medical theories with unique characteristics. What is known as "Yishui school" in Chinese medical history is one such major school that emerges during this era. Pathogenesis theory is a core component of basic theory of Chinese medicine. Yishui school gradually perfected their theory of pathogenesis which assumes the role of inheriting the past and ushering in the future. It is an important contribution in the history of Chinese medicine.
At present, there is no literature of comprehensive study on the Yishui school pathogenesis theory and theory of syndrome differentiation of zang-fu viscera, as well as their impact on the later generations. The content of medical theory in Yishui school is very rich. A comprehensive study and display of its medical contents will not only enrich the theoretical system of Chinese medicine but also serve as basic material for further development of Chinese medicine. At the same time the Yishui school medical theories are closely related with clinical practice. The Yishui doctors provide rich clinical experience for our reference. They are still important in providing guidance for clinical practice today.
This research uses the major writings of the four most important doctors, Zhang Yuansu, Li Dongyuan, Wang Haogu, Luo Tianyi of Yishui school as main research material. At the same time it is supplemented with other related material including medical records, writings of doctors and related literature throughout the generations. While relying on the research result and research methods of predecessors, this thesis also analyzes, expounds and reorganizes the original texts on pathogenesis theory related content using methods of philology and medical history research. It seeks to investigate on the genesis and development of its medical content and explain the content of the theory.
The main scholastic content of Yishui school is the study on zang-fu pathogenesis theory. Modern Chinese medicine defines pathogenesis as mechanism of genesis and development of disease. Tracing its origin the term "pathogenesis" is first found in "Theory of Vital Importance" of Suwen which defines its meaning. This shows the meaning of pathogenesis in Nei jing refers to the most important point or key point of disease. At the same time it implies the etiology of disease. Therefore, a good understanding of pathogenesis is the key to effective treatment. That is why starting from the foundational classic text of Neijing, Chinese medicine always seeks to find out the root cause of disease. The nineteen items of pathogenesis actually propose a method for grasping pathogenesis. It is a method of examining the symptoms in order to find the root cause, meaning arriving at a theory of pathogenesis by detailed observation of symptoms. A model is established for syndrome differentiation since then. It has become the guiding principle of pathogenesis in Chinese medicine, and serves as its foundational theory.
The understanding of pathogenesis from Neijing onward, including Neijing, aside from referring to the critical point of disease, it also includes the process of genesis, development, life and death reversal, and the reason of change in the process of disease. There are very specific explanations on the meaning of pathogenesis. The understanding of pathogenesis in Chinese medicine is based on its understanding of human pathology, including its peculiar view of human zang-fu viscera and qi-blood body fluid. It uses the Yin-yang theory and theory of five elements and its logical tool. Its premises and methodology are sharply differently from that of modern medicine. Any study on pathogenesis should notice their differences.
The main body of this thesis seeks to discover the specific content of theory of pathogenesis from the original writings of the four main doctors of Yishui school. Special attention is put on the founder of Yishui school Zhang Yuansu. Since current literature is very deficient on the study of Zhang Yuansu, in-depth research on his medical propositions is especially meaningful. The research shows the pathogenesis theory of Zhang Yuansu is a system of zang-fu viscera pathogenesis syndrome differentiation based on the five Zang-organs and six Fu-organs as focal point, trying to differentiate cold, heat, deficiency or excess, and using pulse symptom to judge disease condition. The theory is a complete system covering pathological change, life and death reversal, clinical principles, methods, prescriptions and medicine. In the matter of manifestation and root cause, after thorough analysis it is found that what Zhang Yuansu means disease of root cause refers to zang-fu viscera disease, while manifestation disease refers to meridian disease. For Zhang Yuansu,. treating disease at its root cause means identifying which of the five zang-fu viscera is responsible for the disease. This is the root cause of the disease and also where pathogenesis arises. Having been influenced by Liu Wansu, Zhang Yuansu assimilated Liu Wansu's six climatic factors pathogenesis theory to become part of his zang-fu pathogenesis theory. In constructing the main body of his zang-fu pathogenesis theory Zhang Yuansu attempts to incorporate the "Seven major chapters" with the pathogenesis content of Neijing.
Zhang Yuansu formulated a more balanced and comprehensive zang-fu pathogenesis theory. This provides a solid foundation for later generation to continue adding more details on top of it. On the other hand, Li Dongyuan emphasizes more on the spleen-stomach system among the five zang-fu viscera. He thinks the spleen-stomach system is critical in the genesis of disease. He proposed the very famous slogan of "various diseases arise after the spleen-stomach is hurt". He provides in-depth analysis of the etiology and pathogenesis of exogenous febrile diseases and endogenous febrile diseases from the point of view of spleen-stomach internal disorder. He also describes in detail the method of symptom differentiation. Li Dongyuan asserts that the reason for endogenous febrile disease is the weakness of spleen-stomach. As for the pathological mechanism, Li Dongyuan proposes the concept of "yin fire". The so-called "yin fire" proposed by Li Dongyuan is due to weakness in spleen-stomach, causing deficiency of primordial qi. Instead of going upward the spleen qi reverses downward towards kidney, causing the hyperactivity of ministerial fire. This causes the body to generate heat as a symptom of abnormal fire.
As for Wang Haogu he proposes the yin syndrome theory and three-burner syndrome differentiation system. In his yin syndrome theory Wang Haogu considers the yang disease symptoms such as fever, dysphoria, thirst desiring to drink cold water, etc as manifestation symptoms only, or even as fake phenomena. The root of yin syndrome is coldness. The cause is rooted in the degradation of spleen and kidney functionality. He also pointed out that if the patient suffers from kidney yang deficiency, it is inappropriate to use elevating and dispersing yang qi. This is sharply different from Li Dongyuan's proposal of using method of elevating and dispersing yang qi to treat spleen-stomach diseases. Wang suggests one must differentiate whether the root cause is in the kidney or spleen-stomach system. This widens the thinking for syndrome differentiation. Since the three-burner system has no specific anatomical shape and position, being the so-called "one with name but without shape", it has caused much debate over the generations. However, the understanding of the functionality of three-burner system is quite unanimous. Most think that the main function of the three-burner system is the path of qi as well as path of food. Wang Haogu separates three-burner system into upper burner, middle burner and lower burner in consideration for their disease etiology and pathogenesis. This is a further development on top of Zhang Yuansu's three-burner cold-heat-deficiency-excess pathogenesis. This theory coupled with the clinical practice of treating the three-burner cold and heat with specific medicine, it forms the preliminary three-burner syndrome differentiation and treatment system.
In terms of zang-fu viscera pathogenesis theory Luo Tianyi mainly elaborates the spleen-stomach theory of Li Dongyuan, and establishes the three-burner syndrome differentiation system. As for the cause of spleen-stomach impairment, he does not differ from what Li Dongyuan says, being mainly due to inappropriate food consumption and over-fatigue. However, Luo Tianyi further theorizes that drink and food should be treated separately, since injury due to drink and injury due to food are different both in terms of pathogenesis and method of treatment. While putting emphasis on spleen-stomach, he also notices that three-burner is closely related to the spleen-stomach. The description of Luo Tianyi on three-burner has further development from that of Zhang Yuansu and Wang Haogu. The symptoms he mentions about the three burners obviously cover the five Zang-organs and six Fu-organs. His upper burner diseases include heart and lung diseases. His middle burner diseases include spleen-stomach diseases. His lower burner diseases include liver and kidney diseases. The way Luo Tianyi treats three burners as three separate systems for treatment actually applies three-burner syndrome differentiation to the whole body, forming the preliminary model of an independent syndrome differentiation system.
The influence of zang-fu viscera pathogenesis theory of Yishui school on later generations is mainly on three aspects. Namely, spleen-stomach theory, kidney-vitalgate theory and three-burner syndrome differentiation theory. In terms of spleen-stomach theory, the spleen-yin theory of Miao Xiyong and the stomach-yin theory of Ye Tianshi are also discussed. Xue Ji inherits various sects of the Yishui school and further develops on both the spleen-stomach and kidney-vitalgate. For kidney-vitalgate the contributions of Sun Yikui, Zhang Jiebin and Zhao Xianke are also discussed. The descriptions of three-burner system of various sects of Yishui school finally bring about the establishment of a three-burner system syndrome differentiation.
引文
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