最新消息显示在全站导航条下方,非常给力的推广位置

人体气机圆转及升降法时

中医与命理 昌达空间 1140℃ 0评论

    人体气机升降调节中,心肾相交为一对,脾胃枢纽为一对,肝升肺降为一对,此配偶之功。如此,各显其功,各得其衡,人体气机升降之圆运动自能相谐而旋。

   《黄帝内经》有脏气法时观,再深化一步就是人体的升降法时。古人之论,多喜以年之春、夏、秋、冬,而临床之证,未必都经四季,故变之为昼、夜、晨、昏,应更具实操性。

  中医学本为体道之学,作为本原之道,中医学倾向于以“气”为道;作为规律之道,中医学更多的是参照阴阳、五行规律与法则。故由本原之道所演,天人合一、道理相贯之气在人体的运作,所循规律亦不离阴阳、五行法则,并主要体现在脏腑气机的升降上。

 1.jpg

气机圆转

  气机圆转,指人体内气的正常运行机制,包括脏腑经络等的功能活动。

    气运动的基本形式是升、降、出、入。而其过程主要是通过脏腑的功能及相互之间的协调来体现,并常以圆转之升降而显,如图1所示。

  图1之太极左阳右阴,左主升而右主降,中间为升降之枢轴。应于人体脏腑,脾胃居中,一升一降,为气机升降的枢纽。肝应春木,主疏泄,从左而升;肺应秋金,主肃降,从右而降,为气机升降之圆的外翼。心火宜降,肾水宜升,水升火降,相互为用,即为既济。既济者,水火之轮运转,升降由此启动。然此论尚简,个中义蕴对临证思路之启迪处,意犹未尽,仍可深论。

1.心肾相交启升降2.jpg

  心属火,配离卦,居太极之上而属阳;肾属水,配坎卦,居太极之下而属阴。两者关系主要表现为阴阳、水火、升降间的互制互用与平衡协调。从阴阳交感观念看,位于下者,以上升为顺;位于上者,以下降为和。所以,心火当下暖于肾,肾水须上济于心,这样心肾之间的生理功能才能协调。心与肾功能间若能建立这种良性联系,称为“心肾相交”,亦《易经》所云水火既济卦。此卦坎水居离火之上,上水能制约下火,下火能蒸腾上水,相互为用,故云“既济”,如图2。“既济”于人体言,喻心火能降于下而温肾水,故离火居于下;肾阳得心火之助则蒸水上腾以制心火,故坎水居上。如是则水火既济,心肾相交而相和谐。3.jpg

  然心属火,本居上,火性又炎上;肾属水,本居下,水性又润下,两者易分不易合。则水升当需上达之动力,火降亦需下行之引子。即“既济”是需要条件的,但条件在哪?八卦本有卦主之说,《易纂言外翼·卷一》云:“小成之卦八,震巽下为主,坎离中为主,艮兑上为主,此因乾坤交易而定也。”具体到坎、离两卦,则卦主为坎中之阳爻与离中之阴爻,此即“坎离中为主”。坎配肾,坎中之阳,即肾中之阳,火处水中,则易蒸津而使肾水上济,此自然界“地气上为云”之象;水既上济,即补离中之阴,离阴既足,其性降,仿若“天气下为雨”,引领离火下温坎阳,坎阳得离火之助,其力更充,蒸水化气之功愈强,水复腾上,更助离阴带动离火下降……如是不断坎离互转,水火既济,呈良性的功能循环。

  值得注意的是:心肾相交的意义并不局限在两脏间的功能协调,更是全身气机升降的动力,即朱丹溪《格致余论》所言的“人之有生,心为之火居上,肾为之水居下,水能升而火能降,一升一降,无有穷矣,故生意存也”。然心肾两者何为原动力?基于火性炎上原理,当阳居下位,其气温升自能煦暖其上之脏腑,且阳性主动,故坎中之阳(肾阳、命火、龙火)当为人体升降的原动力,下降的离火则为其最大助力。如此,阳木得煦则肝升,阴土得暖则脾升,启动人体太极左半圆之温升。此理置之临床,如中气下陷之证,以补中益气丸治之,若效不甚著,可加肾气丸少火生气以助温升;若不用丸而用补中益气汤,笔者常以李可先生之肾四味(补骨脂、淫羊藿、菟丝子、枸杞子)益之。若阳虚无力助肝升之证,同样可以在疏肝、升肝基础上以肾气丸为助。阳升至极则阴降,离中之阴(心阴)滋洒,燥金得润,肺能顺降;阳土受霖,胃自和降,旋转人体右半圆之凉降。古方麦冬之用颇值玩味,麦冬一味能滋心、润肺、益胃,故滋阴或兼滋阴的名方如麦门冬汤、沙参麦冬汤、百合固金汤、益胃汤、一贯煎、生脉饮、竹叶石膏汤、玉女煎,等剂中,其身影屡现,道理或在右半圆之凉降自心而降,方能甘霖遍洒。

2.脾升胃降枢轴转

  脾胃共居中焦,脾主升清,运精微与津液上达;胃主降浊,降食糜与糟粕下行。《临证指南医案》说:“脾宜升则健,胃宜降则和。”脾升胃降,对于全身气机的调节起的是中轴枢转作用。黄元御于《四圣心源》中谓:“四维之病,悉因于中气,中气者,和济水火之机,升降金木之轴。”彭子益的《圆运动的古中医学》承此意进一步论证:“中气左旋则木火左升,中气右转则金水右降,转者由上而下,旋者由下而上。中气为轴,四维为轮。”即中土脾升胃降为人体太极的枢纽,在此枢纽的升降带动下,肝木、肺金、心火、肾水四维均绕其周而旋转,共同完成人体生命的气化圆运动,其理仍可参图1。

  枢纽不是空谈,临证可法。譬如心肾不交的失眠,清心益肾同时,亦可旋转脾胃枢机,以促水火既济。南方人阳热易偏于上、外,而亏于下、内,因此心火旺、肾阳虚之心肾不交失眠者不在少数,笔者在临床上常以交泰丸加龙骨、牡蛎、白术、茯苓治之,疗效颇佳。方中黄连清心火,味苦能降,不仅降心火,亦可降胃浊;肉桂温肾阳,引火归源,肾阳暖则脾土得温而自能升。《医宗金鉴》云:“脾阳苟不运,心肾必不交。”南方不仅热,而且湿,湿易伤脾,则白术、茯苓一燥一渗,燥者温化而升清,渗者利湿而降浊;黄连、肉桂、白术、茯苓合而斡旋中州(脏腑与地势相应的部位。六腑膈下三脏应中州),运转枢轴,使水升火降,交相既济;龙骨、牡蛎镇心安神,引浮阳下潜,则心肾益交。

3.肝肺升降外翼旋

  中医向有左肝右肺之说,常遭垢病(指责),这是以解剖学视角,对中医观点断章取义的一例。上说非言肝、肺的解剖位置分列人体左右,而是依太极之圆(参图1),以左右为路径,肝从左升、肺从右降,协合为人体升降之外翼。

  太极左升右降之说,主要源于中国东南西北不同的地理阴阳环境。中国南方阳气旺,日照时间长,《周易·说卦》有:“圣人南面而听天下,向明而治。”南面、向明即面向阳,古谓主吉,于建筑物则利于采光。所以,自古以来从帝王到普通老百姓住的房子多是坐北向南。此时,南在前,北在后,东在左,西在右。而东方(左)是太阳升起的方位,西边(右)是太阳下山的方位,左阳右阴、左升右降的观念由此产生。《素问·阴阳应象大论》曰:“左右者,阴阳之道路也。”中医藏象学有着明显的重功能轻结构倾向。肝主疏泄,以木气之升发、条达(疏通)、舒畅为生理特性,故应四季之春,一日之晨,方位之东,为少阳之处,故从于左;肺主肃降,以金气之肃降、收敛为生理特性,故应四季之秋,一日之夕,方位之西,为少阴之处,故从于右。左肝右肺之说由是产生。至于肝肺的解剖位置,古人早有明述,并无错位。

  在这里,我们还要明白一个道理,中医所言的气机升降并非垂直升降,而是太极圆转的升降。圆,才有可能于旋转之中升极而降,降极而升,升降相因,相反相成,相互协调。如果是垂直升降,则降将有碍升,升将有碍降了。是以肝气升发与肺气肃降升降相因,相反相成,成人体气机升降之外翼,协调人体气机,保持升降平衡状态。

  笔者对肝气郁结证一般以四逆散或柴胡疏肝散治之,多能奏效。偶若未果,则喜加一味前胡,于大队疏肝、升肝之品中,略降肺气,以使肝升肺降,相因相成,太极旋转,一身之气自转,每能增效。柴胡与前胡之协,《本经疏证》有谓:“柴胡主肠胃中结气,前胡主心腹结气;柴胡主饮食积聚,前胡主痰满胸胁中痞。足以见柴胡之阻在下,前胡之阻在上,在下则有碍于升,在上则有碍于降,去其阻而气之欲升者得升,欲降者得降。”

  既为外翼,则肝升、肺降就不纯粹是两脏间的关系,它脏它腑亦可一借其力。如补中益气汤以黄芪、升麻升中土之脾气,然脾居太极之中,恐其升力有未逮(达不到),顾肝位太极之左,肝从左升,力矩较长,易于带动力矩短的脾升,是以加一柴胡,从肝、从木、从少阳之升以助脾升。《雷公炮制药性解》谓柴胡:“补中益气汤用之,亦以其能提肝气之陷者,由左而升也。” 肝升助脾升的药有了,然则降肺以助降胃的药有没有?有,枇杷叶、竹茹可降肺,亦可降胃,是一举两得之药。

  参考力矩作用,再考究力量,肝气、肝阳易亢不易虚,肺之肃降有赖呼吸,而呼吸是可自调的,若善于利用,两翼升降之力不比中轴之转为弱。故左半圆之升常依肝木生升,右半圆之降需赖肺金顺降。

  综合而论,在人体气机升降调节的功能配合中,心肾相交为一对,脾胃枢纽为一对,肝升肺降为一对,此配偶之功。肾、肝、脾,从左从阳而升,为一组;心、肺、胃,从右从阴而降,为另一组,此同心之力。肾、肝在下,在下者宜升;心、肺在上,在上者宜降;脾胃在中间,则一升一降,此交感之道。如此,各显其功,各得其衡,人体气机升降之圆运动自能相谐而旋。

  若轮失其转,多为配偶失谐,或同组离心,或交感不再,当察而调之。

 

升降法时

  法时,效法宇宙日出日落,四季交替的时间变化。

    《周易·系辞下》的“变通者,趣时者也”,以及《乾》文言的“终日乾乾,与时偕行”中所倡的“变通趣时,与时偕行”观,应是中医法时理论之源头。《黄帝内经》由是而有脏气法时观,再深化一步就是人体的升降法时。

  升降法时理论最实用处常显在临床之治。《侣山堂类辩》曰:“升降浮沉则顺之,寒热温凉则逆之。谓春宜用升,以助生气;夏宜用浮,以助长气,秋时宜降,以顺收令;冬时宜沉,以顺封藏。此药性之宜顺四时者也。”但古人之论,多喜以年之春、夏、秋、冬,大而化之而论。

    而临床之证,未必都会经历四季,因此,变之为昼、夜、晨、昏,更具实操性。如图3。夏天最热,中午是一天中温度最高,明亮度最大的时间,均有阳气最盛的特点,因此配太极图阳气最旺的太阳位(离);冬天最冷、夜半是一天中温度最底,明亮度最小的时间,均有阴气最盛的特点,因此配太极图阴气最重的太阴位(坎);春天气温回暖,阳气渐长,早上在一天中也是气温渐升,明亮度渐清之时,故处阳气渐长而未盛的少阳位(震);秋天气温转凉,阴气渐长,傍晚在一天中也是气温渐降,明亮度渐暗之时,故处阴气渐长而未盛的少阴位(兑)。故夏与午同位、冬与夜同位、春与晨同位、秋与夕同位,则“春宜用升,以助生气;夏宜用浮,以助长气,秋时宜降,以顺收令;冬时宜沉,以顺封藏”可作同位之词的置换而成:“晨宜用升,以助生气;午宜用浮,以助长气,夕时宜降,以顺收令;夜时宜沉,以顺封藏。”

  升降法时于临床如何把握?这里以一治验为例:曾接诊一男性患者,31岁,主诉是腰酸痛一年,余无明显不适,舌略淡,脉两尺略细,此肾虚无疑。患者无明显寒热表现,不难推断:不是肾气虚就是肾精虚。看过往治史,所开处方大多为金匮肾气丸,或济生肾气丸加减之类,只是易丸为汤。方证应是合拍,然何一直未效?仔细询之,他的“腰酸每发于早上5~7时,每因痛而醒”,这一句话引起了笔者注意。细思,卯时正当阳升之时,应于少阳。肾之精气不足,于阳升之时当升而无力升,故气憋郁而痛。于是,以金匮肾气丸为底方,加柴胡12克,葛根30克,七剂,嘱晨起5~6时服药。下周来复诊,诉仅服1剂,腰痛即愈,一周未犯。后因它病来诊,再询此患,回复是一直未再犯。

  本方所加柴胡、葛根两药,意在助其阳升,然升阳之药不少,何以选此两味?柴胡较易理解,在太极图中,卯时、春天、少阳均在东方、左边,格局相同。《本草经疏》谓:“柴胡禀仲春之气以生,兼得地之辛味。春气生而升,故味苦平,微寒而无毒,为少阳经表药。”《本经逢原》曰:“柴胡能引清阳之气,从左上升,足少阳胆经之药。”是以柴胡之升,在于升少阳,可助郁而不升之肾气,于少阳之时借时而升。《本草思辨录》所说的“人身生发之气,全赖少阳,少阳属春,其时草木句萌(嫩芽)以至鬯茂(茂盛),不少停驻。然当阴尽生阳之后,未离乎阴,易为寒气所郁,寒气郁之,则阳不得伸而与阴争,寒热始作。柴胡乃从阴出阳之药,香气彻霄,轻清疏达,以治伤寒寒热往来,正为符合。邹氏所谓鬯郁阳以化滞阴也”,可为笔者当时的用药思路作注。

  上说为常规之理。其实,当时笔者还有一个略深的想法,就是腰脊属督脉所过(图4),于经脉当属督病。若把督、任两脉放进太极图,则为“阳脉之海”的督脉,当循左、循阳而升;为“阴脉之海”的任脉(图5),当循右、循阴而降;既然督在左、在阳位,则与春天、卯时、少阳,在一定意义上也是同格局。“类同则比”,这是取象比类的基本原则或内在逻辑,前人虽然没有以柴胡升督之说,但既然格局相同,又安知柴胡不能因此而升督?不妨一试。至于葛根之用,则循另一思路,腰疼于骨属脊,于脏属肾,若从经络循行看,膀胱经所过正是肾脏所在,肾俞就是其对应穴,且肾与膀胱相为表里,表里经互用是针灸常法。《本草崇原》谓:“葛根延引藤蔓,则主经脉,甘辛粉白,则入阳明,皮黑花红,则合太阳,故葛根为宣达阳明中土之气,而外合于太阳经脉之药也。……起阴气者,藤引蔓延,从下而上也。”葛根的作用正是升膀胱经之气,当可助肾气上达。

4.jpg

  《孙子兵法·兵势》云:“凡战者,以正合,以奇胜。”奇正之道在于守正出奇。正者,就是以“正兵”当敌,“正兵”者,就是在预期的时间、地点,以预期的方式作战,就如本例以金匮肾气丸为底方,这是用兵的常法,也是遣方用药的常法。但当守“正”不能完全奏效时,就得考虑“出奇制胜”了,“奇”者,于兵法上就是用敌人认为不可能的,超越常规的作战方法,就如本例的柴胡、葛根之用,不属常法,颇有出其不意的“奇兵”之效。但用药之道,不能刻意为了翻新出奇而“奇”,“奇”也要“奇”得符合医理、药理。

5.jpg

  嘱晨起5~6时服药,当然是借自然之气与人体之气于卯时的升势以助药势了。效《孟子·公孙丑》的“虽有智慧,不如乘势”意。

  升降法时,顺时服药是一法,如本例的卯时服药;借药物所含时象亦是一法,如本例借柴胡内含之少阳时象。(本文节选自作者所著的《寻回中医失落的元神》一书)

(文本来源于网络,略有改动)

转载请注明:贞吉网 » 人体气机圆转及升降法时

喜欢 (1)

您必须 登录 才能发表评论!

(28)个小伙伴在吐槽
  1. Nice weblog right here! Also your site so much up fast! What host are you the use of? Can I get your affiliate link to your host? I want my web site loaded up as fast as yours lol asmr 0mniartist
    匿名2021-04-12 04:43
  2. I'm truly enjoying the design and layout of your blog. It's a very easy on the eyes which makes it much more enjoyable for me to come here and visit more often. Did you hire out a designer to create your theme? Great work! asmr [http://j.mp] 0mniartist
    匿名2021-04-14 20:47
  3. You're so awesome! I do not think I've truly read through something like this before. So good to find someone with some original thoughts on this subject. Really.. many thanks for starting this up. This site is one thing that is required on the web, someone with some originality! asmr (http://j.mp) 0mniartist
    匿名2021-04-16 16:17
  4. What's up, all is going well here and ofcourse every one is sharing data, that's truly excellent, keep up writing. my site; it gamefly
    匿名2021-04-28 11:58
  5. This is my first time pay a visit at here and i am truly happy to read everthing at one place. my web page; our asmr
    匿名2021-04-29 13:50
  6. Article writing is also a fun, if you be familiar with afterward you can write if not it is complex to write. Also visit my blog - asmr off
    匿名2021-04-29 14:31
  7. Wow, that's what I was seeking for, what a information! existing here at this weblog, thanks admin of asmr this web site.
    匿名2021-04-29 19:56
  8. There is definately a lot to know about this issue. I like all the points you have made. Also visit my blog - on gamefly
    匿名2021-05-04 06:23
  9. Howdy very nice web site!! Man .. Beautiful .. Superb .. I will bookmark your site and take the feeds additionally? I am happy to search out numerous helpful info right here within the submit, we want work out extra techniques on this regard, thank you for asmr sharing. . . . . .
    匿名2021-05-04 13:53
  10. Magnificent goods from you, man. I have take into account your stuff previous to and you're simply extremely magnificent. I really like what you've acquired here, really like what you're saying and the way in which during which you are saying it. You are making it enjoyable and you still take care of to keep it sensible. I cant wait to read much more from you. This is actually a great site. Also visit my page ... asmr (j.mp)
    匿名2021-05-07 20:01
  11. Hello everyone, it's my first pay a visit at this web page, and paragraph is genuinely fruitful for me, keep up posting such content. Feel free to visit my web site asmr their
    匿名2021-05-08 09:50
  12. I constantly spent my half an hour to read this weblog's posts all the time along with a mug of coffee. Here is my page: in asmr
    匿名2021-05-09 12:58
  13. scoliosis (bitly.com) I'm curious to find out what blog system you happen to be working with? I'm experiencing some small security issues with my latest site and I would like to find something more safe. Do you have any solutions? scoliosis
    匿名2021-05-15 21:42
  14. scoliosis - http://bitly.com/, Usually I don't read post on blogs, but I wish to say that this write-up very compelled me to try and do so! Your writing taste has been surprised me. Thanks, quite great post. scoliosis
    匿名2021-05-17 03:03
  15. dating sites Thank you, I have recently been searching for information about this subject for ages and yours is the best I've discovered till now. However, what about the conclusion? Are you sure about the supply? free dating sites https://785days.tumblr.com/
    匿名2021-05-20 05:06
  16. dating sites I'm not sure where you're getting your information, but good topic. I needs to spend some time learning much more or understanding more. Thanks for wonderful info I was looking for this information for my mission. free dating sites Also visit my blog post https://6869milesoflove.tumblr.com/
    匿名2021-05-20 17:03
  17. Link exchange is nothing else however it is simply placing the other person's blog link on your page at suitable place and other person will also do same in asmr favor of you.
    匿名2021-05-21 20:50
  18. I am curious to find out what blog platform you have been using? I'm experiencing some small security issues with my latest website and I would like to find something more risk-free dating sites the. Do you have any solutions?
    匿名2021-05-26 11:01
  19. Your style is so unique compared to other people I have read stuff from. Many thanks for posting when you have the opportunity, Guess I'll just bookmark this page. Feel free to visit my site ... our free dating sites
    匿名2021-05-26 18:25
  20. I could not refrain from commenting. Well written! Also visit my blog post :: for free dating sites
    匿名2021-05-29 14:52
  21. surgery scoliosis what i do not understood is in fact how you are not actually a lot more well-favored than you may be now. You're so intelligent. You know therefore significantly in relation to this subject, produced me in my opinion believe it from so many numerous angles. Its like women and men don't seem to be involved until it's one thing to do with Lady gaga! Your individual stuffs nice. Always care for it up!
    匿名2021-05-31 00:02
  22. hello!,I love your writing so much! proportion we keep up a correspondence extra approximately your post on AOL? I require a specialist in this house to unravel my problem. Maybe that is you! Taking a look forward to peer you. my website: scoliosis surgery why
    匿名2021-05-31 16:12
  23. Its not my first time to pay a visit this free dating sites site, i am browsing this web page dailly and get good facts from here every day.
    匿名2021-05-31 19:07
  24. Thanks on your marvelous posting! I genuinely enjoyed reading it, you may be a great author.I will make certain to bookmark your blog and will come back sometime soon. I want to encourage that you continue your great job, have a nice morning! Here is my blog - dating sites the
    匿名2021-06-01 10:37
  25. This design is steller! You certainly know how to keep a reader amused. Between your wit and your videos, I was almost moved to start my own blog (well, almost...HaHa!) Fantastic job. I really loved what you had to say, and more than that, how you presented it. Too cool! My web page - on web hosting (tinyurl.com)
    匿名2021-08-10 15:37
  26. Write more, thats all I have to say. Literally, it seems as though you relied on the video to make your point. You obviously know what youre talking about, why throw away your intelligence on just posting videos to your blog when you could be giving us something enlightening to read? Also visit my blog; is ps4 games (http://tinyurl.com/74etfrdm)
    匿名2021-08-11 05:14
  27. You're so cool! I don't suppose I've read something like this before. So good to discover someone with a few original thoughts on this issue. Really.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality! Here is my blog post: what ps4 games (bit.ly)
    匿名2021-08-11 17:39
  28. My brother recommended I may like this website. He used to be entirely right. This post truly made my day. You can not believe simply how so much time I had spent for this information! Thanks! My site - web hosting there - tinyurl.com -
    匿名2021-08-12 06:13