吕海江运用升阳法治疗眼科病经验

冯磊，沈瑞祥，蔡超产，指导：吕海江

河南中医大学第三附属医院，河南 郑州 450008摘要：中医眼科自《内经》以来经过历代医家发展和补充，其辨证论治渐趋完善，至金元时期李东垣《脾胃论》对脾胃的重视，使升阳法逐渐被医界接受而广泛应用于各科。吕海江教授经过40多年的临床实践和对李东垣升阳法的继承与创新，逐渐形成了自己运用升阳法论治眼科病的经验特色。本文结合临床医案，从升阳通络、升阳散火、活血化瘀、祛湿化痰4个方面总结吕老运用升阳法论治眼科病的诊疗经验。关键词：名医经验；吕海江；升阳法；眼科病

DOI：10.3969/j.issn.1005-5304.2017.11.031

中图分类号：R272.977 文献标识码：A 文章编号：1005-5304(2017)11-0121-03

Experience of LV Hai-jiang in Using Raising Yang Therapy for Treatment of Ophthalmic Diseases

FENG Lei, SHEN Rui-xiang, CAI Chao-chan, Instructor: LV Hai-jiang (The Third Affiliated Hospital to Henan University of Chinese Medicine, Zhengzhou 450008, China)

Abstract: Since Nei Jing, through the development and supplement of ancient physicians, syndrome differentiation of TCM ophthalmology has been gradually improved. To the Jin and Yuan Dynasties, LI Dong-yuan’s Pi Wei Lun paid attention to spleen and stomach, which made raising yang therapy has been accepted and widely used in medical subjects. After 40 years of clinical practice and inheritance and innovation of LI Dong-yuan’s raising yang therapy, Professor LV Hai-jiang gradually formed his own experience features of using raising yang therapy to treat ophthalmic diseases. Combined with the clinical medical records, this article reviewed diagnosis and treatment experience of Professor LV in using raising yang therapy to treat ophthalmic diseases from the aspects of raising yang and removing obstruction in collaterals, raising yang and dissipating heat, activating blood circulation and expelling stasis, and eliminating dampness and phlegm.

Key words: experience of famous doctors; LV Hai-jiang; raising yangtherapy; ophthalmic diseases

河南中医药大学吕海江教授是第五批全国中医药专家学术经验继承工作指导老师，从事临床、教学和科研工作 40 余年，长期致力于角膜病和眼底病的研究，擅长运用中医药治疗糖尿病性眼底病变和视神经、视网膜疾病等，在多年的眼科临床实践和前人经验基础上逐渐形成了自己的特色。兹就吕老运用升阳法治疗眼科病的经验特色总结如下。

1 理论溯源

对升阳法阐释最深刻且应用最广的当属李东垣无疑。李东垣认为，人体有两种气，即升发的阳气与闭藏的阴气。脾胃功能正常，则先行升发之性，输送精微物质至皮肤、筋骨、血脉等，然后升已而降，行闭藏之性，下输于膀胱。《脾胃论•天地阴阳生杀之理在升降浮沉之间论》“盖胃为水谷之海，饮食入胃，而精气先输脾归肺，上行春夏之令，以滋养周身，乃清气为天者也。升已而下输膀胱，行秋冬之令，为传化糟粕，转味而出，乃浊阴为地者也”，即是对脾胃 正常情况下生理过程的详细描述。病理方面，“夫脾胃虚，则湿土之气溜于脐下，肾与膀胱受邪。膀胱主寒，肾为阴火，二者俱弱，润泽之气不行”（《脾胃论•胃虚脏腑经络皆无所受气而俱病论》），即脾胃虚弱之时，一则脾胃不能行生发之令，二则湿邪下流，郁闭阳气。由此，则“真气下溜，或下泄而久不能升，是有秋冬而无春夏，乃生长之用，陷于殒杀之气，而百病皆起”（《脾胃论•天地阴阳生杀之理在升降浮沉之间论》）。据此，李东垣提出升阳之法，“大抵圣人立法，且如升阳或发散之剂，是助春夏之阳气，令其上升，乃泻秋冬收藏殒杀寒凉之气”（《东垣试效方•妇人门•崩漏治验》）。升阳法助春升之气，而泻秋冬收藏殒杀寒凉之气，是治疗上述脾胃虚弱致有秋冬而无春夏的正法。在治法方面，李东垣《内外伤辨惑论•四时用药加减法》有详细论述：“脾胃不足之证，须用升麻、柴胡苦平，味之薄者，阴中之阳，引脾胃中清气行于阳道乃诸经，生发阴阳之气，以滋春气之