虚阳外越病机与证治规律探析

孟冠辰，王冉然，曲夷*

（山东中医药大学，山东济南250355）

虚阳外越病机与证治规律探析

孟冠辰，王冉然，曲夷*

（山东中医药大学，山东济南250355）

虚阳外越是指在阳气本已亏虚的病理状态下，阴气仍不能正常地发挥其收敛潜降的作用，阳气虽虚却浮越于外而不得返宅，其包括阳虚阴盛状态下的上热下寒证和阴盛格阳证，及阴虚阳亢状态下，久病阴损及阳证。研究虚阳外越就必须从阴阳二气各自的特性以及阴阳对立制约、互根互生的关系入手，才能更加准确地把握虚阳外越的根本病机和病理表现，更好地鉴别“实火”和“虚火”，并最终为摄生防病及其辨证论治提供理论指导。

虚阳外越；阴阳；阳虚；虚火；阳虚阴盛；阴虚阳亢

〔Abstract〕Outward going of Yang in deficiency condition means that when yang itself is deficient，Yin still can not restrain and descend，so that Yang goes outward and can not return，even though it is in a deficient condition.It includes the syndrome of upper heat and lower cold，and excessive Yin refusing Yang under the state of abundant Yin due to Yang deficiency，and also includes Yin deficiency affecting Yang due to chronic disease under the state of abundant Yang due to Yin deficiency.To study this，we should start with the respective characteristic of Yin and Yang，Yin-Yang opposites restriction，and interdependence between Yin and Yang，so that we can understand its pathogenesis and pathological manifestations preferably，and distinguish the excess fire and deficient fire more precisely.Finally，it can put forward theoretical guidance for keeping fit，disease prevention and treatment based on syndrome differentiation.

〔Keywords〕outward going of Yang in deficiency condition；Yin-Yang；Yang deficient；deficiency fire；abundance of Yin due to yang deficiency；Yin deficiency and Yang hyperactivity

近现代医家受温病学派思想影响颇深，往往见“火”便是“毒”，见“热”就须“清”，加之西医抗生素的滥用，使得“清热解毒”俨然成为当下流行的治疗法度。祝味菊在《伤寒质难·第十四篇》［1］云：“余治医三十年，习见可温者十之八九，可清者百无一二”，清·黄元御在《四圣心源》［2］中亦云：“夫纯阳则仙，纯阴则鬼……病于阴虚者，千百之一，病于阳虚者，尽人皆是”，这些描述虽不排除有过激和夸大的个人主观色彩，但足以引起后人对“阳气”的重视，也提醒后世医家“阴易盛而阳易衰，阴盛则病，阳绝则死，切勿率以阳虚之人而妄投补阴之药以泻火伐阳”。而在阳虚诸证中，最易混淆、最难辨证的便是虚阳外越。以阴盛格阳之真寒假热为例，病人亡阳欲脱，生死处于反掌之间，若医者失其色脉，只顾其“假热”而不顾其“真寒”，以寒远寒而犯“虚虚之戒”，实乃南辕北辙。