基于小儿内伤发热医案探讨钱乙对“阴火”理论形成的影响

高作玺　陈贵海　赵元彪

〔摘要〕 通过分析《小儿药证直诀》误治小儿内伤发热医案，结合古今医家相关阐述，认为钱乙《小儿药证直诀》已初步具有了“阴火”理论的内涵，对李杲“阴火”理论的形成有很大的影响，且为后世治疗小儿气虚发热、伤食发热、肾阳不足发热等“阴火”所致内伤热病的治疗奠定了理论基础。李杲“阴火”的概念应为饮食、情志等病因内伤脏腑，或病人素来身体羸弱，中气不足，肾气不充，脏腑虚损，以致阳气升发、潜藏的升降运动失常，导致阳气不归其位、不循其道而致的内伤热病。

〔关键词〕 小儿;内伤发热;阴火理论;钱乙

〔中图分类号〕R272.6       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.02.003

〔Abstract〕 Based on the analysis of the medical cases of treating children's internal injury fever by mistake in Key to Therapeutics of Children's Diseases， combined with the ancient and modern medical related elaboration. It is believed that Qian Yi's Key to Therapeutics of Children's Diseases has a great influence on the formation of Li Gao's theory of "Yin fire"， which has the connotation of the theory of "Yin fire"， and has laid a theoretical foundation for the treatment of internal injury fever caused by "Yin fire" in children fever of qi deficiency， dyspeptic fever， fever of kidney Yang deficiency， ect. Li Gao's concept of "Yin fire" should be the internal injury of viscera caused by diet， emotion and other causes， or the patient is always weak， lack of middle qi， kidney qi is not filled， viscera are damaged， resulting in abnormal ascending and descending movements of Yang qi， which leads to Yang qi not returning to its position and not following its path.

〔Keywords〕 children; internal injury fever; theory of Yin fire; Qian Yi

“陰火”理论源于《黄帝内经》，成型于李杲“阴火论”，经后世医家发展完善，广泛应用于指导发热、失眠、盗汗、消渴等诸多病症的治疗[1-5]。李杲在其学术思想形成过程中推崇、继承了钱乙脏腑辨证理论，因此，钱乙脏腑证理论对“阴火”理论的形成有深刻的影响[6-7]。“阴火”理论内容较为丰富，但在发热疾病的治疗过程中，医家却多重视甘温除热法治疗脾胃虚损所致的内伤热病[8]。本文通过分析《小儿药证直诀》中小儿误治内伤发热医案的辨证、遣方、用药，结合古今医家相关阐述，探求钱乙对“阴火”理论形成的影响及李杲“阴火”理论的内涵。

1 钱乙小儿内伤发热案二则浅析

1.1  病因病机

两则病案的初始病因原文中并未言明，《小儿药证直觉·卷中·记尝所治病二十三证》铁粉丸误治案[9]，在投寒凉之品不效后，患儿出现多涎喜睡等症状，医者见涎多而又投以金石沉重之品欲以下涎。……