邓琼琪 曾子纯 罗素萍 罗尧岳

〔摘要〕 《临证指南医案》中“方合岁气体质调理”理论与《黄帝内经》中“天人相应”的思想一脉相承，依据患者个体因素，并结合四时岁气的变化立法遣方，将其运用至临床实践，在《临证指南医案》中记载的诸多验案中得以体现。分析叶天士《临证指南医案》中相关医案，对其中“方合岁气体质调理”理论在临床辨证、用药施治、指导养生防病等方面的运用进行探讨，以为现代临证提供指导与借鉴。

〔关键词〕 临证指南医案;岁气;体质

〔中图分类号〕R2-0       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.04.028

〔Abstract〕 The theory of "harmonize the qi and constitution to adjust" in Guide to Clinical Practice with Medical Records is consistent with the thought of "correspondence between heaven and man" in Inner Canon of Yellow Emperor. According to the individual factors of patients and the changes of qi in the four seasons， the prescription is applied to clinical practice， which is reflected in many cases recorded in Clinical Practice with Medical Records. In this paper， by analyzing the relevant medical records in Ye Tianshi's Clinical Practice with Medical Records， the application of the theory of "harmonize the qi and constitution to adjust" in clinical syndrome differentiation， drug administration， guidance of health preservation and disease prevention were discussed， so as to provide guidance for modern clinical practice.

〔Keywords〕 Clinical Practice with Medical Records; four seasons; constitution

“岁气”是指一年的气候情况。《类经·卷十二·论治类》注：“五运有纪，六气有序，四时有令，阴阳有节，皆岁气也。”自然界中的六种气候，风、寒、暑、湿、燥、火与人的生理病理变化息息相关，是在治疗疾病过程中不可忽视的因素。叶天士《临证指南医案》中记载“人在气交，法乎天地，兼参体质施治”，并在《临证指南医案·木乘土》中明确指出“方合岁气体质调理”[1]142，说明在祛邪治病过程中，四时岁气变化及体质均是不可忽视的因素。中医历来强调四时岁气在辨证论治过程中的重要性，关于中医体质的论述也有着悠久历史，目前，对于四时岁气和体质的研究多数在于与疾病的相关性研究，而有关的调治方法鲜有见到。叶天士提出的“方合岁气体质调理”是根据四季阴阳、寒暑、气候寒热温凉变化特点，结合病人各自的体质特点遣方用药，调体却病，本文试就其进行探讨，以期对现代临床防治疾病有所启发。……