“阴火论”是由补土派医家李东垣基于其内伤脾胃学说提出的一种中医“火邪致病”的学术思想。脾胃为后天之本，内伤脾胃，百病由生，火热病亦然。本文从脾胃引出阴火，继而对阴火与快速性心律失常进行探讨，得出阴火内生是快速性心律失常的根本病因，脾虚、火旺为其最基本的病理机制。治则为益气升阳、泻火养阴，内涵复杂，方药多变。基于“阴火”理论对快速性心律失常进行辨治，当认识到脾胃是心悸病进行过程中的枢纽，应以调和脾胃为治疗之本。 “Yin fire theory” is a kind of academic thought of TCM “fire evil causes disease” put forward by Li Dongyuan, a doctor of Butu School, based on his theory of internal injury to the spleen and stomach. Spleen and stomach for the acquired this, internal damage to the spleen and stomach, all diseases from birth, fire disease is also. This paper introduces Yin fire from the spleen and stomach, and then discusses Yin fire and tachyarrhythmia. It is concluded that Yin fire endogenous is the fundamental cause of tachyarrhythmia, and spleen deficiency and fire excess are its basic pathological mecha-nism. The treatment is to nourish qi and promote yang, relieve fire and nourish yin, the connotation is complex, and the prescription is changeable. Based on the theory of Yin fire, the treatment of tachyarrhythmia should be based on the harmonization of the spleen and stomach, which is the key point in the process of palpitation.
“阴火论”是由补土派医家李东垣基于其内伤脾胃学说提出的一种中医“火邪致病”的学术思想。脾胃为后天之本，内伤脾胃，百病由生，火热病亦然。本文从脾胃引出阴火，继而对阴火与快速性心律失常进行探讨，得出阴火内生是快速性心律失常的根本病因，脾虚、火旺为其最基本的病理机制。治则为益气升阳、泻火养阴，内涵复杂，方药多变。基于“阴火”理论对快速性心律失常进行辨治，当认识到脾胃是心悸病进行过程中的枢纽，应以调和脾胃为治疗之本。
阴火，快速性心律失常，益气升阳，泻火养阴，调和脾胃，心悸
Shoushun Wang1, Naizhi Geng2
1First Clinical School of Medicine, Heilongjiang University of Chinese Medicine, Harbin Heilongjiang
2Three Departments of Cardiovascular, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin Heilongjiang
Received: Oct. 25th, 2023; accepted: Nov. 19th, 2023; published: Nov. 27th, 2023
“Yin fire theory” is a kind of academic thought of TCM “fire evil causes disease” put forward by Li Dongyuan, a doctor of Butu School, based on his theory of internal injury to the spleen and stomach. Spleen and stomach for the acquired this, internal damage to the spleen and stomach, all diseases from birth, fire disease is also. This paper introduces Yin fire from the spleen and stomach, and then discusses Yin fire and tachyarrhythmia. It is concluded that Yin fire endogenous is the fundamental cause of tachyarrhythmia, and spleen deficiency and fire excess are its basic pathological mechanism. The treatment is to nourish qi and promote yang, relieve fire and nourish yin, the connotation is complex, and the prescription is changeable. Based on the theory of Yin fire, the treatment of tachyarrhythmia should be based on the harmonization of the spleen and stomach, which is the key point in the process of palpitation.
Keywords:Yin Fire, Tachyarrhythmia, Replenishing Qi and Elevating Yang, Purging Fire and Nourishing Yin, Harmonize the Spleen and Stomach, Palpitations
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当心脏起搏的频率、节律、起源部位、传导速度或激动次序异常，即可称之为心律失常。其可分为快速性与缓慢型心律失常两种，通过心律失常发生时心率的快慢进行区别 [
快速性心律失常属于中医心悸病范畴。心悸病的辨治在当代中医多以“本虚标实”理解 [
“阴火”病名是由金元时期补土派名家李东垣在其著作中率先提出。补土派理论核心为“内伤脾胃，百病由生”，“火热病”亦不例外，其疾病本质亦为“脾胃内伤”，故而多在此基础上进行辨证施治。由此可知阴火学说的根本来源即是内伤脾胃学说，而脾胃内伤就是阴火产生的根本原因，因此李东垣认为调理脾胃是治疗阴火的核心。李东垣所著《脾胃论·饮食劳倦所伤始为热中论》中曾提到“既脾胃气衰，元气不足，而心火独盛。心火者，阴火也” [
从脾胃治心的理论依据为心脾之间紧密相连。首先，二者虽被隔为两界，一在上焦一在中焦，并无直接联系，但却通过脾胃与心之间的支脉、大络等进行经气流通，从而联系密切，相互影响。现代研究显示肠道菌群与心悸等多种心血管疾病密切相关，而肠道菌群与中医的脾胃在功能上有许多相似之处，可笼统代指为中医之脾胃，为心脾之间的关系提供了证据 [
因脾胃功能失调常常导致心脏的病变，故心脏病变的治疗往往从脾胃入手。而快速性心律失常从阴火治疗，实质上就是从脾胃治疗的一个方面。如脾气亏虚，运化功能失调，气血无从生化，或脾不能统血，以致血液妄行，皆可造成心血心气不足，引起心脾两虚，进而表现为心悸、气短、脉结代等证。若脾阳衰微，水湿失于温煦，水饮上凌于心，则将表现为心悸、气短、咳喘等症。由此可知无论是气血虚弱这种病理状态还是水饮等病理产物均可由脾胃功能失常引起，进而使心脏发生病变。因此治疗心系疾病从脾胃入手，是有据可依的。
李东垣在《内外伤辨惑论·辨脉》中云：“若饮食不节，劳役过甚，则心脉变……见于气口，是心火刑肺……时一代也。”从这段文字可以看出，东垣列举了内伤的四种典型脉象，分别为①“气口脉急大而涩数，时一代而涩也”；②“右关脾脉大而数，谓独大于五脉，数中显缓，时一代也”；③“惟内显脾脉之大数微缓，时一代也” [
脾胃内伤是快速性心律失常发生的基础。脾为生痰之源，若脾胃内伤，痰浊内生，极易蕴热生火，则发为痰火。脾胃为气机升降斡旋之中枢，若脾胃亏虚，气机升降不利，停滞的气机从阳而化火，则发为气火。肾为水脏，内蕴命门之火，脾脏亏虚，脾阳不能温煦，阴盛格阳，虚火上僭于心，即为病理相火。故脾虚为阴火证的基本病机。由此可知阴火乃脾胃内伤，功能失常的产物。阴火燥热浮越，上扰神明，发为惊悸、怔忡。因此，快速性心律失常阴火证以脾虚、火旺为最基本的病理机制。
补中升阳，脾肺共补为益气之本。快速性心律失常乃脾胃气虚，湿浊下流，郁闭下焦，相火妄动，病理性亢奋所致。故补中益气，健运中焦是治疗的根本。可用黄芪、人参、太子参、党参等具有补中益气功效的药物。脾胃气虚，阳道不行，湿气郁闭下焦而生阴火，故脾之生发作用非常关键。治疗应在补中益气之上略施升阳举陷。升阳之品用量宜轻，仅一两味，略拨转枢机即可，临床多用升麻、柴胡、葛根。黄芪本身也具有升阳作用。东垣《脾胃论·长夏湿热胃困尤甚用清暑益气汤论》云：“脾始虚，肺气先绝” [
快速性心律失常阴火之热象多样，治疗也应灵活多变。不同情况选择不同的祛火方法。若正气内亏、气虚发热之火，宜益气升阳，甘温除热。此火治疗应效补中益气汤之法，益气升阳，甘温除热。若体虚外感、湿遏热伏之火，宜升阳散火，辅以益气。临床见正气内虚，湿浊阻遏气机，阴火郁于肌表之象，此火宜用东垣之升阳散火汤加减治疗，用大剂量风药“火郁发之”，使邪随汗出而解，又风能胜湿。风药多选升麻、防风、柴胡、葛根。若土虚阳郁、四肢发热之火，宜补中舒脾，轻透郁火。此火乃脾虚中阳郁滞所化之火，因脾主四肢，故四肢发热。脾虚阳气不得生发，故躯干发冷。此火治疗宜在补中益气的基础上，配伍火郁汤以轻透发散脾经郁火。若脾虚火旺、躁热阵作之火，宜泻火救水，滋补元阴。此火乃东垣所述“阴火上冲”之火。因阴火源自下焦，阴火易耗伤真阴。真阴不足，水不制火，反增火势，致使阴火上冲。此火治疗宜在补中益气的基础上，配伍苦寒之黄柏、知母等清泻肾火，又宜配伍甘寒之生地滋补元阴。若气陷大悗、懊侬焦躁之火，宜升阳理气，泻火养阴。此火病机乃脾胃气陷，阴火由生，火扰神明及火伤气阴，心神失养，再加清阳不升、浊阴不降，清浊相干，乱于胸中所致。治疗应在补中益气的基础上升阳理气，并配伍苦寒泻火和甘寒养阴之品，药物选择黄连、苦参、知母、黄柏、生地、麦冬、制首乌等。若阴火传变、脏腑蕴热之火，宜随证泻火，分经用药。阴火游行三焦，通行十二经脉，可导致多个脏腑组织火热。治疗应根据临床表现，辨证分析火属何脏何腑，配伍泻火养阴药。如患者若出现除心悸之外的焦躁烦闷，中气下陷，清阳不升如头昏头晕等症，即可加之以黄连，苦参等药，依此类推。
火旺伤阴，血虚心神失养，发为惊悸怔忡，故在快速性心律失常阴火证中泻火滋补阴血是安神定悸的直接方法。本病阴虚，多为火旺所伤，治疗泻火为主，辅以养阴。因肾水为人体阴液之源，疗应从肾治心，泻肾火，补肾水。津血同源，本病阴虚之象，主要表现为津亏之口干，或兼血虚之唇甲色淡。治疗总体以养阴为主，配伍补血，因津血同源，可以互生。但若以血虚表现为主者，则应以养血为主。因阴阳互根互用，故我们在养阴治疗时必配益气或生阳之品。本病养阴，应在甘温益气的基础上进行。本病滋补肾水宜遵其法，大量使用时常配伍温热之肉桂、仙灵脾，取阳生阴长之意。因肝肾之阴息息相关，一荣俱荣，一损俱损，盛衰与共，故欲补肾水者，必养肝阴。我们在养阴时，充分认识到肝肾同源的意义，治疗多从滋肾养肝入手，常用生地、山萸肉、枸杞、制首乌等。
综上所述，阴火内生是快速性心律失常的根本病因，脾虚、火旺为其最基本的病理机制。治法当为益气，祛火，养阴，内涵复杂，方药多变。基于“阴火”理论对快速性心律失常进行辨治，当认识到脾胃是心悸病进行过程中的枢纽，应以调和脾胃为治疗之本，治则为益气升阳、泻火养阴，异于祛邪扶正的常见治法，愿能为快速性心律失常的中医辨治提供一个新的诊疗思路。
王首舜,耿乃志. 基于阴火论浅析快速型心律失常的辨证论治The Analysis of Differentiation and Treatment of Tachyarrhythmia Based on the Theory of Yin Fire[J]. 临床医学进展, 2023, 13(11): 18348-18352. https://doi.org/10.12677/ACM.2023.13112576