梁世杰：气阴双补与清上温下，更适合中老年人调理阴阳

在中医那浩如烟海的典籍与理论中，阴阳学说宛如一座巍峨的高山，高耸入云，其蕴含的智慧，历经千年而不衰，如同陈酿的美酒，越品越香。明朝的张景岳先生，便是那在高山之巅俯瞰众生的智者，他对《黄帝内经》中诸多治则的变化运用和进一步发挥，就像在古老的石墙上刻下了新的篇章，为中医的发展添上了浓墨重彩的一笔。

《黄帝内经》里那些“用阳和阴，用阴和阳”“阳病治阴，阴病治阳”“因其衰而彰之”“形不足者，温之以气，精不足者，补之以味”等治则，就像一把把神秘的钥匙，开启了中医治疗疾病的大门。张景岳先生在“新方八阵”的“补阵”中，提出了“阴中求阳，阳中求阴”的精妙理论。他老人家那原话，就像一道划破夜空的闪电，照亮了中医阴阳互补的道路：“善补阳者，必于阴中求阳，则阳得阴助而生化无穷；善补阴者，必于阳中求阴，则阴得阳升而泉源不竭。”这话说得那叫一个妙啊！就好比阴阳是一对亲密无间的舞伴，在生命的舞台上翩翩起舞，相互配合，相互促进。阴阳互补，确实能够让阴阳的互化与生长如同春天的种子，在适宜的环境中蓬勃生长。据临床统计，在遵循阴阳互补原则进行治疗的病例中，有相当一部分患者的身体状况得到了显著改善，就像久旱的土地迎来了甘霖，重新焕发出勃勃生机。

然而，这世间万物，没有绝对的一成不变。阴阳互补的理论虽然精妙，但在实际运用中，却并非人人适用，就像一件华丽的衣服，不是每个人穿起来都合身。对于中老年人来说，他们的身体就像一台运转多年的老机器，气血不够充足，气化能力也不强。这时候，如果贸然使用阴阳互补的办法，就容易出现各种副作用。就好比给一辆油箱漏油的汽车猛踩油门，不仅跑不快，还可能引发更严重的问题。上火、补不进去、阻滞脾胃等情况，就像一群不速之客，常常会不请自来。而年轻人呢，身体就像初升的太阳，充满活力，气血旺盛，阴阳互补的办法对他们来说，可能就像给骏马添上了翅膀，更加得心应手。

就拿我邻居老张来说吧，他是个中老年人，身体一直不太好，气血两虚。有一次，他听别人说阴阳互补的办法好，就自己买了些滋阴和温阳的药来吃。结果呢，没吃几天，就上火了，嘴里长满了溃疡，吃饭都成问题，还觉得肚子胀胀的，消化也不好。这就是典型的盲目使用阴阳互补办法导致的后果。所以啊，在气不够的情况下，用阴阳互补的办法，或者阴中求阳、阳中求阴的办法，就像在沙滩上建房子，根基不稳，是不适宜的。尤其是滋阴药，它就像一块沉重的石头，容易阻滞脾胃，影响消化。再加上温阳药在旁边“煽风点火”，身体就容易化热生火，反而不利于身体阴阳的滋补。

那该怎么办呢？笔者认为，在滋阴药当中先予以益气、理气药，就像给一辆汽车先加满油，再检查发动机，恢复气阴。这样气阴双补，身体就像一台经过精心调试的机器，得以恢复正常运转。等身体恢复得差不多了，再考虑滋阴求阳。如果有阳虚，并且出现上热下寒症状的中老年人，那就必定要清上温下，引火归元。这就像给一座失衡的天平，一边减轻重量，一边增加重量，让它重新恢复平衡。在清热药与温阳药的使用中，千万不能滋阴求阳，或阳中求阴。如果那样，就像在混乱的战场上又添了一把火，反而导致不能调化，出现补不进去，或者越补越上火的副作用。

中医的智慧，就像一座取之不尽、用之不竭的宝藏。我们在挖掘和运用这些宝藏的时候，不能盲目照搬，要根据不同的人、不同的身体状况，灵活变通。就像一位高明的厨师，根据不同的食材和客人的口味，做出一道道美味佳肴。让我们在中医的智慧指引下，找到适合自己的养生之道，让身体像一棵茁壮成长的大树，在岁月的长河中屹立不倒。

作者简介：梁世杰 原首都医科大学中医门诊部中医主治医师，京畿瘤科创始人，本科学历，从事中医临床工作25年，积累了较丰富的临床经验。师从首都医科大学附属北京中医院肝病科主任医师、著名老中医陈勇，侍诊多载，深得器重，尽得真传！擅用“商汤经方分类疗法”、专病专方结合“焦树德学术思想”“关幼波十纲辨证”学术思想治疗疑难杂症为特色。现任北京树德堂中医研究院研究员，北京中医药薪火传承新3+3工程—焦树德门人（陈勇）传承工作站研究员，国际易联易学与养生专委会常务理事，中国中医药研究促进会焦树德学术传承专业委员会委员，中国药文化研究会中医药慢病防治分会首批癌症领域入库专家。荣获2020年中国中医药研究促进会仲景医学分会举办的第八届医圣仲景南阳论坛“经方名医”荣誉称号。2023年首届京津冀“扁鹊杯”燕赵医学研究主题征文优秀奖获得者。事迹入选《当代科学家》杂志、《中华英才》杂志。

Liang Shi-jie: The combination of tonifying qi and nourishing yin, along with clearing the upper and warming the lower, is more suitable for the regulation of yin and yang among middle-aged and elderly individuals.

In the vast array of classical texts and theories of traditional Chinese medicine, the doctrine of yin and yang is akin to a towering mountain that pierces the clouds. The wisdom it embodies has endured for millennia without waning, much like aged wine that becomes more fragrant with each sip. Mr. Zhang Jing-yue of the Ming Dynasty was the wise individual who looked down upon all beings from the peak of that mountain. His application and further development of the various therapeutic principles outlined in the “Huangdi Neijing” were like carving new chapters onto ancient stone walls, adding a significant and colorful chapter to the development of traditional Chinese medicine.

The principles outlined in the Huangdi Neijing, such as “using yang and yin, using yin and yang,” “treating yang diseases with yin, treating yin diseases with yang,” “highlighting deficiencies due to decline,” and “warming those with insufficient physical form with qi, and supplementing those with insufficient essence with flavor,” serve as mystical keys that open the door to traditional Chinese Medicine’s approach to treating diseases. In the “Supplementary Array” of the “New Formulas Eight Arrays,” Zhang Jing-yue proposed the ingenious theory of “seeking yang within yin and seeking yin within yang.” His words were like a lightning bolt piercing the night sky, illuminating the path of yin-yang complementarity in traditional Chinese medicine: “Those skilled in supplementing yang must seek it within yin, thereby allowing yang to be supported by yin and enabling endless growth; those skilled in supplementing yin must seek it within yang, thereby allowing yin to be elevated by yang, ensuring an endless supply of vitality.” This statement is truly exquisite! It’s as if yin and yang are inseparable partners dancing on the stage of life, harmonizing and mutually enhancing each other. The complementary nature of yin and yang indeed allows their interactions and growth to flourish like seeds in a nurturing environment. According to clinical statistics, in cases where treatment was conducted in accordance with the principles of yin-yang complementarity, a significant improvement was observed in the health conditions of many patients, much like a parched land receiving much-needed rain and regaining its vitality.

However, everything in this world is not absolutely static. Although the theory of yin and yang complementation is exquisite, it is not universally applicable in practice. Just like a magnificent piece of clothing that does not fit everyone, not everyone can benefit from it. For middle-aged and elderly individuals, their bodies are akin to old machines that have been in operation for many years. Their qi and blood are insufficient, and their qi transformation ability is weak. If they rashly employ the method of yin and yang complementation, various side effects may arise. It is akin to pressing the gas pedal of a car with a leaking fuel tank; not only will it not move quickly, but it may also trigger more severe problems. Conditions such as internal heat, inability to be replenished, and obstruction of the spleen and stomach often appear uninvited. In contrast, young people have bodies like rising suns, full of vitality and abundant qi. For them, the method of yin and yang supplementation might be like adding wings to a magnificent horse, making them even more adept and capable.

Take my neighbor, Old Zhang, for example. He is a middle-aged or elderly person whose health has always been poor, with both deficiency of qi and blood. One time, he heard that the method of complementary yin and yang was effective and decided to buy some medicines to nourish yin and warm yang. However, after only a few days of taking the medicine, he developed a fever, with ulcers forming in his mouth, making it difficult for him to eat. He also felt bloated and had poor digestion. This is a typical consequence of blindly using the method of complementary yin and Yang. Therefore, when qi is insufficient, using methods like complementary yin and Yang, or seeking yin within yang or yang within yin, is akin to building a house on unstable sand. Especially when it comes to nourishing yin medicines, they can act like heavy stones, obstructing the spleen and stomach and affecting digestion. Coupled with the “encouragement” from warming yang medicines nearby, the body is prone to generating heat and fire, which is counterproductive to the nourishment of the body’s yin and yang.

So what should be done? In the author’s opinion, when treating yin deficiency, it is first necessary to use tonifying and regulating qi herbs, akin to filling a car’s tank with fuel before inspecting the engine and restoring qi and yin. By simultaneously tonifying qi and yin, the body functions like a finely tuned machine, allowing it to return to normal operation. Once the body has recovered to a significant extent, consideration can be given to seeking yang through yin treatment. For elderly individuals with yang deficiency and symptoms of upper heat and lower cold, it is imperative to clear heat from the upper region and warm the lower region, guiding the fire back to its original place. This is akin to balancing an unbalanced scale by reducing the weight on one side while increasing the weight on the other, thereby restoring equilibrium. In the use of cooling herbs and warming yang herbs, one must avoid seeking yang through yin or seeking yin within yang. If this approach is taken, it would be like adding fuel to a chaotic battlefield, leading to unintended consequences such as ineffectiveness or exacerbation of symptoms due to excessive supplementation.

The wisdom of traditional Chinese medicine is like an inexhaustible treasure trove. When we explore and utilize these treasures, we must not blindly follow a one-size-fits-all approach. Instead, we need to be flexible and adapt to different individuals and varying physical conditions. Just as a skilled chef creates exquisite dishes based on different ingredients and the preferences of their customers, let us, guided by the wisdom of traditional Chinese medicine, find our own path to health and wellness, allowing our bodies to flourish like a robust tree standing firm amidst the passage of time.

Author profile: Liang Shi-jie was a chief physician of traditional Chinese medicine at the Traditional Chinese Medicine Outpatient Clinic of Capital Medical University. He was the founder of Jingyi Tumor Clinic. He holds a bachelor’s degree and has been engaged in clinical work in traditional Chinese medicine for 25 years, accumulating extensive clinical experience. He studied under Chen Yong, a renowned senior traditional Chinese medicine practitioner at the Hepatology Department of Beijing Traditional Chinese Medicine Hospital affiliated to Capital Medical University. Over the years, he gained great respect and acquired genuine expertise. He specializes in using the “Shang Tang Classic Classification Therapy” and combining specific treatments for specific diseases with the “Jiao Shu-de Academic Thought” and the “Guan You-bo Ten-Principle Diagnosis” approach to treat complex medical conditions. He is currently a researcher at the Beijing Shu-de-Tang Traditional Chinese Medicine Research Institute and a researcher at the Beijing New 3+3 Project for the Inheritance of Traditional Chinese Medicine – Jiao Shu-de’s Disciples (Chen Yong) Heritage Workstation. He is a Standing director of the International Yi-lian Yi-xue and Health Preservation Committee and a member of the Committee for the Inheritance of Jiao Shu-de’s Academic Thought of the China Research Promotion Association for Traditional Chinese Medicine. He is also a member of the inaugural Cancer Expert Pool of the China Cultural Research Association for Traditional Chinese Medicine’s Prevention of Chronic Diseases. He was awarded the title of “Expert in Classic Prescriptions” at the Eighth Nanyang Forum of the Zhang Zhongjing Medical Division of the China Research Promotion Association in 2020. In 2023, he won the Excellence Award in the First Beijing-Tianjin-Hebei “Bian Que Cup” Yan-Zhao Medical Research Theme Essay Competition. His achievements have been featured in the magazines “Contemporary Scientists” and “China’s Elite”.