A Brief Analysis of the Academic Thought of Emphasizing "Middle Yang" in The Genuine Case Records of YE Tianshi in His Later Years

Author：WEI Yuxin1, LIU Zhengxin1, MA Zhanlong1, LIU Tingting1, SONG Zhenzhen2, HAN Lingna1, SUN Zhiguang2

Unit：1.The Affiliated Hospital of Nanjing University of Chinese Medicine / Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing Jiangsu 210029, China; 2.Nanjing University of Chinese Medicine, Nanjing Jiangsu 210023, China

Quote：引用：魏雨欣，刘政新，马占龙，刘婷婷，宋珍珍，韩玲娜，孙志广.《叶天士晚年方案真本》重“中阳”学术思想浅析[J].中医药导报,2026,32(4):241-245.

DOI：10.13862/j.cn43-1446/r.2026.04.040

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Abstract：

The Genuine Case Records of YE Tianshi in His Later Years collects the medical cases of YE Tianshi, a famous physician in the Qing Dynasty, from his later years. By analyzing the medical records related to "Middle Yang" in this book, this paper further explores YE Tianshi's academic thought of "emphasizing Middle Yang". YE Tianshi held that Middle Yang is an important part of the human body. Physiologically, Middle Yang promotes the generation and movement of Qi and blood as Yang Qi functions to propel. Middle Yang supports congenital Qi as water and earth reinforce each other. Middle Yang assists defensive Yang as the middle energizer strengthens defensive Qi, and Middle Yang integrates Yin essence as the spleen and stomach are treated separately. According to the characteristics of Yang Qi, YE Tianshi categorized the etiology and pathogenesis of Middle Yang injury into four aspects: dampness as the primary factor, impairment of Yang by overstrain, Yin deficiency involving Yang, and accumulation of turbid Yin. In clinical practice, he emphasized treatment based on etiology. For patients with excessive dampness impairing Yang, he adopted the principle of "drainage and dispersion", and applied separation of dampness and heat as well as triple energizer differentiation according to the severity and location of dampness and heat. For patients with Yang injury due to overstrain, he was adept at using sweet-warm medicinals to relieve fatigue, and treated with modified Xiaojianzhong Decoction (小建中汤). For patients with Yin deficiency involving Yang, he applied treating the same disease with different methods, and adopted regulating the pivot, intensely invigorating primordial Yang, or replenishing genuine Yin on the basis of protecting Middle Yang. For patients with accumulated turbid Yin, he mostly used acrid-warm medicinals to dissipate turbid Yin and applied Banxia (Pinelliae Rhizoma) to descend and drain turbidity.

Key words：The Genuine Case Records of YE Tianshi in His Later Years; Middle Yang; YE Tianshi; Xiaojianzhong Decoction; Miaoxiang San (妙香散)

摘要：《叶天士晚年方案真本》收录了清代医家叶天士晚年诊治存案。本文通过分析书中有关“中阳”之医案，进一步探讨叶天士“重中阳”之学术思想。叶天士认为，中阳是人体重要组成。生理上，阳气推动，中阳生行气血；水土互资，中阳可资先天；以中助卫，中阳可助卫阳；脾胃分治，中阳共合阴精。根据阳气特点，叶天士将中阳受损病因病机分为4个方面：以湿为先、劳烦伤阳、阴损及阳和浊阴固聚。临证诊疗重视审因论治，对湿盛阳伤者，以“分消走泄”立法，依据湿热偏盛及部位之不同，治以湿热分消及三焦分消；对烦劳伤阳者，善用甘温之品以除劳，治以小建中汤加减；对阴损及阳者，同病异治，在顾护中阳基础上，分别治以旋转枢轴，峻补元阳，填补真阴之法；对浊阴固聚者，多以辛温之品以开散浊阴，以半夏等泄下降浊。

关键词：《叶天士晚年方案真本》；中阳；叶天士；小建中汤；妙香散

Release time：2026-04-26

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