劉河間《三消論》「天地六位臟象圖」之五運六氣病因說

Polyphagia, Polyuria and Polydipsia Disease Explained by Liu-Hejian’s San-Xiao-Lun with the “Heaven-Earth Six Levels Simulate Six Organs” Emerging the “Five-Circuit and Six-Qi” Pathological Reasoning

《三消論》乃金元時期劉完素（河間）晚年之著作，由後學張子和付梓出刊，張氏依書中之內容補入「天地六位臟象之圖」，此論天地人三才自太虛至黃泉共六位，即心肺居天之金火合德、肝膽居人之木火合德、脾腎居地之土水合德，此三才之位各有五行及三陰三陽，孔子曰：「天地設位，而易行乎其中矣。」相對河間而言天地六位確立而臟象六氣運行在其中。天地有五運六氣而人亦應之，河間認為消渴病之病機，是由濕寒之陰氣極衰，導引腸胃之外燥熱太甚，脾胃之濕氣竭，三焦腠理怫鬱結滯因而致三多之証（多食、多飲、多小便），三消是六氣中之燥氣獨勝。河間認為脾胃腎是人之根本，提出脾不主時，寄王四季之末各十八日之觀念，說明其重視脾土濕腎水寒之依據，若根枯葉焦便成腎消之病機了。治療三消以去胃陽土之燥氣及三焦之怫鬱結滯為主，燥熱消除則肺金清氣來復而水道通暢，其中六一散便是依三消之理法所制成，是退燥熱之主要處方；調胃承氣湯用以盪滌三焦之實熱，所謂：「相火之下，水氣承之」是河間善用亢害承制之理法所製；至於在下之腎消，則依《藏氣法時論》︰「腎苦燥，急食辛以潤之。」金匱腎氣丸、六味地黃湯，可隨證選用。河間重視五運六氣病因說，從標本而言，則六氣為本，經絡及本臟為標，這三者對了解河間之學術思想，有重要之啟發。

San-Shao-Lun was a book which written by Liu Wansu (Hejian) in the Jen-Yuan Dynasty in his old age. His book was published by his follower Cheng Chiho after he died and Cheng added a picture based on Hejian which is called “Heaven-Earth six levels simulate Six Organs”. It gives out the message of Heave-Earth-Human six levels from Zenith to lower world. Upper level is the lung and heat, Middle is the liver and gall bladder, Lower level is the spleen and kidney, levels represent yin-yang and five-elements running around. Confucius said that positions are ready in the heaven and earth then Yi《易》 wandering thereafter. As Heijan said that the six levels with six organs running around them. Heaven and Earth has had this six levels which refers to human is also true. Heijian considered that polydipsia, polyuria and polyphagia (diabetes like syndrome) is caused by the weakness of dampness and coldness, contrarily is the dryness and heat emerged externally of the gastrointestinal organs as well as occlusion of the three visceral cavities which gives the three polys syndrome. Three polys caused by dryness and heat dominantly. Heijian believes that spleen and kidney are the roots of the body which drains nutrients to the other four organs and four limbs. If roots lack of water and dry then three polys syndrome will be diseased. Based on the facts of dryness and heat, occlusion and stasis, we treat patients with the Liu-I formula which is effective to treat three polys syndrome even diabetes (NIDDM). Enormous heat in the body, Heijian applied treatement which is called heat above and treat it with coldness underneath. Kidney level then Liu-Wei-Di-Huang-Wan or Kidney-Qi-Tonifying Pill will be applied. Heijian emphasized on the five circuits and six qi for treatments which can further be classified into root cause and superficial causes while six qi is the root, the twelve meridian and internal organs are the superficial accordingly. This root and superficial concepts may lead us to learn much more from Heijian and is crucial in treatment too.