祝味菊外感五段论及扶阳法临证思想

Zhu Weiju’s Theory of the Five-Stage Progression of Exogenous Diseases and His Clinical Thoughts on Yang-Fortifying Method

摘要: 祝味菊是近代海派中医的重要代表人物，其学术思想以“重阳”为核心，临床善用附子，有“祝附子”之称。本文系统梳理祝味菊在《伤寒质难》中提出的“外感五段论”，阐释“阳气为枢”的理论内涵，归纳五段对应的五种治法——和阳、抑阳、通阳、扶阳、回阳/潜阳，结合《祝味菊医案经验集》中的五个典型医案。总结出祝味菊以阳气为生命之本，将阳气盛衰为抗力消长的决定因素，五段变化的本质是阳气由盛转衰的动态过程，五段治疗的核心在于调整阳气。本文通过理论与医案互证，试图认识祝味菊“善护真阳者即善治伤寒”的学术精髓，以期为其扶阳思想的临床运用提供帮助。

Abstract: Zhu Weiju is an important representative of modern Shanghai-school TCM. His academic thought centers on “valuing yang”, and he was known for his skillful use of Fuzi (Aconiti Lateralis Radix Praeparata), earning him the nickname “Zhu Fuzi”. This article systematically reviews the “Five-Stage Progression of Exogenous Diseases” proposed by Zhu Weiju in “Difficult Questions on Cold Damage”, elucidates the theoretical connotation of “yang qi as the pivot”, and summarizes the five corresponding treatment methods for the five stages—harmonizing yang, restraining yang, unblocking yang, fortifying yang, and restoring/suppressing yang. Five typical medical cases from “Collected Medical Records and Clinical Experiences of Zhu Weiju” are analyzed. The article concludes that Zhu Weiju regarded yang qi as the foundation of life, and considered the rise and fall of yang qi as the decisive factor in the ebb and flow of the body’s resistance. The essence of the five-stage changes is a dynamic process of yang qi transitioning from abundance to decline, and the core of treatment lies in regulating yang qi. Through mutual verification of theory and medical cases, this paper attempts to grasp Zhu Weiju’s academic essence that “one who excels at protecting genuine yang excels at treating cold damage”, hoping to provide assistance for the clinical application of his yang-fortifying approach.