基于“一气周流，土枢四象”理论对瘿病病因病机的探讨

Exploration of the Etiology and Pathogenesis of Goiter Based on the Theory of “One Qi Circulating, Earth as the Hub and the Four Symbols”

摘要: 医家黄元御在《四圣心源》中提出了“一气周流，土枢四象”的学术理论，强调中焦土气斡旋，左路木火升发，右路金水敛降，形成人体之圆运动。本文基于“一气周流，土枢四象”理论探讨瘿病的病因病机，认为中土之气升降失调是其发生的根本病机。该病治以健运土气、复其斡旋为关键，同时把握肝、肺、心、肾四象气机动态圆动，以复气机升降为规矩，令中气复常不失为正治之举，为瘿病的辨证论治提供新思路。

Abstract: In his work Si Sheng Xin Yuan, the physician Yuanyu Huang proposed the academic theory of “One Qi Circulating, Earth as the Hub and the Four Symbols”, emphasizing the rotation of Earth qi in the middle energizer, the rise and expression of wood and fire on the left path, and the contraction and descent of metal and water on the right path, forming a circular movement in the human body. This paper discusses the etiology and pathogenesis of goiter based on the theory of “One Qi Circulating, Earth as the Hub and the Four Symbols”, suggesting that the imbalance of the ascending and descending of Earth qi in the middle energizer is the fundamental pathogenesis of the disease. The treatment of this disease focuses on promoting the smooth circulation of Earth qi, restoring its rotation, and dynamically adjusting the liver, lung, heart, and kidney qi in a circular motion to regulate the body’s qi mechanism collectively, facilitating the restoration of normal ascending and descending processes as the guiding principle. This offers a new perspective for the differential diagnosis and treatment of goiter.