| 摘要: |
| 文章依据国医大师李士懋教授提出的“火郁发之”理论，系统探讨乌梅丸治疗寒热错杂型抑郁症的作用机制。李士懋教授认为，“火郁”证的核心病机为热邪内结、不得透达，并伴随气机升降失常，治疗应遵循“发之”原则，即通过宣畅气机促使内郁之热透散外解。乌梅丸为寒热并用、调和肝脾之经典方，其酸收、辛散、苦降、甘补的药味配伍与“火郁发之”理论高度契合，方中附子、干姜、桂枝等辛温药通过温养肝阳、疏利气机、温通中焦三重途径透达郁热，是“发之”治则的核心药味体现，兼具泄木安土、调和阴阳、透发郁热之效。文章结合李士懋源自《平脉辨证相濡医案》《李士懋田淑霄医学全集》《平脉辨证脉学心得》的平脉辨证核心思想，平脉辨证是以脉诊为核心的辨证体系，以沉取有力无力判定虚实，强调以脉定证、以脉解症，脉无虚假，不轻言舍脉从症，以此明确“脉弦而无力/沉弦无力”为乌梅丸应用核心依据，突出其与火郁发之理论的内在逻辑，杜绝仅凭症状辨证的方药泛化倾向，以期为该方治疗寒热错杂型抑郁症的临床应用提供严谨的理论支持与实践参考。 |
| 关键词: 火郁发之 乌梅丸 抑郁症 寒热错杂 李士懋 平脉辨证 |
| DOI：10.11656/j.issn.1673-9043.2026.09.01 |
| 分类号:R749.4 |
| 基金项目:全国名老中医药专家传承工作室建设项目（国中医药人教函〔2022〕75号）；河南省中医药科研专项课题项目（2025ZY3033）。 |
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| Exploring the application of Wumei Wan in treating depression of Cold-Heat complex syndrome based on the theory of “releasing stagnant fire” put forward by national traditional Chinese medicine Master LI Shimao |
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LI Bingru1, LI Chentao1, DENG Nan1, CHANG Xuehui2
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1.The Second Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou 450002, China;2.Academic Affairs Office, Henan University of Chinese Medicine, Zhengzhou 450046, China
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| Abstract: |
| Based on the theory of “Releasing Stagnant Fire” proposed by Professor LI Shimao，a National Master of traditional Chinese medicine（TCM），the paper systematically explores the therapeutic mechanism of Wumei Wan in treating depression of cold-heat complex syndrome. Professor LI held that the core pathogenesis of stagnant fire syndrome lies in internal accumulation of heat pathogens failing to disperse outward，accompanied by disorder of qi ascent and descent. The therapeutic principle of “releasing stagnant fire” aims to disperse constrained internal heat by unblocking and smoothing qi movement. As a classical formula that combines cold and warm medicinals to harmonize liver and spleen，Wumei Wan matches perfectly with the theory of releasing stagnant fire via its combined medicinals with sour astringent，pungent dispersing，bitter descending and sweet tonifying properties. The pungent-warm medicinals in the formula，including Radix Aconiti Lateralis Preparata，Rhizoma Zingiberis and Ramulus Cinnamomi，relieve stagnant fire through three pathways：warming and nourishing liver yang，smoothing stagnant qi movement，and warming and activating the middle jiao. These medicinals embody the core connotation of the therapeutic principle of “releasing” and can soothe liver excess to tonify spleen，harmonize yin and yang，and disperse stagnant heat. Combined with Professor LI’s core academic thought of pulse-centered syndrome differentiation，a diagnostic system taking pulse palpation as the core，which differentiates deficiency and excess by pulse strength under deep palpation，advocates determining syndrome and interpreting symptoms based on pulse manifestations，and opposes abandoning pulse diagnosis merely according to symptomatic manifestations，this paper clarifies that string-thin forceless pulse or deep string-thin forceless pulse is the core diagnostic basis for applying Wumei Wan. This paper further elaborates the internal logical connection between this formula and the theory of releasing stagnant fire，and avoids indiscriminate application of prescriptions only based on symptoms. It is expected to provide rigorous theoretical support and clinical reference for the clinical application of Wumei Wan in the treatment of depression with cold-heat complex syndrome. |
| Key words: releasing stagnant fire Wumei Wan depression cold-heat complex syndrome LI Shimao pulse-centered syndrome differentiation |
