摘要
桂枝去桂加茯苓白术汤是《伤寒论》中颇具争议的一首方剂,原方由芍药、生姜、大枣、甘草、茯苓、白术组成。历代医家对原文“去桂”持质疑态度,多认为应去芍药而保留桂枝。本方争议的核心点在于桂枝和芍药作用的差异,一般认为芍药不具备解表作用,去桂枝后整方几乎无解表作用而无法治疗发热无汗、头项强痛诸症。解决争议的关键在于深入探讨桂枝、芍药功效的差异,通过梳理历代本草有关芍药功用的记载,总结芍药的作用特点为通降和利下。通过分析原文,认为第28条的核心病机为体表营卫壅堵,心下水气阻碍营卫代谢。结合营卫理论,提出芍药的核心作用为通降营卫,促进体表营卫回流。本方保留芍药的目的在于促进体表营卫回流,疏通体表营卫壅堵,通降中焦营卫至下焦,利心下水气,使邪气从小便走。去桂枝的目的在于桂枝主升,与通降的抗病趋势相悖。结合两则临床案例,初步验证桂枝去桂加茯苓白术汤证的合理性,从理论和实践证明了本方的有效性。
Guizhi Qugui plus Fuling Baizhu Decoction(桂枝去桂加茯苓白术汤)is a controversial prescription in Treatise on Febrile Diseases.The original prescription is composed of Shaoyao(Paeoniae Radix Alba),Shengjiang(Zingiberis Rhizoma Recens),Dazao(Jujubae Fructus),Gancao(Glycyrrhizae Radix Et Rhizoma),Fuling(PORIA)and Baizhu(Atractylodis Macrocephalae Rhizoma).Doctors of past dynasties doubted the original“withdrawing Guizhi(Cinnamomi Ramulus)”and thought that Shaoyao(Paeoniae Radix Alba)should be removed and Guizhi(Cinnamomi Ramulus)should be retained.It is generally believed that Shaoyao(Paeoniae Radix Alba)dose not have the effect of relieving the exterior symptoms.After removing Guizhi(Cinnamomi Ramulus),the whole prescription has almost no effect of relieving the exterior symptoms and can not treat fever,anhidrosis or headache.The key to solve the dispute lies in the in-depth discussion of the difference between the efficacy of Guizhi(Cinnamomi Ramulus)and Shaoyao(Paeoniae Radix Alba).By combing the records of Shaoyao(Paeoniae Radix Alba)in the past dynasties,the characteristics of Shaoyao(Paeoniae Radix Alba)were summarized as dredging and purging.Through the analysis of the original text,it is considered that the core pathogenesis of Article 28 lies in the blockage of Ying-Wei on the body surface and the obstruction of Ying-Wei metabolism by the water obstructing the heart.Combined with the theory of Ying-Wei,the core function of Shaoyao(Paeoniae Radix Alba)is to reduce Ying-Wei and promote the return of Ying-Wei on the body surface.The purpose of retaining Shaoyao(Paeoniae Radix Alba)is to promote the reflux of Ying-Wei on the body surface,relieve the blockage of Ying-Wei on the body surface,pass the Ying-Wei in the middle Jiao to the lower Jiao,benefit the heart and lower Qi,and make the evil Qi pass away from urine.The purpose of removing Guizhi(Cinnamomi Ramulus)is the effect of making Qi ascending is contrary to the trend of disease.Combined with two clinical cases,the rationality of Guizhi Qugui plus Fuling Baizhu Decoction was preliminarily verified,and its effectiveness was proved theoretically and practically.
作者
金雨静
黄世敬
JIN Yujing;HUANG Shijing(Guang'anmen Hospital,Chinese Academy of Chinese Medicine Sciences,Beijing 100053,China)
出处
《辽宁中医杂志》
CAS
2022年第7期71-74,共4页
Liaoning Journal of Traditional Chinese Medicine
基金
国家自然科学基金(81573790,81603443)
关键词
桂枝去桂加茯苓白术汤
伤寒论
经方
营卫
升降
Guizhi Qugui plus Fuling Baizhu Decoction(桂枝去桂加茯苓白术汤)
Treatise on Febrile Diseases
classical formula
Ying-Wei
ascending and descending
作者简介
金雨静(1997-),男,湖南汉寿人,硕士研究生,研究方向:中医药防治老年疾病;通讯作者:黄世敬(1964-),男,贵州道真人,主任医师、研究员,博士研究生导师,博士,研究方向:中医药防治老年疾病,E-mail:gamhsj@126.com。
