摘要
[目的]基于张锡纯先生大气理论,探析加味桂枝汤以药代粥的理论基础及临床拓展运用。[方法]通过查阅《黄帝内经》《伤寒论》以及后世医药典籍,分析服用桂枝汤后啜热粥助汗的理论依据,结合《医学衷中参西录》的大气理论,探讨大气与营卫的关系、热粥对大气的影响,分析加味桂枝代粥汤的理法方药,进而归纳总结加味桂枝代粥汤以药代粥的理论依据,并通过对两则验案的分析,拓展该理法方药的临床运用。[结果]《伤寒论》桂枝汤后文通过啜热粥调养,化生精微,以资汗源,益气固卫,达到助邪外出之效;张锡纯认为大气有主持全身之功,与营卫之气息息相通,啜粥可滋养大气,从而达到调营养卫、助汗御邪的效果;加味桂枝代粥汤取桂枝汤合升陷汤之意,尤以黄芪益气固卫、代粥助汗为特点,适用于大气亏虚、卫气不固之虚人外感。夏永良老师演绎张氏之法,临床以加味桂枝汤法,加减治疗虚人外感,具有颈项不适、荨麻疹等表现者。如配伍益气升津、活血通络之品,治疗颈椎病脾胃亏虚、风寒外束之证;配伍祛风散寒、行气消滞之品,治疗咳嗽外感风寒、营卫不和致肺气不得敛降之证等,疗效颇佳。[结论]加味桂枝代粥汤以药代粥,基于张锡纯大气理论,以一味黄芪补养大气,调营养卫,滋源达邪,弥补了现代人服药少粥之憾,施之临床,疗效可观,值得借鉴。
[Objective]To explore the theoretical basis of revised Guizhi Decoction replacing porridge with medicine and its clinical application,based on ZHANG Xichun's theory of pectoral Qi.[Methods]By referring to"Huangdi Neijing""Treatise on Febrile Diseases"and later medical classics,the theoretical basis for sipping hot porridge to perspire after taking Guizhi Decoction was analyzed,combined with the theory of pectoral Qi in"Records of Traditional Chinese and Western Medicine in Combination",the relationship between hot porridge and the effect of hot porridge on the pectoral Qi was explored,the rationale prescription of revised Guizhi Daizhou Decoction,and the theoretical basis of revised Guizhi Daizhou Decoction with medicine instead of porridge were summarized,and the clinical application of rational prescriptions was expanded through presenting two cases as proof.[Results]Guizhi Decoction in"Treatise on Febrile Diseases"was rearranged by sipping hot porridge,subtling metamorphosis,providing the source of sweat,benefiting Qi and strengthening the Wei Qi,so as to achieve the effect of nourishing the source and eliminating pathogenic factors.ZHANG Xichun believed that pectoral Qi had the power to preside over the whole body,and connected closely with Ying Qi and Wei Qi,and sipping porridge could nourish pectoral Qi,in order to achieve the effect of regulating Ying and Wei,and helping perspiration and resisting pathogenic factors.Flavoring Guizhi Daizhou Decoction takes combination of Guizhi Decoction and Shengxian Decoction,especially characterized by Astragalus membranaceus,benefiting Qi and strengthening health,and substituting porridge for helping perspiring,and it is suitable for the diseases caused by external factors of the weak patient with deficiency of pectoral Qi and instability of Wei Qi.Teacher XIA Yongliang interpretates ZHANG's method,using Guizhi Decoction for the diseases caused by external factors of the weak patient,with neck discomfort,urticaria and other manifestations,such as compatibility with her
作者
石曼皓
陈佳丽
夏永良
SHI Manhao;CHEN Jiali;XIA Yongliang(Zhejiang Chinese Medical University,Hangzhou(310053),China;The First Affiliated Hospital of Zhejiang Chinese Medical University)
出处
《浙江中医药大学学报》
CAS
2020年第8期803-806,共4页
Journal of Zhejiang Chinese Medical University
关键词
张锡纯
医学衷中参西录
大气理论
汗法
加味桂枝代粥汤
临床运用
医案
ZHANG Xichun
Records of Traditional Chinese and Western Medicine in Combination
theory of pectoral Qi
perspiration method
revised Guizhi Daizhou Decoction
clinical application
medical records
