摘要
历节的病因分为内因和外因,内因为禀赋素亏,营血虚耗,外因为风、寒、湿三气合至。发为内因者,多以本虚(关节失养)为主,需补益气血,填补肾精,扶助正气,基于“辛润”理论,“升脾气”为首要问题。仲景所用方剂中,桂枝附子汤和桂枝附子去桂加术汤多用于治疗本证。发于外因者,除感受外邪之外,在内必有脏腑虚衰所致之湿邪,而外湿多在皮膜肌肉之间,与内湿相合,随虚入经,注于关节,痹阻骨节腔隙,仲景用乌头汤治疗。历节初起,表证明显而游走不定者,宜选用辛甘之防风,辛温之羌活、独活、苍术,散风除湿解表;疼痛为主者,可选用大辛大热之川乌、草乌,辛温之麻黄、细辛,温经散寒止痛;湿邪偏胜,关节重浊者,可选用辛温之五加皮、苍术,辛苦之防己以祛除湿邪重浊;脏腑受累,痰瘀留滞而关节肿胀不消、变形者,除川乌外,亦可选用辛温之半夏、制天南星,散湿邪、化痰浊。辛味药的选择,是历节病选方用药的关键。除了性味,归经也同样重要,以上所述药物大多入脾经,再合其辛之性,便可使药物在体内完成“辛润”的整个过程。
The causes of multiple arthralgia are divided into internal and external ones.The internal cause is the deficiency of endowment, the depletion of nutrient blood, while the external cause is the combination of wind, cold and dampness.If multiple arthralgia is caused by internal causes mainlymanifested as the root deficiency of the joint′s loss of nourishment.It is necessary to replenish qi and blood, replenish kidney essence, and support the healthy qi.Based on the theory of "pungent medicine having nourishing effect", "activating spleen qi" is the primary problem.Among Zhang Zhong-jing′s formulas, Cinnamon Twig and Aconite Decoction, Cinnamon Twig and Aconite Decoction Removing Cinnamon Twig plus Rhizoma Atractylodis Macrocephalaeare mostly used to treat this syndrome.If multiple arthralgia is caused by external causes, there must be dampness pathogenic factors caused by the deficiency of the viscera in the external pathogenic factors.The external dampness is mostly between the skin and muscle, consistent with the internal dampness, then enters the meridian with the deficiency, and is injected into the joints, blocking the joints cavity.Zhang Zhong-jing often treats it with Aconite Main Root Decoction.At the beginning of multiple arthralgia, for those with obvious symptoms and uncertain location, it is advisable to use pungent-sweet Fangfeng(Radix Saposhnikoviae),pungent-warm Qianghuo(Radix et Rhizoma Notopterygii),Duhuo(Radix Angelicae Pubescentis),Cangzhu(Rhizoma Atractylodis) for dispersing wind, dehumidifying and relieving the exterior.For those who suffer from pain, it is advisable to choose Chuanwu(Radix Aconiti) and Caowu(Radix Aconiti Kusnezoffii) with heave pungent and heat nature, pungent-warm Mahuang(Herba Ephedrae) and Xixin(Radix et Rhizoma Asari) for warming meridians, dispersing cold and relieving pain.For those with excessive dampness and severe joint turbidity, it is advisable to choose pungent-warm Wujiapi(Cortex Acanthopanacis) and Cangzhu(Rhizoma Atractylodis),pungent-bitter Fangji(Radix S
作者
郭宏明
史光伟
李金田
梁永林
GUO Hong-ming;SHI Guang-wei;LI Jin-tian;LIANG Yong-lin(Guangdong Changxing RunKe Education Technology Co.,Ltd.(Lanzhou Branch),Lanzhou,Gansu,China,730000;Jiuquan Hospitai of Traditionai Chinese Medicine,Jiuquan,Gansu,China,735000;Gansu University of Chinese Medicine,Lanzhou,Gansu,China,730000)
出处
《河南中医》
2023年第2期163-166,共4页
Henan Traditional Chinese Medicine
基金
国家社会科学基金地区项目(18XMZ031)。
关键词
历节
“辛以润之”
桂枝附子汤
桂枝附子去桂加术汤
乌头汤
《金匮要略》
张仲景
multiple arthralgia
"pungent medicine having nourishing effect"
Cinnamon Twig and Aconite Decoction
Cinnamon Twig and Aconite Decoction Removing Cinnamon Twig plus Rhizoma Atractylodis Macrocephalae
Aconite Main Root Decoction
Synopsis of the Golden Chamber
Zhang Zhong-jing
