摘要
柴胡桂枝干姜汤出自《伤寒杂病论》,历代医家对其病机认识各有不同,导师袁红霞从原文入手,条文互参,参考《神农本草经》和《黄帝内经》等,以经解经,得出柴胡桂枝干姜汤的病机有以下两点:一是表邪仍在,邪热内陷;二是阳虚为主兼以阴伤。据此将柴胡桂枝干姜汤功效拆分为祛邪、扶阳、滋阴三部分,并根据疾病所处阶段不同予以加减应用。如欲以祛邪为主,若见表邪盛则增加柴胡、黄芩用量以解表祛邪,若见邪热内陷明显则炙甘草改生甘草以增强清热之功,同时可减少桂枝用量以达到宣通气机之用;如欲以扶阳为主,则增加干姜用量,严重时致肾阳虚损可配伍附子理中丸;若欲以滋阴为主,则减干姜用量,增加栝楼根、牡蛎用量以增强滋阴清热生津之力。附病案1则。
Chaihu Guizhi Ganjiang Decoction(柴胡桂枝干姜汤)was originated from Treatise on Cold Damage and Miscellaneous Diseases.Physicians of all dynasties had different understandings of its pathogenesis.The tutor YUAN Hongxia started from the original text,and referred to Shennong’s Classic of Materia Medica and Huangdi’s Canon of Internal Medicine,etc.,to interpret the text,and concluded that the pathogenesis of Chaihu Guizhi Ganjiang Decoction has the following two points:first,exterior pathogen still exists,while pathogenic heat has already invaded inward;second,yang deficiency predominates with yin consumption.Accordingly,the efficacy of Chaihu Guizhi Ganjiang Decoction is divided into three parts of expelling pathogen,reinforcing yang and nourishing yin,which can be applied by adding or subtracting according to the different stages of the disease.If the main purpose is to expel pathogen,the dosage of Chaihu(Bupleuri Radix)and Huangqin(Scutellariae Radix)can be increased to relieve exterior syndrome and expel pathogen in case of exuberance of exterior pathogen;we can use Shenggancao(Glycyrrhizae Radix et Rhizoma)instead of Zhigancao(Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle)to enhance the efficacy of clearing heat in case of invasion of pathogenic heat,meanwhile,reduce the dosage of Guizhi(Cinnamomi Ramulus)to achieve the purpose of promoting qi movement.If the main purpose is to reinforce yang,the dosage of Ganjiang(Zingiberis Rhizoma)can be increased,combining with Fuzi Lizhong Pills(附子理中丸)in severe cases of kidney yang deficiency.If the main purpose is to nourish yin,the dosage of Ganjiang can be reduced,and the dosage of Gualougen(Trichosanthis Radix)and Muli(Ostreae Conch)can be increased to enhance the effect of nourishing yin,clearing heat and promoting fluid production.A medical case is recorded in this paper.
作者
冯奕鸣
孔洋洋
张可颐
袁红霞
FENG Yiming;KONG Yangyang;ZHANG Keyi;YUAN Hongxia(Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)
出处
《山东中医药大学学报》
2024年第3期295-299,共5页
Journal of Shandong University of Traditional Chinese Medicine
基金
袁红霞天津市名中医传承工作室建设项目(批文号:津卫中〔2022〕303号)
天津市教学成果奖重点培育项目(编号:PGYJ-032)。
关键词
《伤寒杂病论》
柴胡桂枝干姜汤
祛邪
扶阳
滋阴
袁红霞
Treatise on Cold Damage and Miscellaneous Diseases
Chaihu Guizhi Ganjiang Decoction(柴胡桂枝干姜汤)
expelling pathogen
reinforcing yang
nourishing yin
YUAN Hongxia
