摘要
《金匮要略》瓜蒌薤白三方一直被学界认为是治疗胸痹痰证的重要经方。但张仲景制瓜蒌薤白三方的原意可能不在于此:首先,从痰的历史发展源流来看,秦汉至晋并无后世独立意义的病理概念之"痰"。《金匮要略》成书年代,多以"淡"代"痰","痰饮"当作"淡饮","淡"主要形容水流动状貌,更遑论明确提出"痰"这一概念;其次,瓜蒌薤白三方的主药瓜蒌、薤白并不符合张仲景"病痰饮者,当以温药和之"的治疗原则;最后,从章节顺序看,瓜蒌薤白三方只出现在《金匮要略·胸痹心痛短气病脉证治第九》中,与痰饮水密切相关的《金匮要略·痰饮咳嗽病脉证并治第十二》和《金匮要略·水气病脉证并治第十四》并未见到应用瓜蒌、薤白治疗痰饮。通过分析《金匮要略》胸痹的病因病机,张仲景应用瓜蒌薤白三方原意,并非专为胸痹之痰治而设,而重在通阳宣痹。后代把瓜蒌薤白三方作为治疗胸痹痰证的重要方剂,可理解为是对"痰"及其相关概念,以及对瓜蒌等药物药味药性的认识不断深化细化的结果。
The Gualou Xiebai Three Decoctions in Jingui Yaolue had been regarded as classical prescriptions to treat phlegm syndrome of thoracic obstruction for a long time. Maybe, it was not the original meaning of ZHANG Zhong-jing. Firstly, from the historical development of phlegm, the concept of ‘phlegm' hadn't been put forward and the word ‘phlegm' was replaced by ‘light' from Qin and Han Dynasty to Jin Dynasty; Secondly, the main herbs Fructus Trichosanthis and Bulbus Allii Macrostemonis in the Gualou Xiebai Three Decoctions were not matched with ZHANG Zhong-jing's principle which was called ‘people who suffered from phlegm and fluid retention should be treated with warm-natured Chinese medicine'; Finally, according to the chapter order, the Gualou Xiebai Three Decoctions didn't appear in the chapter of Jingui Yaolue-phlegm cough syndromes and treatment twelfth, and Jingui Yaolue-water disease syndromes and treatment fourteenth, which was closely related to the phlegm syndrome. By analyzing the cause and the pathogenesis of thoracic obstruction in Jingui Yaolue, it revealed that the original function of Gualou Xiebai Three Decoctions was activating stagnated yang instead of eliminating the phlegm. The reason why the Goulou Xiebai Three Decoctions were regarded as important prescriptions to treat thoracic obstruction with phlegm syndrome should be that people gained a better understanding of the ‘phlegm' and the related concepts, as well as the property of Chinese medicines including Fructus Trichosanthis.
出处
《中华中医药杂志》
CAS
CSCD
北大核心
2017年第5期2288-2290,共3页
China Journal of Traditional Chinese Medicine and Pharmacy
基金
国家重点基础研究发展计划(973计划)项目(No.2014CB542903)
中国中医科学院基本科研业务费自主选题研究项目(No.YZ-1668)~~
关键词
瓜蒌薤白白酒汤
瓜蒌薤白半夏汤
枳实薤白桂枝汤
金匮要略
胸痹
痰
原意
理论探究
Gualou Xiebai Baijiu Decoction
Gualou Xiebai Banxia Decoction
Zhishi Xiebai Guizhi Decoction
Jingui Yaolue
Thoracic obstruction
Phlegm
Original meaning
Theory research
