张仲景经典药方112个.docx
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1、张仲景经典药方112个 摘 要:探讨了伤寒论、金匮要略有关胁痛、臌胀、黄疸等病症的医论方药文献,认为仲景辨治胁痛主要责之于实邪阻滞肝胆经脉以及精气虚损二端,治疗上强调固本培源,补益精气;辨治黄疸多责之于湿热、寒湿、瘀血、气血虚损、气机不利等,治疗上强调急则治标,缓则治本;辨治臌胀多责之于瘀血气滞两端,瘀血有寒凝血瘀、湿热血瘀、精枯血瘀等之别,气滞有寒凝气滞、痰浊气滞之分,治疗上强调攻补适宜。总结看,仲景辨治现代肝病相关病症,病位上多责之于肝胆脾胃,治法上强调健运肝胆脾胃,虚则补之,滞则通之,热则清之,寒则温之,总以相应脏腑真元之气充盈丰沛,通畅调达为务。 关键词:张仲景;胁痛;臌胀;黄疸;现代
2、肝病 中图分类号:R222.3文献标识码:A 文章编号:1673-7717(2011)04-0805-03 ZHANG Zhong-jing Clinical Theory Research Based on Modern Liver Diseases Treatment Fields TAN Chun-yu, LIANG Hui-feng, ZHU Yin, HUANG Ying, ZHANG Ning, FANG Li-xing (Research Institute of TCM Literatures Shanghai University of TCM,Shanghai 201203
3、,China) Abstract:To demonstrate the medical treatise related to Hypochondriac pain, tympanites, jaundice and other diseases in Treatise on Febrile Diseases and Medical Treasures of the Golden Chamber, we believe that ZHANG Zhong-jing treated hypochondriac pain based on syndrome differentiation, owin
4、g its etiology to excess-evil blocking liver and gallbladder channels and vessels, attaching importance to relieving secondary symptoms in acute cases, treatment of chronic disease aiming at the principal aspect. Regarding to tympanites, owing its etiology to blood and Qi stagnation, blood stagnatio
5、n could be induced by cold obstruction, damp-heat, scarce of essence , while Qi stagnation by cold obstruction, turbid phlegm, attaching importance to simultaneous application of purging and nourishing therapeusis. In conclusion, when Zhang Zhong Jing diagnosing and treating modern liver diseases ba
6、sed on syndrome differentiation, owing disease sites to liver, gallbladder, spleen and stomach, emphasizing invigorating liver, gallbladder, spleen and stomach, deficiency should be treated by supplementary therapy, stagnation should be treatment by promoting, treating heat syndrome with cold therap
7、y, cold disease should be treated by warm therapy. All in all the treatment principles would be nourishing and invigorating the Qi of related Zang and Fu organs, also regulating and harmonizing them. Key words:ZHANG Zhong-jing;hypochondriac pain;tympanites;jaundice modern liver diseases 收稿日期:2010-11
8、-20 基金项目:上海市重点学科建设项目(T0305,S30301);教化部重点试验室项目(GS090502) 作者简介:谭春雨(1972),男,助理探讨员,探讨方向:医史学术流派探讨。 传统中医没有现代解剖学范畴的肝病观念,从病症对应分析,现代医学范畴的各类急慢性肝病大体包含于胁痛、臌胀、黄疸等传统中医病症之中。本探讨主要通过探讨总结分析伤寒论、金匮要略有关胁痛、臌胀、黄疸等病症的相关医论文献,试图比较系统的阐述张仲景有关现代医学肝病相关病症的临床辨证论治思想特色,以期“古为今用”,为现代中医肝病专科探讨供应珍贵的理论实践阅历启迪。 1 张仲景胁痛临症学术思想特点 仲景胁痛病机主要责之于肝胆
9、,病因主要则之于外感。证候上,仲景将其分为两大类,一是实邪阻滞肝胆经脉,气滞不通,导致气机不通的实邪有热邪、痰浊之邪、瘀血之邪、寒邪等多端,治疗上强调化邪理气,兼以扶正固本;二是精气虚损,肝经失养,多为久病所致,治疗上强调固本培源,补益精气。 1.1 实邪阻结胁痛 实邪阻滞肝胆经脉,气滞不通者,治疗总以化邪理气为原则,佐以扶正固本。 风热郁结者当散化风热,方选小柴胡汤;如伤寒论说:“本太阳病不解,转入少阳者,胁下鞭满,干呕不能食,往来寒热,尚未吐下,脉沉紧者,与小柴胡汤”;“太阳病,十日已去,脉浮细而嗜卧者,外已解也。设胸满胁痛者,与小柴胡汤”。 痰浊痹阻者当散化痰浊,方选小柴胡汤加栝蒌实、茯
10、苓等;瘀血阻滞者当化瘀散结,方选小柴胡汤加牡蛎。如伤寒论说:“伤寒五六日,中风,往来寒热,胸胁苦满,嘿嘿不欲饮食,心烦喜呕。或胸中烦而不呕,或渴,或腹中痛,或胁下痞鞭,或心下悸、小便不利,或不渴、身有微热,或咳者,小柴胡汤主之若胸中烦而不呕者,去半夏、人参,加栝蒌实一枚;若渴者,去半夏,加人参合前成四两半、栝蒌根四两;若胁下痞硬者,去大枣,加牡蛎四两;若心下悸、小便不利者,去黄芩,加茯苓四两。” 小柴胡汤方中,柴胡透解肝胆邪热,疏达经气;黄芩清泄邪热;半夏散浊和胃;人参、炙甘草、大枣扶助正气,反抗病邪;生姜宣化正气,鼓邪外出。若痰浊痹阻者,小柴胡汤加化痰渗湿的栝蒌实、茯苓;若瘀血阻滞肝脉者,小
11、柴胡汤加软坚化瘀之牡蛎。 寒邪凝滞者当温化寒邪,方选柴胡桂枝干姜汤。如伤寒论说:“跗阳脉微弦,法当腹满,不满者必便难,两难受,此虚寒从下上也,当与温药服之”;“伤寒五六日,已发汗而复下之,胸胁满微结,小便不利,渴而不呕,但头汗出,往来寒热,心烦者,此为未解也,柴胡桂枝干姜汤主之”。柴胡桂枝干姜汤,方中柴胡疏肝理气,桂枝、干姜温中散寒,栝蒌根润燥化浊散结,牡蛎软坚化瘀散结,黄岑清化瘀热,炙甘草补中益气。 1.2 阳虚精损胁痛 肝阳虚衰,精气虚损,肝经失养者,治疗以温通肝阳,培源益精为法,方选当归生姜羊肉汤。如伤寒论说:“寒疝腹中痛,及胁痛里急者,当归生姜羊肉汤主之,若寒多者,加生姜成一斤;痛多而
12、呕者,加橘皮二两,白术一两。”本方羊肉滋补肝肾精气,当归养血活血,生姜宣精布散肝脉。若寒邪较甚者加重生姜用量;脾虚气机不利者,加橘皮理气,白健脾。 2 张仲景黄疸临症学术思想特点 黄在五行脏腑理论中为脾胃本色,所以仲景认为黄疸病症病位多在脾胃。脾胃为后天之本,五脏六腑之化源,所以仲景认为,脾胃受损,病变经常会波及三焦,特殊是湿热互结脾胃之邪为病,由于内外气机不通,更简单引起充满三焦。黄疸在病因上,仲景责之于外感内伤两端,外感多责之于风热、风湿;内伤多责之于饮食不调、酒色过度等。病机多责之于湿热蕴蒸、寒湿凝滞、瘀血阻结、气血虚损、气机不利等。治疗上仲景强调急性期治标,治标当随病因病机而宜;慢性期
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