辨《伤寒杂病论》中“麻黄升麻汤主之”证治

Analysis on Method and Clinical Application of Mahuang Shengma Decoction

麻黄升麻汤是《伤寒杂病论》所载著名方剂,出自《伤寒论》厥阴病篇第357条。从古至今对麻黄升麻汤进行评论的医家不乏其人。妄议此方为谬者有之,付诸临床活人者有之,运用麻黄升麻汤于临床医家亦有颇多,因此历代医家争议颇大。在中医理论指导下运用中药方剂治病的范围内,麻黄升麻汤方药物组成阴阳相配,恰有扶正而不助邪、祛邪而不伤正的治疗特点。在临床运用的过程中,结合病人当下的症状及病机,针对病邪所在而非针对病症所在适当处以有靶向性的药队则病情是可以确切控制的。当今临床医家在临床上治疗肺系疾病的疑难杂症中常会以麻黄升麻汤加减,疗效显著确切且经验颇丰。甚或有医家治疗其他系统疾病时,亦见以麻黄升麻汤加减。因此,文章梳理历代医家研究、运用麻黄升麻汤之经验脉络,举隅历代医家理论辨析及临床应用,深入挖掘麻黄升麻汤所正治的病因、病机、病证,试明晰麻黄升麻汤之真义。通过析议麻黄升麻汤的理论和治法,并以孔明望教授用麻黄升麻汤加减治疗顽固性咳嗽、慢性喘息性支气管炎、多重耐药性肺炎的验案为延发,悉心探讨经方有效性。附以古今医家用麻黄升麻汤治疗呼吸系统、循环系统、消化系统、外科的经验整理,旨在辨识麻黄升麻汤在历史洪流中怎样传承、探讨在临床上怎样应用,从而达到让更多医者在临床中面临该方剂所涉之病证时,有效潜方、药到病除之功用。

Mahuang Shengma Decoction is a well-known formula contained in Treatment of Typhoid and Miscellaneous Diseases and is recorded in Article 357 of Jue Yin Disease. There are many doctors who have commented on Mahuang Shengma Decoction since ancient times. There are many people who deliberately consider this method as a fallacy as well as those who put it into clinical practices. Therefore,there is a lot of controversy among doctors all the time. Within the scope of using traditional Chinese medicine prescriptions to treat diseases under the guidance of the theory of traditional Chinese medicine,Mahuang Shengma Decoction has a combination of Yin and Yang,which has the characteristics of nourishing without deterioration and eliminating infection without hurting body. In the clinical applications,combined with the patient’s current symptoms and pathogenesis,a targeted herb can aim at the disease cause rather than its appearance and the condition can be accurately controlled. Nowadays,clinicians often use Mahuang Shengma Decoction to treat the incurable diseases of the pulmonary system in clinical practice and the optimization of Mahuang Shengma Decoction can also be chosen to treat other diseases. Therefore,the author combed the research of previous doctors,used the historical context of Mahuang Shengma Decoction,and analyzed the theoretical analysis and clinical application of the previous doctors to further explore the etiology,pathogenesis,and symptoms of diseases treated by Mahuang Shengma Decoction. This article analyzes the theory and treatment of Mahuang Shengma Decoction,and summarizes the experience of ancient and modern doctors using Mahuang Shengma Decoction to treat the respiratory system,circulatory system,digestive system and surgery diseases. The author further discussed the theory of using Mahuang Shengma Decoction to treat lung diseases such as refractory cough,chronic asthmatic bronchitis,multidrug-resistant pneumonia,and chronic obstructive pulmonary. The author aims to identify how Mahuang Shengma Decoction is inherited and explore how it is applied clinically. It would instruct more doctors to effectively use the medicine facing with the symptoms and symptoms in the scope of the using this prescription.