仲景治血痹用针遣药探析

Analysis of Blood-bi Treated with Acupuncture and Medicine by Zhang Zhongjing

血痹为体虚受风,卫阳不足,血行不畅所致。若病情属较轻,麻木不甚,脉见微涩,寸、关部微紧,脉微主阳气虚弱,脉涩为血行不畅,紧则是外受风寒之寒闭之脉。用针方面,治疗只需针引阳气令阳气通行,对于血分凝滞之病,不独治血分,可用针刺法引动阳气,亦即"气行则血行"之意。针能导引经络去诸痹,故宜针引气血,以泻其邪,而"用针之类,在于调气""调气"不仅是调阳气,调血气,还调一身之气,气被调动了,阳气行则外邪去,气血调和,则寒散痹除。用药方面,张仲景治血痹用黄芪桂枝五物汤以益气通阳,和营行痹,此方即桂枝汤去甘草加黄芪,倍用生姜。为何要去甘草加黄芪,倍用生姜?去甘草之意在于去掉甘草的缓和之性,使药效更快发挥作用;倍用生姜是取其辛温行阳,温振中阳而行卫表,助桂枝走表散邪,阳通血行,血痹自除。

Blood-bi results from wind evil due to weak body,yang deficiency and unsmooth blood circulation. If not serious,it is manifested as slight numbness,indistinct and unsmooth pulse,a little tight in cunkou and guanyuan（ CV4）. Indistinct pulse is because of yang qi deficiency; Unsmooth pulse id because of blocking blood flow; Tight pulse is because of meridians attacked by cold pathogen. In terms of acupuncture,the focus is on activating yang qi; In terms of xuefen obstruction disease,xuefen is treated,and acupuncture is also used to motivate yang qi,because qi movement leads to blood movement. Acupuncture can direct meridians and vessels,so needling is used to direct qi and blood to eliminate evils. The key of acupuncture lies in regulating q,including yang qi,blood qi,and the quiz of whole body. Regulating quiz leads to movement of yang qi to eliminate external evils,to harmonize qi and blood,and to relieve cold and bi. In terms of meridians,Zhang Zhongjing uses Scutellariae-Ramuli Cinnamomi-FiveDrugs Decoction to tonify qi and activate yang,harmonize ying qi and eliminate bi. This prescription comes from Ramuli Cinnamomi Decoction added Huangqi（ Radix Scutellariae） instead of Gancao（ Radix Glycyrrhizae） and used double Shengjiang（ Rhizoma Zingiberis Recens）. Why doing so？ Removing Gancao means removing its abirritant nature in order to make drug effect exert quickly. Double use of Shengjiang can make good use of its acid-warm activating middle yang to move on the weiqi surface,helping Guizhi（ Ramulus Cinnamomi） to remove surface evils. In this way,yang qi and blood are activated,and blood-bi is naturally eliminated.