试析仲景《金匮要略》下法的应用特点

Application characteristics of the purgative method in Synopsis of Golden Chamber of Zhang Zhongjing

下法作为中医八大治疗方法之一,具有应用广泛、见效相对迅速的特点及优势。在中医古籍中有丰富的记载与论述。《金匮要略》中涉及下法的条文约五十余条,相关方剂包括大小承气汤、大黄硝石汤、栀子大黄汤、茵陈蒿汤、泻心汤、苓甘五味加姜辛半杏大黄汤、大黄甘草汤、麻子仁丸、猪膏发煎、走马汤、大黄附子汤、大黄?虫丸、下瘀血汤、大黄牡丹汤、抵当汤、桔梗白散、十枣汤、己椒苈黄丸、大黄甘遂汤、甘遂半夏汤、厚朴三物汤、厚朴七物汤、厚朴大黄汤、大柴胡汤,共计25方,运用下法所治疗的疾病有:胸满、腹满、痰血、黄疸、肠痈、产妇腹痛、产妇少腹坚痛、妇人水与血俱结血室等十七个病证,应用范围相当广泛。本文基于《金匮要略》,对涉及下法的条文、病证、治法、方药进行归纳总结,从下法所治疗疾病的性质、患病部位、阴阳表里、用药特点等6个方面,探讨仲景下法治疗的应用特点,以期对现代中医学临床疾病诊治有所参考。

Purgative method,as one of the eight therapeutic methods of traditional Chinese medicine（ TCM） with many characteristics and advantages such as wide application and relatively quick effect.There are a lot of records and discussions on it in the ancient books of TCM. For example,there are more than 50 articles about purgative method and a total of 25 relevant prescriptions are involved in Synopsis of Golden Chamber. The relevant prescriptions includes Dachengqi Decoction, Xiaochengqi Decoction,Dahuang Xiaoshi Decoction,Zhizi Dahuang Decoction,Yinchenhao Decoction,Xiexin Decoction,Linggan Wuwei Decoction modified with Jiangxin Banxing Dahuang,Dahuang Gancao Decoction,Maziren Pill,Zhugaofa Decoction,Zouma Decoction,Dahuang Fuzi Decoction,Dahuang Zhechong Pill,Xiayuxue Decoction,Dahuang Mudan Decoction,Didang Decoction,Jiegengbai Powder,Shizao Decoction,Jijiao Lihuang Pill,Dahuang Gansui Decoction,Houpo Sanwu Decoction,Houpo Qiwu Decoction,Houpo Dahuang Decoction and Dachaihu Decoction. Besides,there are 17 kinds of diseases are treated with such method,including chest turgor,stomach turgor,bloody phlegm,jaundice,acute appendicitis,maternal abdominal pain,maternal intestinal carbuncle and maternal congestion of water and blood in blood chamber,so it is widely applied. This paper summed up the the provisions,diseases and syndromes,therapies,and prescriptions involving purgative method based on Synopsis of Golden Chamber,and discussed the application characteristics of the purgative method of ZHANG Zhong-jing from the following 6 aspects,such as nature of disease,diseased parts,exterior and interior of Yin and Yang,and medication features,in order to provide some reference for the diagnosis and treatment of the clinical diseases in modern TCM.