略述《金匮要略》对下法的运用

An Outline of the Application of TCM Purgation in Synopsis of Golden Chamber

仲景在运用下法时,强调辨证施治,谨守病机,对证用药。认为津伤者不可下,气虚者不可下,阳虚者不可下,正虚邪实者不可下,脾胃虚者不可下。为防下法伤正,仲景十分注重脾胃的顾护和滋养,除了应用甘缓和中的药物,还常采用以蜜为丸的方法,如麻子仁丸,意在甘缓润下,益气和中。仲景认为攻下药物多峻猛,易损伤正气,然患者体质不尽相同,对峻猛之药耐力有所差异,故下法方药剂量当因人而异。药物切勿因过服而伤正,故当中病即止。同时当机体邪气得去,正气初复,应注重调护以促进正气实、机体安。仲景还列举了大量误下而致的变证,将理、法、方、药、禁忌证有机结合起来,对后世完善下法理论体系有着重大意义和深远影响。

In the. application of purging,Zhang Zhongjing emphasizes treatment based on syndrome differentiation and strictly ob- serving the pathogenesis and symptomatic use of drugs. He holds that purging should be applied to patients with body fluid con- sumption,qi deficiency, yang deficiency, deficiency healthy qi and excessive pathogen,and deficiency of the spleen and the stomach. In order to prevent purging from impairing healthy qi ,Zhongjiang attaches great importance to the protection and nourishment of the spleen and the stomach. Besides the use of drugs sweet in taste and mild, neutral nature, he also often uses honeyed pills such as Mazireu Pills sweel in taste and mild in nature with the effeet uf lubricant laxation,benefiting qi and harmnnizing the mid- die energizer. Zhongjing believes that purgatives are strong in nature which tend to impair healthy qi. Since patients have different constitutions and their resislance to strong drugs vary from person to person,the dose of purgatives should be based on individual condition. Be sure not to overuse drug in case of impairing healthy qi. For this reason,discontinue medication as soon as getting effect. When the pathogenic, qi leaves and healthy qi recovers, regulation and protection should be valued to promote sufficiency of healthy qi and balanced body. In addition ,Zhongjiang lists a lot of variant syndromes due to raisuse of purgatives, lie combines the theory,strategy,formula and drugs into an organic whole,which has great significance and profound influence on the perfection of purging theory by later generations.