《伤寒论》辨治心阳虚三方证治解析

Analysis of three formulas against heart-yang deficiency based on syndrome differentiation in Treatise on Cold-Induced Diseases

心阳虚证由心阳虚衰、鼓动无力、阴寒内盛所致,以心悸怔忡、胸闷乏力、畏寒肢冷、面色苍白等为主症,严重者可见心阳虚脱之危候。桂枝甘草汤、桂枝甘草龙骨牡蛎汤、桂枝去芍药加蜀漆牡蛎龙骨救逆汤为仲景辨治心阳虚证的主要方剂。既往多认为,桂枝甘草汤治心阳虚损之轻证,桂枝甘草龙骨牡蛎汤治心阳虚损较重者,而桂枝去芍药加蜀漆牡蛎龙骨救逆汤治心阳虚损更重者,甚则达到了亡阳之危候。但通过解析心阳虚三方证治特点,提出以上三方证当皆属急症、重症,所不同者,桂枝甘草汤重在补心通阳,兼能温营养血、化气行水、平冲降逆;桂枝甘草龙骨牡蛎汤重在潜敛,桂枝去芍药加蜀漆牡蛎龙骨救逆汤则兼表邪不解、痰热内迫。

Heart-yang deficiency syndrome,due to heart-yang deficiency,weak beating and internally exuberant yin cold,is characterized by palpitation or severe palpitations,stuffiness in the chest,lacking in strength,aversion to cold and cold limbs,pale complexion,or even critical signs triggered by syn-drome of collapse of heart-yang.Heart yang collapse syndrome can be seen in sever conditions.Guizhi Gancao Tang,Guizhi Gancao Longgu Muli Tang and Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang,directed at hear-yang deficiency syndrome recorded in Treatise on Cold-Induced Diseases （Shang Han Lun）written by ZHANG Zhongjing,were referred to apply on mild,moderate and severe conditions of heart-yang deficiency.However,based on the analysis of the features of signs and syndromes of the three formulas against,this article puts forward that their indications are all emergency and intensive. And the difference among them are that Guizhi Gancao Tang focuses on tonifying heart to unblock yang, as well as warming the nutrient to nourish blood,resolving qi to move water,calming surging and direc-ting counterflow downward,Guizhi Gancao Longgu Muli Tang emphasizes in subduing and astringing, and Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang can both treat unreleased of exterior pathogen and internally oppressed phlegm-heat.