半夏泻心汤证考

Textual Research on the Syndrome of Pinellia Heart-Draining Decoction

历代医家对少阳证误下后的痞证治疗宜半夏泻心汤,不宜小柴胡汤的研究较多。成无己和柯琴从痞证病位的分析比较深入,小柴胡汤用于病位在半表半里之证,半夏泻心汤用于病位比半表半里更深的部位——心下。陈修园从六经病位的角度解释了痞证的原因,开阔了问题思路。方有执认为痞证的病邪是阴邪内伏,虚热上凝,因此半夏泻心汤有“清热倾痞之用”。张璐和程应旄认为痞证是由于邪气入里,内有痰饮,所以半夏泻心汤是“清热涤饮”之剂。黄元御和钱潢认为痞证是由于阴邪痞塞于心下,但黄元御认为痞塞不消会继续郁而生热,所以半夏泻心汤是“清上温下,寒热并用”之方;而钱潢认为痞证只有阴邪,半夏泻心汤方中的黄连、黄芩只起反佐作用,黄连量少姑且说得通,但黄芩的量(与干姜量同)是黄连量的三倍,理解为反佐的作用就太过牵强。徐灵胎和吕震在分析半夏泻心汤组成和用法时更倾向于小柴胡汤与半夏泻心汤之间的相同点,不同点在于半夏泻心汤变换了两味药来治疗痞证。

Medical scholars of past dynasties have done more research on Pinellia Heart-Draining Decoction for the treatment of fullness syndrome caused by mistreatment of Shaoyang syndrome rather than Minor Bupleurum Decoction. Cheng Wu-ji and KE Qin made a thorough analysis of the location of fullness syndrome. Minor Bupleurum Decoction is often used for the location of fullness syndrome with half-exterior half-interior syndrome,while Pinellia Heart-Draining Decoction is often used for the deeper location---under the heart. Chen Xiu-yuan explained the causes of fullness syndrome from the point of view of six meridians and broadened the thinking of the problem. Fang You-zhi held that the pathogenic factors of fullness syndrome include hidden yin pathogen,and excess heat due to deficiency,so Pinellia Heart-Draining Decoction has functions of clearing away heat and removing fullness. Zhang Lu-he and Cheng Yin-mao believed that fullness syndrome is caused by pathogen entering the body and phlegm retention in it,so Pinellia Heart-Draining Decoction is the agent of clearing away heat and removing fluid retention. Huang Yuan-yu and Qian Tian-lai believed that the syndrome of fullness is due to the obstruction of yin pathogen in the heart,but Huang Yuan-yu thought that the obstruction of fullness would continue to be depressed and generate heat,so Pinellia Heart-Draining Decoction can clear clearing upper heat and warm the lower part,so consideration is given to both cold and heat. Qian Tianlai thought that the syndrome of fullness is only due to yin pathogen,so that he believed that Huanglian ( Rhizoma Coptidis) and Huangqin ( Radix Scutellariae) in Pinellia Heart-Draining Decoction only play a counter-assistant role in the heat medicine,. The amount of Huanglian is small and proper,but the amount of Huanglian ( the same as that of dried ginger) is three times as much as that of Huanglian. It is too far-fetched to understand the role of counter-assistant role. When analyzing the composition and usage of Pinellia Heart-Draining Decoction,Xu Ling-tai and Lv Zhen seemed to admit there are more more similarities between it and Minor Bupleurum Decoction. The difference is that Pinellia Heart-Draining Decoction changes two kinds of drugs to treat fullness syndrome.