半夏泻心汤与黄连汤证治辨析

Differentiation of Banxia Xiexin Decoction and Huanglian Decoction about Syndrome and Treatment

《伤寒论》半夏泻心汤与黄连汤在方证病机、功效及制方上类近,以致二方的临床应用易为混淆。基于方证相关的学理,结合历代医家的观点,从方证病因病机、治疗立法、制方几个维度对两方的异同进行辨析。结果发现,二方证病机均涉寒热夹杂,中虚胃逆,但在寒热所聚部位、中虚程度及气机升降悖逆机制上有所不同;二方治法均涉及寒热并调、补虚降逆,但在调理部位、补中强度及和中降逆的方式上有所不同。二方组成均涉及半夏、黄连、干姜、人参、炙甘草、大枣,但半夏泻心汤以半夏为君,配伍黄芩,人参用量较大;黄连汤以黄连为君,且用量较大,配伍桂枝;前方去滓再煎以和合药性而助和中之用,后方仅煎一次且小量频服,取药之清气而助分消上下寒热。

Banxia Xiexin Decoction and Huanglian Decoction in Treatise on Febrile Diseases are similar in the pathogenesis,efficacy and prescription formulating,so that they are easy to be confused clinically. Based on the relevant theories of formula and syndrome correlation and connected with historical physicians’ viewpoint,this paper analyzes the similarities and differences between the two sides from the perspectives of cause,pathogenesis,efficacy and prescription. The result shows that the pathogenesis of the two syndromes is related to cold-heat complication,deficiency of middle energizer and inverse of the stomach qi. However,it is different in the location of the cold and heat,the degree of the middle energizer’s deficiency,and the mechanism of the rebellious rise and fall movement of qi. Their efficacy involves harmonizing cold and heat,tonifying and descending inverse,but they differ in the position of regulating,the intensity of tonifying,and the way of harmonizing middle energizer and descending inverse. The composition of both the two prescriptions involves Banxia(Pinelliae Rhizoma),Huanglian(Coptidis Rhizoma),Ganjiang(Zingiberis Rhizoma),Renshen( Ginseng Radix Et Rhizoma), Zhigancao(Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle),Dazao(Jujubae Fructus). However,there is Huangqin(Scutellariae Radix) and the amount of Renshen is larger in Banxia Xiexin Decoction,with the Banxia being the monarch. In Huanglian Decoction,there is Guizhi(Cinnamomi Ramulus) and Huanglian which is the monarch drug with a large amount. To regulate the middle energizer,the preparation of Banxia Xiexin Decoction need to remove slag and boil again to harmonize medicinal. However,the Huanglian Decoction only needs to boil once and serve in a small number for serval times to take the clear qi of medicine to eliminate the pathogen in the up and lower position.