真武汤的方证解析与现代研究概况

Empirical Analysis and Modern Research of Zhenwutang

真武汤是《伤寒论》中温阳利水之经典方,由炮附子、生姜、白术、茯苓、芍药5味药组成,现已收录于国家中医药管理局2018年发布的《古代经典名方目录(第一批)》。《伤寒论》中有两条论述真武汤证,太阳病篇第82条云:"太阳病,发汗,汗出不解,其人仍发热,心下悸,头眩,身瞤动,振振欲擗地者,真武汤主之。"少阴病篇第316条亦有:"少阴病二三日不已,至四五日,腹痛,小便不利,四肢沉重疼痛,自下利者,此为有水气。其人或咳,或小便利,或下利,或呕者,真武汤主之。"原文论述其基本病机皆属少阴阳虚水泛,以小便不利,肢体沉重或浮肿,舌质淡胖,苔白,脉沉为辨证要点。本文从方药配伍、用法用量及方证解读方面,考证《伤寒论》真武汤证;总结真武汤物质基础研究,为其复方药效物质基础及质量控制提供依据;并对近几年来真武汤的药理研究进展进行归纳,发现真武汤具有强心、利尿、降脂、抗氧化、改善肾功能和平衡水液代谢等诸多功效;列举运用真武汤辨治心悸、水肿、咳嗽、腹痛、痰饮、眩晕、消渴、带下等中医病证,及充血性心力衰竭、肺源性心脏病、支气管哮喘、慢性结肠炎、肝硬化腹水、慢性肾小球肾炎、慢性肾功能衰竭、前列腺增生、美尼尔氏综合症等西医疾病,阐述真武汤"异病同治"的原理,以期为真武汤及更多的古代经方的研究开发及临床应用提供有益借鉴。

Zhenwutang is the classic formula of Wenyang Lishui in " Treatise on Febrile Diseases". It consists of five kinds of medicines,namely Aconiti Lateralis Radix Praeparata,Zingiberis Rhizoma Recens,Atractylodis Macrocephalae Rhizoma,Poria,Paeoniae Radix Alba or Paeoniae Radix Rubra. It has been included in the Catalogue of Ancient Classics( The First Batch) issued by the State Administration of Traditional Chinese Medicine in 2018. There are two articles in the " Treatise on Febrile Diseases" about the syndromes of Zhenwutang.On the basis of Article 82 of the Chapter of Taiyang disease,the Taiyang disease is demonstrated by sweating,but after that the patient still suffers from fever,epigastric throb,dizziness and shiver,this shall be treated with Zhenwutang. According to Article 316 of the chapter of Shaoyin disease,Shaoyin disease lasts for two or three days,until the fourth and fifth days,and is demonstrated by abdominal pain,difficult urination,severe pain in the limbs and diarrhea,the patient have a cough,diuresis,diarrhea and vomit,this shall be treated with Zhenwutang.The original texts discuss the basic pathogenesis is edema syndrome due to Yin and Yang deficiency,with symptoms of unfavorable urination,heavy limbs or edema,pale tongue,white moss and heavy pulse as dialectical points. In terms of the compatibility of prescriptions,usage and dosage,and the interpretation of prescriptions,this paper examines Zhenwutang syndromes in " Treatise on Febrilediseases ",summarizes the material basic research of Zhenwutang,and provides the basis for the quality control of its compound pharmacodynamics. This study summarizes the progress of pharmacological research for Zhenwutang in recent years,finds that Zhenwutang has many efficacies, such as cardiotonic, diuretic, lowering lipid, anti-oxidation, improving renal function and balancing of water and liquid metabolism,lists traditional Chinese medicine( TCM) syndromes treated with Zhenwutang,such as heart palpitations, edema, cough, abdominal pain, sipping, dizziness, and Western medicine diseases,like congestive heart failure,pulmonary heart disease,bronchial asthma,chronic colitis,cirrhosis,ascites,chronic glomerulonephritis,chronic renal failure,benign prostatic hyperplasia and Meniere’ s syndrome,expounds the principle of Zhenwutang for " treating different diseases with the same therapy",in order to provide useful reference for the research and development and clinical application of Zhenwutang and more classic prescriptions.