叶天士、吴鞠通对苓桂术甘汤方证的发挥

YE Tian-shi and WU Ju-tong′s Flexible Use of Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction Syndrome

苓桂术甘汤的配伍思想分为三点:补脾固阳以治水泛;甘淡利水以消阴;宁心安神而定悸。苓桂术甘汤所治病证的病机特点:元气匮乏,阴盛阳衰导致心下逆满,气上冲胸,头眩;心下有痰饮,胸胁支满,目眩诸证。叶天士根据苓桂术甘汤的方证特点,提出"外饮治脾,内饮治肾"辨治思路,创立"鼓运转旋脾胃"法。其运用苓桂术甘汤常常去掉甘壅的甘草,加入辛通的生姜,称为苓姜术桂汤。吴鞠通称苓姜术桂汤为苦辛温法,将其广泛运用到寒湿伤脾胃之阳导致的诸多病证。由于,寒湿内伤脾胃之阳,所以药用姜、桂既能温通阳气,又能散表邪,并协同苓、术温补脾胃,祛除寒湿,寒湿去,阳气复,脾胃健。

The compatibility thought of Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction can be divided into the following three points:Invigorate the spleen and strengthen the yang to control water retention;Use sweet-mild drugs to promote urination and eliminate yin pathogens;Calm the mind to stop palpitation.Pathogenesis characteristics of Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction are as follows:Deficient original qi,excessive yin and deficient yang lead to counter-flow fullness in the epigastrium,upward adverseness of qi to the chest,and dizziness.The heart has phlegm retention,fullness and discomfort in the chest and rib-side,and dizziness.According to formula syndrome characteristics of Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction,YE Tian-shi put forward the thought of "treating the spleen for external retention,and treating the kidney for internal retention," established the method of "bulging and moving and rotating spleen and stomach".He often removed Gancao(Radix et Rhizoma Glycyrrhizae),and added Shengjiang(Rhizoma Zingiberis Recens) to form Poria and Rhizoma Zingiberis Recens and Atractylodes Macrocephala and Cinnamon Twig Decoction.WU Ju-tong thought the formula as bitter-pungent-warm method,and widely used it in many diseases caused by cold and dampness injury to the yang of spleen and stomach.Because cold dampness injures the yang of the spleen and stomach,so Shengjiang and Guizhi can not only warm yang qi,but also can dissipate exterior pathogen.After being combined with Fuling(Poria) and Baizhu(Atractylodes Macrocephala),the formula can warm the spleen and stomach,remove cold dampness to restore yang qi,strengthen the spleen and stomach.