经方中桂枝配伍应用规律探讨

Analysis on Compatibility and Application of Ramulus Cinnamomi in Classical Formulae

从用法用量、主治病症及配伍应用等3个方面,考察来源于《伤寒杂病论》的经方中桂枝的应用规律。提出:①含桂枝经方的主治病症中出现频率最高的是"疼痛",病位涉及腹、腰、心、咽等处,疼痛特点有大实痛、悬痛、掣痛、刺痛等。治疗疼痛常与芍药等量配伍,若疼痛剧烈则芍药加倍,伴见"虚羸"再配伍胶饴、大枣、甘草等甘缓补益之品;②含桂枝经方的主治病症中"悸"的病机与病位相关,"心(中)悸"的病机多为正气不足;"心下悸""脐下悸"的病机多为水气上冲,治疗时常配伍茯苓以降气散饮;③含桂枝经方的主治病症中"小便不利"的病位有在表在里之别,邪郁在表,可通过"发汗而解";病位在里、半表半里或表里皆有时,常配伍干姜、细辛、附子等辛温之药,通过调节气化功能而解;④桂枝-茯苓-白术为治疗三焦饮停的基本组合;⑤桂枝与麻黄比例不同则主治病位亦不同,麻黄的剂量大于桂枝时,主治病位偏表;桂枝的剂量大于麻黄,主治病位偏里。

The application of Ramulus Cinnamomi(Guizhi)originated in Treatise on Exogenous Febrile and Miscellaneous Diseases was discussed from the aspects of the usage and dosage,indications,and compatibility regularity.The analysis results were as follows:(1)The symptom with the highest frequency in the indications of Guizhi-contained classical prescription is pain,which involves the abdomen,waist,heart,pharynx and so on.The pain is characterized by severe excess pain,hanging pain,palpitation pain and stinging pain.For relieving the pain,Guizhi is usually used together with the same dosage of Radix Paeoniae Alba,and the dosage of Radix Paeoniae Alba will be doubled if the pain becomes severe.For the treatment of the patients with pain accompanied by consumptive disease,Guizhi can be used together with the sweet and mild herbs of Saccharum Granorum,Fructus Jujubae,and Radix Glycyrrhizae for relieving the pain and tonify the deficiency.(2)The pathogenesis of palpitation in the indications of Guizhi-contained classical prescription is related to the location of the disease,heart palpitation results from insufficiency of healthy qi,while epigastric throbbing and subumbilical throbbing are due to the upward flow of fluid-retention and can be treated with Guizhi together with Poria to descend Qi and disperse fluid-retention.(3)The pathogenesis of dysuria in the indications of Guizhi-contained classical prescription is involved the superficial or the interior or both.For the dysuria induced by the pathogen accumulating in the superficial,the accumulated pathogen can be relieved by the method of diaphoresis;for the dysuria induced by the pathogen accumulating in the interior,in the semi-exterior and semi-interior,or in both of the superficial and the interior,the medication is usually performed together with pungent and warm herbs such as Rhizoma Zingiberis,Herba Asari and Radix Aconiti Lateralis Preparata to activate qi movement function.(4)Ramulus Cinnamomi(Guizhi)-Poria-Rhizoma Atractylodis Macrocephalae is the basic combination for the treatment of fluid retention in the triple energizers.(5)The variety of compatible proportion of Ramulus Cinnamomi(Guizhi)and Herba Ephedrae results into the various indications.If the dosage of Herba Ephedrae is larger than Ramulus Cinnamomi(Guizhi),the indicated syndrome is usually located in the exterior,and if the dosage of Ramulus Cinnamomi(Guizhi)is larger than Herba Ephedrae,the indicated syndrome is usually located in the interior.