桂枝去桂加茯苓白术汤应否“去桂”

Discussion About Whether It Is Reasonable to Remove Guizhi in Cinnamon Twig Decoction Removing Extra Cinnamon Plus Poria and Radix Angelicae Dahuricae

桂枝去桂加茯苓白术汤证病位在太阳,虽已用桂枝汤治疗,然邪未尽,或复下之,益伤正气而表邪不解,故仍头项强痛,翕翕发热,无汗。在外之邪不解,体内气化不行,水饮难消而停于心下,故心下满、微痛。病机为外有邪气,内挟水饮,治宜表里分消。桂枝走表,茯苓、白术、芍药走里,使在外之表邪有出处,在内之水邪有退路,表里各司其职,各消其邪。若去桂枝,外邪不解,纵使在内之水气全消,由于膀胱气化功能失调,体内仍会重新聚集水气,故在桂枝去桂加茯苓白术汤证中,"去桂"二字,或为衍文,桂枝去桂加茯苓白术汤不应去桂。

The disease location of syndrome of Cinnamon Twig Decoction Removing Extra Cinnamon plus Poria and Radix Angelicae Dahuricae is in taiyang meridian.Though Cinnamon Twig Decoction has been used,However,if the evil is not exhausted or reoccur,it will hurt healthy qi and make exterior syndrome not relieved,therefore,there will still have strong pain in the head,slight fever,and no sweat.When external pathogens are not relieved,qi movement inside body is unsmooth,water retention stay in the heart,there will fullness in the heart,slightly pain.The pathogenesis is that there is pathogenic qi outside and water retention inside.The treatment should eliminate pathogens of both the exterior and the interior.Guizhi(Ramulus Cinnamomi)is used to remove pathogens of the exterior,while Fuling(Poria),Baizhu(Rhizoma Atractylodis Macrocephalae)and Shaoyao(Radix Paeoniae Alba seu Rubra)are used to remove pathogens of the interior.In this way,the external pathogens in taiyang meridian can come out,and internal water pathogens have route of retreat.The exterior and the interior perform their respective duties and eliminate related pathogens.If Guizhi is removed,the external pathogens in taiyang meridian will not be relieved,leading to dysfunction of bladder qi movement even if the water retention in the inside disappear completely,the water retention in the body will still be gathered again,so in the syndrome of Cinnamon Twig Decoction Removing Extra Cinnamon plus Poria and Radix Angelicae Dahuricae,"removing Guizhi"should be understood as an derivation.