基于“心肾不交”论黄连阿胶汤的临床应用

Clinical application of Huanglian Ejiao decoction based on“heart and kidney non crossing”

黄连阿胶汤首见于《伤寒论》,是仲景经典方中的代表方剂,诚如:“少阴病,得之二三日以上,心中烦,不得卧,黄连阿胶汤主之”。而心肾二者又属于少阴经,故黄连阿胶汤对于调整少阴之病具有很好的疗效。心火亢盛或肾阴不足,水火共济失调,心肾不交,使得心火无法温肾,而肾阴不能濡心,阴阳失调则发为不寐;肾阴不足,无以上行而制约心火,心肾不交,心之阳气过盛而阴气不足,心神失养入里无门,发为焦虑,且心火过旺更加耗伤肾阴伤津,恶性循环,焦虑更重;“命门火衰”则不能腐熟水谷,水谷精气无法上濡于肺胃等脏,发为消渴。诸病发病均为心肾不交所致,皆可应用黄连阿胶汤治疗,概述黄连阿胶汤治疗少阴病之失眠、焦虑症、糖尿病的思路。

Huanglian Ejiao decoction was first seen in“ShenghanLun”.It is a representative prescription in Zhongjing’s classic prescriptions.It is as follows:“Shaoyin disease,get it for more than two or three days,and be upset,cannot lie down,Huanglian Ejiao decoction is the master”.The heart and kidney belong to the Shaoyin meridian,so Huanglian Ejiao decoction has a good effect on regulating Shaoyin disease.Hyperactivity of the heart or fire or insufficient kidney yin,water and fire ataxia,heart and kidney failure,so that the heart and fire cannot warm the kidney,but the kidney yin cannot moisten the heart,and the imbalance of yin and yang will result in insomnia;insufficient kidney yin,no restriction of the above heart-fire,heart-kidney disagreement,heart-yang qi is too strong and yin-qi is insufficient,the mind is dysfunctional,and it becomes anxious.Excessive heart-fire will damage kidney yin and fluid,a vicious circle,and anxiety will become more serious.“Mingmen fire decay”can not decompose water valley,water valley essence can not be absorbed in the lungs and stomach and other internal organs,it becomes thirst.All diseases are caused by the incompatibility between the heart and the kidneys,and can be treated with Huanglian Ejiao decoction.The ideas of Huanglian Ejiao decoction in the treatment of Shaoyin’s insomnia,anxiety,and diabetes are summarized.