桂枝附子汤与白术附子汤方证辨析

Diff erentiation of Guizhi Fuzi Decoction and Baizhu Fuzi Decoction

《伤寒杂病论》对风湿三附子汤的论述详见于《金匮要略·痉湿暍病篇》。历代医家对于桂枝附子汤与白术附子汤的病证解读仁智互见,尤以白术附子汤为著。通过对其方证进行探讨,试析桂枝附子汤与白术附子汤的发病机制与治法,以便对临床诊治提供新思路。认为桂枝附子汤与白术附子汤乃内外合邪致病,治疗均旨在取微汗之义,注重顾护里气。然发汗太过,风邪虽去,病必不除,湿邪辗转,流滞皮下而现白术附子汤证。两方虽然症状相同,但是证候不同,病理反映亦不同。然药随方变,而方随证转,故制方加减用药应当以证为着眼点。

The discussion on Fengshi Sanfuzi Decoction in Shanghan Zabing Lun(The Treatise on the Cold Pathogenic and Miscellaneous Diseases)is originated from The Synopsis of the Golden Chamber·On Diseases Caused by Wind,Damp or Summerheat Pathogens.Physicians of the past dynasties have their own interpretations of the diseases and syndromes introduced in Guizhi Fuzi Decoction and Baizhu Fuzi Decoction,especially those in Baizhu Fuzi Decoction.This paper explores the two prescriptions themselves and the syndromes in them,and analyzes the pathogenesis and treatment methods of the two prescriptions,so as to provide new ideas for the clinical diagnosis and treatment of this type of diseases.It is believed that the pathogenesis of the diseases the two prescriptions both attend is the combination of the internal and external pathogenic factors,and the treatment purpose is for patients to sweat slightly,paying attention to the care of internal qi.If patients sweat too much,although the wind pathogens are gone,the disease itself is not cured,with the dampness pathogens transferring to and lingering under the skin,showing the syndrome comforming to that described in Baizhu Fuzi Decoction.Therefore,although the symptoms described in the two prescriptions are the same,their syndromes are diff erent,and the pathological refl ections are also diff erent.However,just as medicating changes with prescriptions,and prescribing changes with syndromes,the prescription preparation and medication should be based on the syndrome.