从“方证相应”探讨黄连汤组成

Discussion on Composition of Huangliantang Based on Theory of Correspondence Between Prescription and Indications

黄连汤被列于首批古代经典名方目录中,然而历代医家对黄连汤中桂枝的作用认识却不尽相同,可归为解表、驱胃中寒邪、交通上下阴阳等几种观点,但均有局限之处。为阐明黄连汤中桂枝的作用,该文基于条文症状、药证、方证,将黄连汤与其药物组成相似的半夏泻心汤、小柴胡汤进行对比,发现黄连汤中的桂枝应对症治疗黄连汤条文中的"腹痛"症状。然黄连汤之"腹痛"与桂枝的药证不符,而与芍药的药证相合,故提出"黄连汤中桂枝应为芍药"的可能。进一步的方证分析发现,将黄连汤中的桂枝换为芍药后,黄连汤的药证相应、方证相应,进一步证明"黄连汤中桂枝应为芍药"的观点。桂枝和芍药从简帛医书时代便经常配伍使用,两者单独使用时存在误用的可能,故进一步总结《伤寒论》中桂枝和芍药的功效并加以辨析。

Huangliantang has been included in Catalogue of Ancient Classical Prescriptions(the First Batch). However,opinions on the function of Cinnamomi Ramulus in Huangliantang vary significantly among doctors of all dynasties,which can be summarized as releasing exterior,expelling cold pathogen out of the stomach,and communicating Yin and Yang of the upper body with those in the lower body. Considering the limitations of each opinion,this paper compared Huangliantang with Banxia Xiexintang and Xiao Chaihutang that are composed of similar Chinese medicinals based on the stated symptoms, herbal indications, and prescription indications to expound the function of Cinnamomi Ramulus in Huangliantang. The findings demonstrated that Cinnamomi Ramulus in Huangliantang was mainly responsible for alleviating the abdominal pain. Nevertheless,the abdominal pain treated by Huangliantang was not the indication of Cinnamomi Ramulus but the indication of Paeonia lactiflora. Hence,it was believed that Cinnamomi Ramulus in Huangliantang should be P. lactiflora. The replacement of Cinnamomi Ramulus with P. lactiflora allowed the correspondence between herbs and indications as well as between prescription and indications. Cinnamomi Ramulus and P. lactiflora have often been used in combination since the era when medical books were written on bamboo and silk. When used alone,they might be confused. Therefore,the efficacy of Cinnamomi Ramulus and P. lactiflora in Shanghanlun(《伤寒论》)should be further analyzed.