应用麻杏甘石汤从阳明论治咳喘

Application of Maxing Ganshi Decoction in Treating Cough and Asthma from Yangming

《伤寒论》中第62条及第162条论述麻杏甘石汤均有“无大热”的描述,借此与阳明腑实证相鉴别。运用“开阖枢”理论剖析,《伤寒论》第36条麻黄汤证所致太阳阳明合病的咳喘是因太阳开机与阳明阖机的失常,病变为表卫津气不能泄越,留滞胃肠。病变若再进一步,则转变为阳明失阖,发展成麻杏甘石汤证,以胃腑津气郁滞渐热、肺津化热、气机壅逆、大肠腑气不降为病变特点。在遣药组方上,麻杏甘石汤意在恢复阳明阖机。麻黄宣肺行滞利水;配伍苦降质润的杏仁、辛寒清泻的石膏,升降相因、清散相成;甘草调和诸药,缓和偏性。四味并用,阳明阖机得降,诸证向愈。

Articles 62 and 162 in Shanghan Lun discuss that Maxing Shigan Decoction has the description of"no great heat",which can be distinguished from Yangming fu-viscera excess.According to the theory of"Open-Close Axis",the cough and asthma caused by Mahuang Decoction syndrome in Article 36 in Shanghan Lun is due to the abnormal startup of the Taiyan and the closing of the Yangming,and the pathological changes are that the surface Weiqi and Jinqi can not be discharged,remaining in stomach and intetine.If the disease further deteriorates,it will lead to Yangming losing the fuctionn of closing and develop into Maxing Ganshi Decoction syndrome.The pathological changes are characterized by stagnated heat of Jin qi in stomach,Lung fluid transforming to heat,obstruction of qi movement and non-decline of qi in large intestine.In the prescription of dispensing medicine,Mahuang Decoction is used to restore the closing function of Yangming.Mahuang(Ephedra)can ventilate lung qi,activate stagnancy and promote diuresis.It is compatible with bitter,degraded and moist Xingren(Semen Armeniacae Amarum)and pungent,cold and purging Shigao(gypsum),which is formed by the combination of ascending and descending,and clearing and dispersing.Gancao(Licorice)can reconcile various drugs and ease the bias.When the four flavors of medicine are used together,the closing function of the Yangming can be lowered and all syndromes are healed.