基于开阖枢理论探析木防己汤之方证

Analysis on prescription and syndrome of Mufangji Tang( 木防己汤) based on theory of opening,closing and pivoting

历代医家对《金匮要略》木防己汤方证、组方认识不一,方中各药应用指征不明,尤以石膏争议最大,限制了其临床应用。为挖掘木防己汤方药的系统性作用机制,基于"三阴三阳六经开阖枢气化理论"对其方证及方药配伍规律进行了研究,发现木防己汤证是以三焦停饮致使"少阳枢之不及"为核心病机,整体上是由于外邪(阴邪)、内饮交相影响导致机体"太阳开之太过、少阳枢之不及、阳明阖之太过"而出现的病理状态,"少阳枢之不及"为关键因素,而"阳明阖之太过"是相对而言;木防己汤则是针对三焦水饮与少阳枢机而设,方中防己味辛走表、苦寒泄热、疏土利水,桂枝祛外邪、助气化,人参补津液、"阖少阴以关太阳",石膏"泄阳明以阖太阳",四药合用使三焦停饮气化而出,少阳之枢机得以恢复,诸症得以向愈。

Doctors in the past dynasties have different understanding to the prescriptions,syndromes and composing prescriptions of Mufangji Tang(木防己汤)in Synopsis of Prescriptions of the Golden Chamber,and the application indications of various medicinals in the prescription are unclear,Gypsum Fibrosum is the most controversial in particular,which limits its clinical application.To explore the systematic action mechanism of Mufangji Tang,based on the“three yin,three yang and six meridians opening and closing pivot transformation of qi theory”,the prescription and syndrome along with prescription and medicinals compatibility law were studied.It is found that the core pathogenesis of Mufangji Tang syndrome is“dysfunction of shaoyang pivot”caused by the fluid retention of triple energizer.On the whole,it is the pathological state caused by the interaction of exogenous pathogenic factors(yin pathogenic factor)and internal fluid retention resulting in“excess opening of taiyang,dysfunction of shaoyang pivot and excess closing of yangming”,among which“the dysfunction of shaoyang pivot”is the key factor,while“the excess of yangming closing”is relatively speaking;And Mufangji Tang was designed for targeted at fluid retention of triple energizer and shaoyang pivot,Stephaniae tetrandrae radix therein is pungent in flavor and wandering the exterior,clearing away heat with bitter-cold herb as well as dispelling spleen-earth and excreting water;Cinnamomi ramulus therein is eliminating external pathogenic factor and strengthening transformation of qi;Ginseng radix therein is replenishing body fluid and“pivots on shaoyin to close taiyang”,Gypsum Fibrosum therein“purges yangming to pivot on taiyang”,the combined use of the four medicinals renders fluid retention in triple energizer to come out by qi transformation,whereby the pivot of shaoyang restores and all kinds of symptoms recover.