升麻的功效源流、变迁及其分析

Origin,Changes and Analysis of Efficacy of Cimicifugae Rhizoma

升麻首载于《神农本草经》,金元以前无论是本草著作还是方书记载,其功效均为“清热解毒”。自金元张元素起,功效大变,开始出现“升举阳气”的功效。李东垣、王好古尊张元素之说,未意识到升麻“清热解毒”效用,将升麻看作“升浮”“升阳”的代表药。明清时期,对升麻认识主要分为两类,一类认为升麻兼具“清热解毒”与“升举阳气”,一类认为升麻只具有“升举阳气”这一功效。近代以来,对前代升麻的功效认识开始有了批判,出现了两种观点,一种继承前代“清热解毒”与“升举阳气”的双向说;一种认为升麻单纯为清热解毒药,坚决驳斥升麻的“升举阳气”说,恢复金元以前升麻的功效认识,日本学者亦多持此观点。《中华人民共和国药典》自1985年版始,总结升麻有“发表透疹”“清热解毒”“升举阳气”三大功效,这代表了目前学术界比较主流的认识。当代一些学者对升麻的“升举阳气”仍有反对意见,包括临床医学家、医学史家、药学家等。该文系统梳理了升麻的功效源流与功效变迁,并对升麻的功效变迁进行了深入分析。笔者结合哲学思考与现代药理学研究成果亦认为升麻不能升举阳气。

Cimicifugae Rhizoma originated from Shennong′s Classic of Materia Medica(《神农本草经》).Before the Jin−Yuan period(1115−1368 AD),the efficacy of Cimicifugae Rhizoma was clearing heat and removing toxin whether it was recorded in herbal works or medical formularies.Since ZHANG Yuan-su in the Jin-Yuan period,its efficacy has changed,and that of raising Yang Qi has begun to appear.LI Dong-yuan and WANG Hao-gu followed ZHANG Yuan-su's point of view,and did not realize the efficacy of clearing heat and removing toxin and regarded Cimicifugae Rhizoma as a representative medicine for raising Yang Qi.During the Ming and Qing dynasties,the efficacy of Cimicifugae Rhizoma was mainly divided into two categories:both clearing heat and removing toxin and raising Yang Qi,and raising Yang Qi only.In modern times,the efficacy realized by previous generations is criticized,and two views emerge.One is inheriting the two-way theory of both clearing heat and removing toxin and raising Yang Qi.The other is that Cimicifugae Rhizoma is purely the medicine for clearing heat and removing toxin and its efficacy of raising Yang Qi is firmly refuted,which conforms to that of Cimicifugae Rhizoma before the Jin-Yuan period,and is also supported by Japanese scholars.Chinese Pharmacopoeia(1985)concludes that Cimicifugae Rhizoma has three major functions:releasing exterior and promoting eruption,clearing heat and removing toxin,and raising Yang Qi,which represents the current mainstream understanding of Cimicifugae Rhizoma in the academic world.Some contemporary scholars,including clinical physicians,medical historians,and pharmacists,still object to the raising Yang Qi of Cimicifugae Rhizoma.This article systematically sorted out the origin and changes of the efficacy of Cimicifugae Rhizoma,and analyzed the reasons for the changes.Combining philosophical thinking and modern pharmacology research,the authors also believe that Cimicifugae Rhizoma can not raise Yang Qi.