基于“从化”理论探讨桂枝汤证之病因病机

Etiology and Pathogenesis of Guizhitang Syndrome Based on″Transformation in Accord with Constitution″Theory

目的:重新探讨桂枝汤证的病因病机,厘清历代医家所争论的有关疑案,为桂枝汤的临床运用提供参考。方法:采用比较分析与文献考证法,从“从化”理论的角度,结合《伤寒论》《金匮要略》原文及其他经典的论述,对比书中相关条文,对桂枝汤证的病因病机进行辨析。结果:桂枝汤证不仅指太阳中风证,其可分为两大类,一为外感桂枝汤证,一为杂病桂枝汤证。外感桂枝汤证的病因:内有血虚或大下利后阴虚,此为体质基础,即内因,外为风寒所伤以风为主,此为外因;杂病桂枝汤证的病因:内有津血亏虚,无外感因素。桂枝汤证的病机不是营卫俱弱,亦非营强卫弱,而是营弱卫强或卫气不和。桂枝汤证的病机实质非“表虚”,而当为“营虚”。“阳浮阴弱”非指病机而当指脉象,阳指寸脉,阴指尺脉。结论:古今医家及诸版教材关于桂枝汤证的病因病机存在疑议,注家众多而鲜有注意到体质基础者。根据“从化”理论,体质基础是病证形成的内在根据。桂枝汤证的形成,有其内在的体质基础,“从化”理论有助于理解桂枝汤证形成的机制。从“从化”理论重新认识桂枝汤证的病因病机,有助于揭示仲景书中桂枝汤法的原理。从“从化”理论寻绎六经病各证及杂病形成的机理与仲景立法处方的本旨,亦可为仲景学说的理解提供新的思路。

Objective:To explore the etiology and pathogenesis of Guizhitang syndrome,clarify the related suspicious cases debated by doctors in the past dynasties,and provide references for the clinical application of Guizhitang.Method:Under the guidance of the"transformation in accord with constitution"theory,the etiology and pathogenesis of Guizhitang syndrome were analyzed by comparing the relevant articles in the classics such as Treatise on Cold Damage(Shanghanlun)and Synopsis of the Golden Chamber(Jingui Yaolue).Result:Guizhitang syndrome not only refers to the greater yang wind-invasion syndrome.Instead,it can be divided into two categories,i.e.,exogenous Guizhitang syndrome and miscellaneous Guizhitang syndrome.The basic etiology of exogenous Guizhitang syndrome is internal blood deficiency or yin deficiency after severe diarrhea,which is the physical basis,namely the internal cause,while the wind is the external cause that results in cold.The basic etiology of miscellaneous Guizhitang syndrome is the deficiency of blood and body fluid without the external cause.The pathogenesis of Guizhitang syndrome is neither weak nutrient Qi and defensive qi nor strong nutrient Qi but weak defensive Qi.It attributes to weak nutrient qi and strong defensive qi or disorder of defensive Qi.The essence of the pathogenesis of Guizhitang syndrome is not″exterior deficiency″but″deficiency of nutrient Qi″.″Floating Yang and weak Yin″does not refer to the pathogenesis,but the pulse.Yang refers to the Cun pulse and Yin refers to the Chi pulse.Conclusion:The etiology and pathogenesis of Guizhitang syndrome are controversial among ancient and modern doctors and textbooks.Many physicians annotate this problem but few pay attention to the constitution basis.According to the″transformation in accord with constitution″theory,the constitution is the internal basis for the formation of diseases and syndromes.The formation of Guizhitang syndrome is underpinned by the inherent constitution.″Transformation in accord with constitution″theory is helpful to understand the formation mechanism of Guizhitang syndrome.A new understanding of the etiology and pathogenesis of Guizhitang syndrome based on the″transformation in accord with constitution″theory is helpful to reveal the use principle of Guizhitang by ZHANG Zhong-jing.The exploration of the formation mechanism of various syndromes of six-meridian diseases and miscellaneous diseases,as well as the original idea of ZHANG Zhong-jing’s prescriptions from the″transformation in accord with constitution″theory can provide a new idea for the understanding of ZHANG Zhong-jing’s theory.