经典名方济川煎主治“肾虚便秘”辨惑

Clarification on Kidney-deficiency Constipation Treated by Classic Prescription Jichuanjian

济川煎出自明代医家张景岳所著的《景岳全书》,由当归、牛膝、肉苁蓉、泽泻、升麻及枳壳6味药物组成,是国家中医药管理局首批公布的百首经典名方之一。原书载“凡病涉虚损,而大便闭结不通,则硝、黄攻击等剂必不可用,若势有不得不通者,宜此主之。”笔者通过古今文献考证发现济川煎的功效主治存在古今演变,明清及近代医籍中其主治多是以原书记载的“虚性便秘”为根本展开,而现代则多围绕肾(阳)虚便秘、阴亏便秘展开,尤其是现代以来,中医院校规划教材中将济川煎的主治功效描述为肾虚便秘,笔者对此存在疑惑,并积极响应习总书记的号召,加强古典医籍精华的梳理和挖掘,以《景岳全书》为基础,通过原文探析、药物组成、溯源及后世发挥3个方面进行分析论证,得出济川煎是因“虚人便秘,津液亏虚,法当急下”而设,治疗虚人津亏便秘证,而非现代教材所描述的“肾虚便秘”证。济川煎的创立有渊源,后世医家从肝肾角度、土湿木郁来理解济川煎也蕴含一定道理,但还有待临床进一步挖掘和验证。通过对济川煎功效主治的梳理与讨论,可为今后经典名方济川煎的临床应用及现代开发提供理论依据与参考。

Jichuanjian,from the Jing Yue’s Collected Works by Zhang Jingyue,a famous doctor of Ming Dynasty,is composed of Angelica,Achyranthes bidentata,Cistanche deserticola,Alismatis Rhizoma,Shengma and Fructus Aurantii.It is one of the first 100 classic prescriptions published by the National Administration of Traditional Chinese Medicine.The original book states that where the disease is related to deficiency,with impacted stool,medicines such as Xiaohuang prescription cannot be used.If the treatment is needed,Jichuanjian should be applied.Through the textual research of ancient and modern literature,it is found that the efficacy of Jichuanjian has changed from ancient to modern times.In the medical books of the Ming and Qing Dynasties and the modern ones,the treatment is mostly carried out based on the constipation due to deficiency recorded in the original book,while in contemporary times,the treatment of Jichuanjian focuses on kidney(yang)-deficiency constipation and yin-deficiency constipation.Especially since modern times,Jichuanjian is frequently used to treat kidney-deficiency constipation according to the description in the planning textbooks of traditional Chinese medicine colleges and universities,which causes doubts among the authors.To actively respond to the call of General Secretary Xi Jinping that we should strengthen the sorting and excavation of the essence of classical medical books,this paper analyzed and demonstrated the original text and the drug composition,traceability and application by future generations of Jichuanjian based on the Jing Yue’s Collected Works.It was concluded that Jichuanjian was prepared for the treatment of constipation due to weak constitution,fluid deficiency,and emergent purgation,aiming for constipation due to weak constitution and fluid consumption rather than kidney-deficiency constipation described in modern textbooks.As Jichuanjian was developed for similar syndromes,it was reasonable that it was understood by later generations of doctors from the perspective of liver and kidney as well as earth dampness and wood stagnation,which however remains to be further explored and verified in clinic.By combing and discussing the efficacy of Jichuanjian,this paper could provide theoretical basis for the clinical application and modern development of Jichuanjian.