基于血痹及其病传理论探讨经方中芍药的配伍规律

Study on Pattern of Compatibility of Chinese Herbaceous Peony in Classical Prescriptions Based on Theory of Progress of Disease of Blood-arthralgia

[目的]研究经方治疗血痹及其病传中芍药的配伍规律,为临床上应用芍药提供思路。[方法]整理《金匮要略》《诸病源候论》《神农本草经》《证类本草》等中医古籍中对血痹和芍药的论述的记载,从文献研究的角度探讨血痹的病机和临床表现,分析芍药除血痹的功效,探讨芍药在血痹及其病传中发挥的作用,并结合临床案例进行分析。[结果]血痹包含津血亏虚、水饮充盛、风邪犯表三方面的病机,芍药除血痹的功效主要是和营除痹、化瘀除痹、利水除痹这三个方面。芍药配伍桂枝,突出和营除痹的作用,可用于治疗血痹本病;配伍饴糖,突出养营除痹的功效,可用于治疗血痹病传虚劳;配伍大黄,化瘀除痹,治疗血痹病传入里;配伍茯苓,利水除痹,治疗血痹病传累及水分。所举两则验案皆属于血痹病传,第一则病传入里,为太阴中风证及血瘀化火证,治以化瘀清热除痹,方拟桂枝加芍药汤;第二则累及水分,属营血不足、血瘀水停证,治以养营利水除痹,方拟当归芍药散改汤。两则验案均收获良效,进一步验证了芍药除血痹的功效。[结论]芍药配伍不同药物能够突显不同功效,在血痹及其病传中使用得宜,可收良好疗效,值得进一步研究。

[Objective]To study the pattern of compatibility of Chinese herbaceous peony within Chinese classical prescriptions in the progress of disease of blood-arthralgia,and provide ideas for the clinical application of Chinese herbaceous peony.[Methods]Reorganize the discussion about blood-arthralgia and the medical effects of Chinese herbaceous peony in traditional Chinese medicine classics including Synopsis of Golden Chamber,General Treatise on the Cause and Symptoms of Diseases,Shennong's Classic of the Materia Medica and Categorization with Evidence of the Materia Medica,from the perspective of literature research,discuss the pathogenesis and symptoms of blood-arthralgia,so as to analyze the medical effect of eliminating blood-arthralgia of Chinese herbaceous peony and discuss the effect of Chinese herbaceous peony applying in the progress of disease of blood-arthralgia together with medical cases.[Results]Bloodarthralgia has three aspects of pathogenesis including the deficiency of body fluid and blood,the retention of water and body fluid as well as the exterior invasion of pathogenic wind.The medical effect of eliminating blood-arthralgia of Chinese herbaceous peony consists of 3 aspects including restoring nutritive Qi,resolving blood stasis and removing water retention.The compatibility of Chinese herbaceous peony with Ramulus Cinnamomi projects the medical effect of reconciling nutritive Qi thus can be applied to blood-arthralgia progress;with malt sugar projects the medical effect of restoring nutritive Qi thus can be applied to blood-arthralgia progressing to consumptive disease;with Rheum Officinale projects the effect of resolving blood stasis thus can be applied to blood-arthralgia progressing into interior body;with Poria Cocos projects the effect of removing water retention thus can be applied to blood-arthralgia progressing into body fluid system.Two medical cases given both belonged to the progress of blood-arthralgia.The first case was classified as blood-arthralgia progressing into interior body,belonging to Taiyin apoplexy and blood stasis transforming fire,taking resolving blood stasis and clearing heat thereby relieving pain as rule of treatment,treated by Guizhi plus Shaoyao Decoction.The second case was classified as bloodarthralgia progressing into body fluid system,belonging to the deficiency of nutritive Qi and blood together with blood stasis and dropsy,taking restoring nutritive Qi and removing water retention thereby relieving pain as rule of treatment,treated by Danggui Shaoyao Powder revised Decoction.Good clinical efficacy was shown in these two cases,further verifying the medical effect of eliminating blood-arthralgia of Chinese herbaceous peony.[Conclusion]Different medical effects are performed within different compatibilities of Chinese herbaceous peony.Good efficacy can be obtained if applying correctly while treating the progress of disease of blood-arthralgia,which is worth further studies.