张仲景分层次用药治疗痰饮水湿病探赜

Exploration of ZHANG Zhong-jing's stratified medication in the treatment of phlegm and water-dampness disease

张仲景治疗痰、饮、水、湿病具有共性,选方治疗形成了分部位、分表里、分三焦的特色,落实到具体的药物上,则有明显的分层次用药的特征。邪在表皮、腠理、毛窍兼表实者,主选麻黄,以宣通卫表、透达腠理、开泄毛窍;邪在表皮、皮下、肌肉兼表虚者,主选黄芪,以祛除肌表之水气兼实表;邪在肌肉,主选白术,以建中气而利水;邪在关节、筋骨,主选附子,以壮元阳、化水气;邪在表皮、皮下、肌肉、筋骨,皆有脉络贯通,故选桂枝,以通阳气、和营气、温经脉而令水邪自消。因此,通过研究张仲景分层次用药的规律,可为临床治疗痰、饮、水、湿诸病提供更为精准的选药依据,提高临床疗效。

There is commonness in ZHANG Zhong-jing’s treatment of phlegm and water-dampness disease. The selection of prescriptions has formed the characteristics of dividing based on sites, exterior and interior, and triple energizer. When implemented on specific drugs, there are obvious features of stratified medication. If those pathogenic factors lie in the epidermis,striae, and pores combined with exterior excess, Ephedra shall be the main choice to dispel and dredge Wei-biao, outthrust the striae, and vent the pores. If those lie in the epidermis, subcutaneous, and muscle combined with exterior deficiency, Astragali radix shall be the main option to eliminate the water-dampness on the fleshy exterior and consolidate superficies. If those lie in the muscles, Atractylodes macrocephala shall be the main choice to nourish the middle-qi, which activates to excrete the waterdampness. If those lie in the joints and physique, Monkshood shall be the main selection to strengthen the primordial yang and promote the flow of qi and water-dampness. If those lie in the epidermis, subcutaneous, muscles, physique, all of which are connected by meridians, so Cassia twig shall be selected to promote yang-qi, harmonize nutritive qi, and warm meridians to dispel the ‘shuixie’ disease. Therefore, it can provide more accurate drug selection basis for clinical treatment of phlegm and waterdampness disease by researching the law of ZHANG Zhong-jing’s stratified medication, so as to improve clinical efficacy.