基于通法理论探析仲景麻黄应用

ZHANG Zhongjing’s usage of ephedra based on TCM theory of"tong"

麻黄味辛,轻清上扬,宣通畅达营卫、发越阳气,仲景常用于治疗风寒束表、卫阳郁闭、阳郁于内之证,因此后世医家多将其归为辛温解表峻剂,或认为麻黄为虎狼之药,致使其临床应用受限。通过引入中医通法理论,系统阐释麻黄功用,以麻黄药性为基础,分析张仲景在《伤寒论》《金匮要略》中应用麻黄的规律,结合后世医家的阐发,发现麻黄具有通清窍、通营卫、通三焦、通阳气、通瘀痹、消癥瘕、通气机之功用。具体言之,通清窍包括通利九窍、开窍醒神;通营卫包括发汗解表、宣通腠理;通三焦包括宣通上焦、升降中焦、开阖下焦;通阳气包括宣通心阳、宣振肾阳、通阳复脉、疏通郁阳;通瘀痹包括通瘀和治痹;通气机包括振奋气机和疏肝解郁。麻黄在临床上应用广泛,可用于治疗诸多病证,通法理论为拓宽麻黄临床应用范围提供了新的思路。

Ephedra has a pungent taste,which has the characteristics of upward and outward divergence.It promotes and dredges nutrient qi and defensive qi and stimulates yang qi.ZHANG Zhongjing often used ephedra to treat superficies syndrome tightened by wind-cold and yang qi crown closure in the body.Therefore,later Chinese medicine doctors mostly classified ephedra as a herbal medicine with strong effects of relieving superficies syndrome with pungent and warm properties,and believed that ephedra was as powerful as tiger and wolf,which limited the clinical application of this Chinese herb.We introduce the"tong"theory of traditional Chinese medicine,and use this theory to systematically explain the function of ephedra.Based on the medicinal properties of ephedra,we analyzed ZHANG Zhongjing′s usage law of ephedra in Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber.Combined with the elucidation of physicians of later generations,we found that ephedra is widely used and has the function of"tong orifices,tong nutrition qi and defensive qi,tong sanjiao,tong yang qi,tong static blood and bi(arthralgia),eliminating masses,and tong qi movement."Among them,"tong orifices"includes dredging the nine orifices and inducing resuscitation;"tong nutrition qi and defensive qi"includes sweating,relieving superficies,and clearing and dredging sweat pores;"tong sanjiao"includes governing diffusion and dredging the upper jiao,adjusting the lifting and lowering of the middle jiao,and closing and opening the lower jiao;"tong yang qi"includes dispersing heart yang,invigorating kidney yang,dredging yang and restoring the pulse,and dredging suppressed yang qi;"tong static blood and bi(arthralgia)"includes removing blood stasis and treating bi disease;and"tong qi movement"includes invigorating qi movement and dispersing stagnated liver qi to relieve qi stagnation.The main purpose of this paper is(ⅰ)to clarify that ephedra can be used to treat many diseases and syndromes and(ⅱ)to provide a new idea for broadening the scope of clinical application of ephedra.