枳实薤白桂枝汤中“桂枝”考证

Research on the"Guizhi"in Immature Bitter Orange and Chinese Chive and Cinnamon Twig Decoction

桂枝作用于人体的部位偏上焦,肉桂则更偏于下焦,枳实薤白桂枝汤是用于治疗胸痹的名方,病位在上焦,故选桂枝较为恰当,若兼见下焦阳虚病证时,可酌情选用肉桂。枳实薤白桂枝汤中桂枝的功效为引枳实、厚朴入上焦以平冲逆,合瓜蒌以振胸阳,合薤白以散结气。历代医家受瓜蒌薤白白酒汤、瓜蒌薤白半夏汤二方病机的影响,皆以胸阳不振、痰浊上凝作为枳实薤白桂枝汤证的病机,但该证以胸满气结、气逆抢心为主,痰浊之象并不明显,故其病机应为阳虚气逆。药物煎煮方法中,桂枝与瓜蒌、薤白皆是轻煎,意在取其气味,而非重其功效,盖枳实、厚朴虽有下气降逆之力,却无入上焦之能,故须以桂枝轻清之气为引;上焦阳虚,无力镇摄阴霾之气上冲,故须桂枝、瓜蒌辛甘化阳,使阳气得充、胸阳得振;气结不去,胸中痞满难除,故须桂枝、薤白辛温相须,使结气得散。本方以桂枝为使,则逆者得降;辛甘相合,则虚者得补;辛温相须,则结者得散,体现了张仲景严谨的用药思路,也凸显了其煎煮方式的灵活性及对方药功效的影响。

Guizhi(Ramulus Cinnamomi)mainly acts on the upper energizer of the human body,while Rougui(Cortex Cinnamomi)is more inclined towards the lower energizer.Immature Bitter Orange and Chinese Chive and Cinnamon Twig Decoction is a famous formula for treating chest impediment.If the disease is located in the upper energizer,it is more appropriate to choose Guizhi.If there are also symptoms of yang deficiency in the lower energizer,Rougui(Cortex Cinnamomi)can be adopted.In Immature Bitter Orange and Chinese Chive and Cinnamon Twig Decoction,the function of Guizhi(Ramulus Cinnamomi)is to guide Zhishi(Fructus Auranti Immaturus)and Houpo(Cortex Magnoliae Officinalis)into the upper energizer to pacify the counterflow of qi;Gualou(Fructus Trichosanthis)is combined to stimulate chest yang,and Xiebai(Bulbus Alli Macrostemi)is added to dissipate stagnated qi.Influenced by the pathogenesis of Trichosanthes and Chinese Chive and White Wine Decoction,Trichosanthes,Chinese Chive and Pinellia Decoction,physicians in past dynasties all took chest yang depression and turbid phlegm as the pathogenesis of Immature Biter Orange and Chinese Chive and Cinnamon Twig Decoction.However,this syndrome is mainly characterized by chest fullness and qi stagnation,qi counterflow invading the heart,while the turbid phlegm is not obvious,so its pathogenesis should be yang deficiency and qi counterflow.In terms of medicinal decocting methods,Guizhi(Ramulus Cinnamomi),Gualou(Cortex Magnoliae Oficinalis),and Xiebai(Bulbus Alli Macrostemi)are all lightly decocted,with the intention of extracting their odor rather than emphasizing their efficacy.Although Zhishi(Fructus Auranti Immaturus)and Houpo(Cortex Magnoliae Officinalis)have the power to lower qi counterflow,they cannot enter the upper energizer.Therefore,it is necessary to use the light and clear qi of Guizhi(Ramulus Cinnamomi)as a guide.If there is yang deficiency in the upper energizer leading to failure to control the upward movement of the haze qi,it is necessary to use Guizhi(Ramulus Cinnamomi)and Gualou with pungent and sweet properties to transform yang,infuse yang,and activate yang.If the qi accumulation does not disperse,it is difficult to remove the fullness in the chest.Therefore,it is necessary to use Guizhi(Ramulus Cinnamomi)and Xiebai(Bulbus Alli Macrostemi)to disperse stagnation through mutual reinforcement by using their pungent and warm properties.In this formula,Guizi is used as the courier ingredient to lower qi counterflow;The pungent-sweet combination replenishes the deficiency;The pungent-warm mutual reinforcement disperses the stagnation.This reflects Zhang Zhongjing's rigorous medication idea,and highlights the flexibility of its decoction method and impact on drug efficacy.