从“一气周流”探析竹叶石膏汤病机及组方思路

Analysis on pathogenesis and prescription of bamboo leaf gypsum soup from"one qi circulation"

竹叶石膏汤源自张仲景《金匮要略》,为现代治疗热证的常用方剂,但是历代医家对竹叶石膏汤方证病机莫衷一是。该文基于黄元御的“一气周流”理论进行分析探讨,认为竹叶石膏汤的本质在于中焦脾胃亏损,升降失司,阴不升而阳不化,阳不降而阴不生,致心、肺、胃三脏火热亢盛,气逆津伤。基于此病机,该方用药配伍以辛、温、甘、寒为主,诸药合用顾护脾胃,使中气枢转得复,火热自除,逆气得降,气津得生。临证时凡脾胃亏虚,中土不运、升降失司、火热亢盛、气逆津伤之证,均可考虑应用本方治疗。从“一气周流”解读竹叶石膏汤可为临床审证求因、遣方用药提供新思路,拓宽该方临床应用范围,并为解读仲景配伍之法提供参考。

Zhuye Shigaotang,first recorded in ZHANG Zhongjing's Synopsis of the Golden Chamber(《金匮要略》),is a commonly used prescription for treating heat syndrome in modern times.However,physicians of the past dynasties have different opinions on the mechanism of Zhuye Shigaotang in disease treatment.Based on HUANG Yuanyu's theory of Qi circulation,this paper holds that the root cause of the diseases treated by Zhuye Shigaotang is the deficiency of spleen and stomach in the middle energizer and the dysfunction of ascending and descending.The failure of Yin ascending leads to the failure of Yang transformation,and the failure of Yang descending causes the failure of Yin generation.As a result,heat and fire become predominant in the heart,lung,and stomach,which causes Qi counterflow and fluid consumption.Based on this pathogenesis,Zhuye Shigaotang is mainly composed of pungent,warm,sweet,and cold herbs.The combination of these herbs can protect the spleen and stomach and recover the Qi movement in the middle energizer,thereby clearing heat and fire,descending Qi,and promoting the generation of Qi and fluid.In clinical practice,this prescription can be applied to treating the syndromes of deficiency in spleen and stomach,dysfunction of middle energizer in transportation,dysfunction of ascending and descending,excessive heat and fire,and Qi counterflow and fluid consumption.The interpretation of Zhuye Shigaotang from the theory of Qi circulation can provide a new idea for differentiating syndromes,seeking causes,and developing prescriptions,which broadens the scope of clinical application of this prescription and provides a reference for interpreting ZHANG Zhongjing's method of compatibility.