经典名方桂枝加葛根汤考证

Textual Research on Guizhi Jia Gegen Decoction(桂枝加葛根汤)

旨在对仲景经方桂枝加葛根汤进行文献考证,以期为该方的现代制剂开发提供文献依据。以“桂枝加葛根汤”为关键词,分别在中华医典数据库和中国知网检索相关古文献和现代研究报道并进行梳理,从“方”“药”2个角度对其历史沿革、药物组成、用量用法、临床应用、中药基原和炮制进行考证。共检索到历代古籍中收载的同名方剂26首,其中22首的组成只包括葛根、桂枝、芍药、生姜、大枣和甘草6味药物,其余4首在此基础上还含有麻黄。12首方遵仲景原方的煎服法,先煎葛根。不同方剂的药物剂量差别较大,但均重用葛根。药物基原方面,桂枝取现版药典中的肉桂,葛根取野葛,芍药取白芍,生姜取四川地区的小黄姜,大枣取山东、山西的优质大枣,甘草选豆科植物甘草最符合原方所指。大部分药物的炮制与现版药典相同,但炙甘草非现版药典所载之蜜炙,实为清炒。该方主治历代以太阳病兼项背不适为主,现代临床治疗范围有所扩展,但仍以治疗与项背不舒为特征的颈肩部疾患为多,其中以颈椎病最为常用且疗效肯定。

This paper aims to carry out textual research on classic prescription Guizhi Jia Gegen Decoction(桂枝加葛根汤)so as to provide a literature basis for the development of modern preparations of Guizhi Jia Gegen Decoction.With the keyword of Guizhi Jia Gegen Decoction in Chinese,we searched ancient literature in the Chinese Medical Classics Database and modern research literature in the database of China national knowledge infrastructure(CNKI),collected and summarized the relevant literature to confirm its historical evolution,herbal composition,dosage and usage,clinical application as well as herbal basis and processing from the perspectives of“whole formula”and“constituent herbs”.A total of 26 formulae with the same name were retrieved from ancient books.Among them,22 formulae only included Gegen(Puerariae Lobatae Radix),Guizhi(Cinnamomi Cortex),Shaoyao(Paeoniae Radix Alba),Shengjiang(Zingiberis Rhizoma Recens),Dazao(Jujubae Fructus)and Gancao(Glycyrrhizae Radix Et Rhizoma)and the other 4 also contained Mahuang(Ephedrae Herba).12 formulae followed the decocting method of the original one that ZHANG Zhongjing had established,to decoct Gegen(Puerariae Lobatae Radix)first and then mix in other drugs to decoct together.There were significant differences in the dosage of each herb in different formulae,but the same thing was that the dosages of Gegen(Puerariae Lobatae Radix)among all these formulae was larger.In terms of the basic elements,Guizhi(Cinnamomi)should be the Rougui(Cinnamomi Cortex)described in the current edition of Pharmacopoeia of the People's Republic of China,Gegen(Puerariae Lobatae Radix)should be the wild Gegen(Puerariae Lobatae Radix),Shaoyao(Paeoniae Radix Alba)should be Baishao(Paeoniae Radix Alba),Shengjiang(Zingiberis Rhizoma Recens)should be the small yellow ginger from Jianwei district of Sichuan province,Dazao(Jujubae Fructus)should be from Shandong and/or Shanxi province,and Gancao(Glycyrrhizae Radix Et Rhizoma)should be taken from Gancao(Glycyrrhiza uralensis Fisch).The processing methods of most herbs in this formula are the same as described in current Pharmacopoeia,but Zhigancao(Glycyrrhizae Radix Et Rhizoma Praeparata Cummelle)should be fried without honey or any other excipients.The formula is mainly used to treat Taiyang disease characterized by nape discomfort in the past dynasties.Until now,although its scope of clinical treatment has been expanded,there are still many neck and shoulder disorders characterized by nape discomfort,among which cervical spondylosis is the most commonly used and it has a positive effect.