古代经典名方真武汤的历史溯源与考证

Historical Tracing and Textual Research on Ancient Classic Formula Zhenwutang

张仲景之真武汤为温阳利水的经典名方,由附子、茯苓、白术、白芍、生姜5味药物组成。后世医家对其进行了较为详细的记载与运用,使真武汤不断被传承并发扬。该文采用文献计量学方法,将记载真武汤方书进行系统梳理,对其历史沿革、主治病证、用药剂量、药物炮制、用法、药味加减变化等进行考证。研究发现,真武汤在明清时期应用最为广泛,诸医家对于真武汤的主治病证多继承仲景之说,个别医家将其用于治疗白喉及一切水证;部分医家对真武汤药味进行加减变化,用以治疗发斑、休息痢、黄疸等。现代临床多用于治疗循环系统、呼吸系统、泌尿系统等疾病。其药物炮制较为明确,建议附子需炮制、去皮,茯苓、白术、芍药、生姜生用;虽用药剂量不尽相同,但大都与《伤寒论》中剂量一致。根据文献考证建议临床该方参考剂量为:茯苓、芍药、生姜各41.25 g,白术27.5 g,附子15 g。用法为以水1 600 mL,煎煮成600 mL,去渣,每次温服140 mL,每日3次。通过对记载真武汤的文献挖掘整理,以期对真武汤的临床应用及成方制剂提供理论参考。

ZHANG Zhongjing's Zhenwutang is a classic formula for warming Yang and excreting water.It is composed of Aconiti Lateralis Radix Praeparata,Poria,Atractylodis Macrocephalae Rhizoma,Paeoniae Radix Alba,and Zingiberis Rhizoma Recens.Physicians of later generations have inherited and developed this formula by detailed recording and application.This paper adopted bibliometrics method to analyze Zhenwutang in terms of history,indications,dosage,drug processing,usage,and modification.The results showed that Zhenwutang was most widely used in Ming and Qing dynasties.Many physicians have inherited ZHANG Zhongjing's theory regarding the application of Zhenwutang in disease treatment,and a few physicians have used it to treat diphtheria and water-related diseases.Some physicians modified this formula to treat maculae,intermittent dysentery,jaundice and so on.Zhenwutang was mainly used to treat diseases of the circulatory system,respiratory system and urinary system in modern clinical practice.The processing of herbal medicines in this formula was clear.Specifically,the raw material of Aconiti Lateralis Radix Praeparata needed to be processed and peeled,while those of Poria,Atractylodis Macrocephalae Rhizoma,Paeoniae Radix Alba,and Zingiberis Rhizoma Recens can be used directly.Although being different,most of the dosages were consistent with those in Treatise on Febrile Diseases.According to the textual research,it is suggested that the reference dosage of this prescription in clinical practice is 41.25 g for Poria, Paeoniae Radix Alba, and Zingiberis Rhizoma Recens, respectively, 27.5 g for Atractylodes macrocephala, and 15 g for Aconiti Lateralis Radix Praeparata. The medicinal materials should be decocted in 1 600 mL water to reach a volume of 600 mL. After removal of the residues, the decoction should be taken warm with 140 mL each time, three times a day. The textual research of Zhenwutang is expected to provide a theoretical reference for the clinical application and formulation of Zhenwutang.