浅析《伤寒论》论治心悸规律

An analysis of the medication rule of treating palpitation in Shanghan Lun

心悸是指心中悸动、惕惕不安甚至不能自主的一种病证,《黄帝内经》虽未明确提及心悸病名,但已认识到宗气外泄及感受邪气是其病因病机。至汉代,张机(字仲景)提出心悸病名,并于《伤寒论》中记载数十条关于心悸病证的条文。张机从病因病机、诊断鉴别及遣方用药等方面论治心悸,对心悸的认识较为完备,对后世产生了深远的影响。斟酌《伤寒论》原文,不难发现张机立论心悸不过三者,或虚或饮或为误治。其因于“虚”者,立足于心之生理特点,“心主血”且“为阳脏而主通明”,心悸或由发汗不当、损伤阳气,或为心脾不足、气血亏虚,阳气与阴血的匮乏必然使得心无所主则见悸动不安;因于“饮”者,或为脾肾阳虚、水饮上犯,或为少阳受邪、三焦气化不利,邪气内舍于心,扰动心神,故使心悸而发;另有因于“误治”,或吐或下,易至津液耗伤,徒伤正气,而使邪气内陷,心神不守,悸动不安。据其病机的不同,张机组建桂枝甘草汤、真武汤、小建中汤、炙甘草汤、茯苓甘草汤等宁心止悸方药,探其遣方用药规律亦有迹可循,一者桂枝甘草汤为温阳止悸基本架构;二者善用茯苓利水止悸。其组方不外乎从虚实两端立论,虚则补之,实则泄之,方药所用极简,对后世心悸的治疗极具阐发意义。故文章从张机立论出发,探析其对于心悸的认识,并从《伤寒论》所遣方药分析心悸诊治规律。

Palpitation is a kind of disease that refers to the heart beating restlessness,willies and even unable to control itself.Although the name of palpitation was not explicitly mentioned in Huangdi Neijing(《黄帝内经》),it was recognized that the etiology and pathogenesis of palpitation were the leakage of Zongqi(宗气)and external pathogenic factor invasion.In the HanP Dynasty,ZHANG Ji put forward the name of palpitation,and recorded dozens of terms about palpitation in his book,Shanghan Lun(《伤寒论》).ZHANG Ji discussed the treatment of palpitation from the aspects of etiology and pathogenesis,diagnosis and differentiation,prescription and medication and so on,and had a complete understanding on palpitation,which had a far-reaching influence on later generations.Considering the original text in Shanghan Lun,it is not difficult to find that ZHANG Ji believed that there were only three causes of palpitation:deficiency,fluid retention,or wrong treatment.Speaking of palpitation caused by deficiency,it refers to improper perspiration that damages Yangqi(阳气),or insufficient heart and spleen that leads to deficiency of Qi(气)and blood,making the heart restless.When it comes to palpitations caused by fluid retention,it refers to Yang(阳)deficiency of spleen and kidney caused by the invasion of stranded fluid,or the dysfunction of triple energizer caused by Shaoyang(少阳)disease,which causes the mind was disturbed,and then leads to palpitation.When it comes to palpitation caused by improper treatment,it means that the vomiting method or the catharsis method leads to the consumption of body fluid,which makes the internal invasion of pathogenic factors,and then lead to the uneasiness of mind.According to the different pathogenesis,ZHANG Ji prescribed the Guizhi Gancao decoction(桂枝甘草汤),the Zhenwu decoction(真武汤),the Xiaojianzhong decoction(小建中汤),the Zhigancao decoction(炙甘草汤),the Fuling Gancao decoction(茯苓甘草汤)and so on to calm the heart and stop palpitation.There are also traces of the prescription and medication rules of the disease.Firstly,the Guizhi Gancao decoction is the basic structure of the prescription for warming Yang and preventing palpitation.The second is to make good use of Fuling(Poria)to stop palpitation.The prescription mainly based on deficiency and excess.The deficiency syndrome was treated by supplementing method.For excess syndrome,it was treated by purgation method.The prescriptions are very simple,which is of great guide significance to the treatment of palpitation in later generations.Therefore,based on the theories of ZHANG Ji,this paper analyzes his understanding of palpitation,and analyzes the medication rules of diagnosis and treatment of palpitation in Shanghan Lun.