从气化受阻论探析活用猪苓汤之心法

Study on clinical application of Zhuling Decoction from gasification obstruction

历代医家常将猪苓汤病机解释为“膀胱水热互结”或“阳明误下后余热结于膀胱”,但无法深刻诠释本方用阿胶及四味渗利水湿药之深意,更无法解释阳明病篇与少阴病篇条文的内在联系。余秋平教授认为,猪苓汤证的核心在于气化受阻。气化受阻之根本原因,为肾阴亏虚、膀胱虚热内生、水热外排不利而稽留、阻滞气化功能。猪苓汤证所见之口渴,也并非阳明热耗伤阴津,口渴甚常为水停表现突出、气化受阻甚的表现,故原方中利水与养阴药用量比例为4∶1;又因其有肾阴不足之根本病机,若口渴不甚、水液内停不重者,当注意减小渗利之品的用量,以防伤阴、更损气化。

Doctors in the past dynasties often explained the pathogenesis of Zhuling decoction as“water and heat in the bladder”or“residual heat in the bladder after Yangming mistakenly went down”,but they could not deeply explain the deep meaning of the prescription with ejiao and four kinds of moist-relieving medicine,and could not explain the internal relationship between Yangming's articles and Shaoyin articles.Professor Yu Qiuping believes that the key point of poring decoction syndrome is the obstruction of gasification.The root causes of blocked gasification are kidney Yin deficiency,bladder deficiency heat endogenous,water heat effluence unfavorable and blocked gasification.The thirst seen in Zhuling Tang syndrome was not caused by Yangming heat depletion,but by severe water withdrawal and obstruction of gasification.Therefore,the ratio of water-removing and yin-nourishing drugs in the original prescription was 4:1.And because of its lack of kidney Yin fundamental pathogenesis,if the thirst is not worse,should pay attention to reduce the amount of products to prevent Yin injury.