五运六气三因司天方麦门冬汤临床应用体会

Clinical application experience on the Sanyin Sitian Maimendong decoction based on five circuits and six Qi theory

三因司天方麦门冬汤由麦门冬、半夏、人参等组成。此方出自《三因极一病证方论》,为宋代医家陈无择针对六戊之年火运太过的运气特点而设立。笔者在学习顾植山教授和马新童教授临床经验的同时,得出自己的临床体会为三因司天方麦门冬汤的病机为“火旺、金燥、土虚”。此病机是融汇运气理论、脏腑辨证、外感六淫辨证及方剂学理论而概括得出。并且将三因司天方麦门冬汤和《金匮要略》中麦门冬汤两方融汇在一起,根据“火旺、金燥、土虚”的特点将两方中相关药物归类,从而把握方证以利于指导临床用药。方中竹叶、桑白皮、紫菀归为“火旺”;麦冬,桑白皮归为“金燥”;人参、半夏、甘草、生姜、大枣、粳米归为“土虚”。在具体运用时,偏重于“火旺”加黄连;偏重于“金燥”,调整麦冬、桑白皮剂量;偏重于“土虚”,加减方中相关药物。本研究将深奥难懂的运气理论概括为简单的“火旺、金燥、土虚”病机,执简驭繁,方便临床应用。只要患者病机具备火旺、金燥、土虚的特点,皆可加减化载,灵活运用,不限于运气之年。本研究通过三则案例介绍相关体会,以期为临床提供参考。

The Maimendong decoction(麦门冬汤)in Sanying Sitian(《三因司天》)is composed of Maidong(Radix Ophiopogonis),Banxia(Rhizoma Pinelliae),Renshen(Radix Ginseng),etc..This prescription is derived from Sanyin Ji Yi Bingzheng Fang Lun(《三因极-病证方论》),which was written by CHEN Wuze,a physician in the Song Dynasty,according to the characteristics of excessive fire circuit in the year of Liu Wu(六戊).While studying the clinical experience of Professor GU Zhishan and Professor MA Xintong,the author has come to his own clinical experience that the pathogenesis of the Maimendong decoction in Sanying Sitian is“fire hyperactivity,gold dryness,and earth deficiency”.The pathogenesis is summarized by integrating the theory of Qi(气),the syndrome of Zang Fu(脏腑),Six external pathogenic factors and the theory of prescription.This pathogenesis summary is to merge the Maimendong decoction Sanyin Sitian and the Maimendong decoction(麦门冬汤)in Jingui Yaolue(《金匮要略》),and classify the relevant medicines in the two prescriptions according to the characteristics of“fire hyperactivity,gold dryness,and earth deficiency”,so as to guide clinical medication.Zhuye(Folium Phyllostachydis Henonis),Ziwan(Radix Asteris),Sangbaipi(Cortex Mori)in the prescription mainly treat“fire hyperactivity”,Maidong and Sangbaipi mainly treat“gold dryness”,Renshen,Banxia,Gancao(Radix Glycyrrhizae),Shengjiang(Rhizoma Zingiberis Recens),Dazao(Fructus Jujubae)and Jingmi(粳米)are mainly used to treat“earth deficiency”.In the specific application,if the patient's condition focuses on“fire hyperactivity”,Huanglian(Rhizoma Coptidis)can be added.If the patient's condition focuses on“golden dryness”,the dosage of Maidong and Sangbaipi can be adjusted.If the patient's condition focuses on“earth deficiency”,the relevant medicines in the prescription can be modified.The abstruse theory of five circuits and six Qi is summarized as a simple pathogenesis of“fire hyperactivity,gold dryness and earth deficiency”,which is convenient for clinical application.As long as the patient's pathogenesis has the characteristics of“fire hyperactivity,gold dryness,and earth deficiency”,the above prescription can be used,which is convenient and flexible,and is not limited by the year of Yun Qi(运气).This article introduces the relevant experience through three cases,in order to provide reference for clinical practice.