仲景辨治奔豚气病方药配伍解析

Explanation of the Prescriptions and Medicines used by Zhongjing in the Treatment of Running Piglet Disease

奔豚气病以临床症状命名,是一种发作性的疾病。在病名方面,奔豚气病与肾积奔豚亦有不同之处,从临床表现、病因病机方面即可将其二者区分开来。奔豚气病的病因不外乎外感与内伤两端,其病机的关键,不论病因如何,最终都将归结于气机逆乱,由各种致病因素引动或随循冲脉之气上逆发为奔豚。治疗则以疏肝解郁、化痰饮及温阳为主。《金匮要略》所载方药有三,奔豚汤养肝平冲、清热降气,主治肝郁化热奔豚;桂枝加桂汤温阳祛寒、平冲降逆,主治心阳虚,下焦寒气上冲,致发奔豚者;苓桂甘枣汤温阳行水、理气降逆,主治素有水饮内停,加之发汗太过,心阳受伤,欲作奔豚者。文章通过对三方君臣佐使组方配伍结构进行剖析,可加深对仲景治疗奔豚气用药规律的理解认识。

Running piglet disease is named of the clinical symptoms and is a paroxysmal disease.According to the name of the disease,there is also a difference between Running piglet disease and Running piglet of kidney accumulation,which can be distinguished from each other in terms of clinical manifestations and cause and mechanism of disease.The key to its pathogenesis,regardless of the cause,will ultimately be attributed to the reversal of Qi,which is triggered by various pathogenic factors or reversible with the Qi flowing through the CHONG meridian.Treatment is based on soothing the liver and relieving stagnation,resolving phlegm and warming Yang.There are three formulas for Running piglet disease contained in Synopsis of Prescriptions of the Golden Chamber:running piglet Decoction emolliates the liver,balances the flush,clears heat and directs Qi downward,majorly treating liver stagnation to heat caused Running piglet;Guizhi Jiagui Decoction warms Yang and dissipate cold,descends adverse-rising Qi,mainly treating deficiency of heart Yang and cold Qi upward from the lower Jiao,resulting in the development of Running piglet;Linggui Ganzao Decoction warms Yang to move water,regulates Qi and reduces rebellion,treating patients who have stagnation of retained fluid plus excessive sweating caused injury of heart Yang and desire to make a running piglet.In this paper,we analyze the structure of the sovereign-minister-assistant-courier of three formulas,which can deepen our understanding of the rules of medicine used by Zhongjing in the treatment of Running piglet disease.