从《金匮要略》窥历节病(诸关节疼痛)诊治  

From the "Synopsis of Golden Chamber" Peep Calendar Section(Joint Pain)Treatment

作　　者：曾德斌[1] 

机构地区：[1]四川省资阳市雁江区妇幼保健院中医门诊,四川资阳641300

出　　处：《实用中医内科杂志》2015年第10期27-28,共2页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：张仲景认为内伤是历节病主因,禀赋不足、调摄不慎、嗜欲不节等造成肝肾筋骨虚损,营卫运行不畅,经脉阻塞;外因为风寒湿等邪气乘虚而入,内外合邪,即成历节;把肝肾筋骨之虚置于前,外邪入侵置于后,提示历节病程分为两阶段,即内伤与外感,依此分为发生与发展阶段,发生阶段培补肝肾,防外邪再入;发展阶段则重祛除外邪,培补肝肾、调养气血。治内因：麻黄附子细辛汤（麻黄10~15g,附子10~30g,细辛、山茱萸、枸杞各5~10g,热服取微汗为止）。治外邪：风湿俱盛（桂枝芍药知母汤：桂枝12g,芍药9g,甘草6g,麻黄12g,生姜、白术15g,知母、防风12g,附子炮10g）;寒邪盛（乌头汤：麻黄、芍药、黄芪、甘草炙各9g,川乌6g,蜜400m L,煎取200m L）;风湿化热（千金犀角汤：犀角100g,羚羊角50g,前胡、栀子仁、黄芩、射干150g,大黄200g,升麻200g,豉1000m L,酌加银花藤,连翘,天花粉,赤芍,丹皮）。内外兼治（肝肾阴虚,治法当养肝肾,清虚热,六味地黄丸（熟地40g,山萸肉20g,山药20g,茯苓、丹皮、泽泻各15g,白芍10g,玉竹5g,知母、黄柏各10g）。并以＂治未病＂为基础,提出＂养慎＂预防策略,外镇邪气、内养正气,包括顺应四时、外避寒暑及内调饮食等。Zhongjing ＂Synopsis of Golden Chamber＂ that the calendar section of injuries is the main reason,lack of endowment,recuperating inadvertent,improper craving caused liver and kidney wasting muscles,caused by poor run camp guard,blocked meridians;outside because of the wind and cold and other evil Cheng Xu in,external evil,Serve calendar section.The virtual liver before Zhongjing put bones and muscles,after the invasion of evils place,suggesting calendar section course is divided into two stages,namely exogenous and internal injuries,and so the calendar section of the disease into the development phase,the training phase should occur Bugan kidney,prevent evils reentry;development stage is important to get rid of evils,Nourishing the liver and kidney,blood nursed back to health.Treatment is divided into internal governance：Mahuangfuzixixin soup（Mahuang 10~15g,Fuzi 10~30g,Xixin,Sahnz huyu,Gouqi,5~10g,hot clothes take slightly sweated so far）.Cure evils：rheumatism club Sheng（Guizhishaoyaozhimu soup：Guizhi 12 g,Shaoyao 9g,Gancao 6g,Mahaung 12 g,Shengjiang,Baizhu 15 g,Zhimu,Fangfeng 12 g,Fuzipao 10g）;Han Xie Sheng（Aconitum Tang：Mahuang Shaoyao,Huangqi,Gancaozhi each 9g,Chuanwu 6g,honey 400 m L,Jianqu 200 m L）;rheumatism of heat（daughter horns soup：Xijiao 100 g,Lingyangjiao 50 g,Qianzhu,Zhiziren,Huangqin,Sheg an 150 g,Dahaung,Shengma 200 g,Chi 1000 m L,Zhuojia Yinhuateng,Lianqiao,Tianhuafen,Chishao,Mudanpi）.Internal and External（liver and kidney,liver and kidney treatment method when raised,Qing Xu hot,Liu Wei Di Huang Wan（Shudi 40 g,Sahnyurou 20 g,Shanyao 20 g,Fuling,Danpi,Zexie 15 g,Baishao 10 g,Yuzhu 5g,Zhimu,Huangbai each 10g）.and ＂disease＂ as the basis,that ＂cautious support＂ prevention strategies,outside the town of evil,keep upright inside,including four seasons conform,to avoid the cold and heat outside and in tune diet.

关 键 词：历节病 诸关节疼痛 金匮要略·中风历节病脉证并治 张仲景 内伤 外感 风湿俱盛 寒盛 风湿化热 治未病 中医药治疗 

分 类 号：R259.932.2[医药卫生—中西医结合]