再论大承气汤  

Discussing Da Cheng Qi Decoction Again

作　　者：尚云冰[1] 曲夷[2] 

机构地区：[1]山东中医药高等专科学校,山东烟台264119 [2]山东中医药大学,山东济南250355

出　　处：《山东中医药大学学报》2016年第2期135-136,共2页Journal of Shandong University of Traditional Chinese Medicine

基　　金：山东省中医药科技发展计划项目(编号:2011-Z-002)

摘　　要：大承气汤属下法的要方,临床运用多以便秘为主症,前人甚至认为大承气汤的适应证需"痞,满,燥,实,坚全俱者"。为纠正大承气汤的运用必伴有大便秘结的线性思维,对《伤寒论》《金匮要略》中涉及到大承气汤的原文进行梳理,总结张仲景运用大承气汤的常法辨证思维与变法辨证思维。同时,全面搜集仲景已降的古今医案,对大承气汤的非典型运用进行分析,探索大承气汤的内在病机。该方属清剂、降剂、泻火之剂,有通腑、泄热、逐湿之功,大承气汤之峻下热结,应突出热结中的"热",即以通腑的手段达到泄热的目的,阳明实热证即可作为大承气汤活用的指征,不必凿求于便秘之一端。Da Cheng Qi Decoction is the representative purgative prescription mainly in treating constipation in clinic. Although predecessors held that the application of Da Cheng Qi Decoction must accord with＂distention,fullness,dryness,excess,hardness＂,we tried to break up the linear thinking of the astriction for Da Cheng Qi Decoction. This paper screened the original texts related to Da Cheng Qi Decoction in Synopsis of the Golden Chamber and Treatise on Febrile Diseases to gain the general thinking of syndrome differentiation and dialectical thinking of syndrome differentiation of ZHANG Zhongjing. Besides,this paper collected the ancient and modern medical records of atypical application of Da Cheng Qi Decoction to explore the real pathogenesis of Da Cheng Qi Decoction. In conclusion,Da Cheng Qi Decoction belonged to clearing,descending and purging prescription with the function of purging the bowl,clearing away the heat and dissipating the dampness. The function of relieving heat should be emphasized in the effect of clearing away the stool. In other words,clearing away the stool meant to achieve the purpose of reducing heat. Excessive heat of Yangming syndrome,not merely constipation,can be used as a practical indicator of Da Cheng Qi Decoction.

关 键 词：大承气汤 大便 阳明实热证 

分 类 号：R222[医药卫生—中医基础理论]