探讨《金匮要略》之“阴阳毒”  

The Probe into "Yin-Yang Toxin" in Essentials from the Golden Cabinet

作　　者：罗雪梅[1] 周凯[1] 王燕平[1] 鄢小君 

机构地区：[1]成都中医药大学,四川成都610075

出　　处：《河南中医》2016年第4期565-567,共3页Henan Traditional Chinese Medicine

摘　　要："阴阳毒"之病机在于"毒邪"从口鼻咽喉进入机体,毒邪蕴于咽喉,所以均可出现"咽喉痛"症状,如果邪气停聚与表,在表浅者,阳气热盛而壅与上,故出现斑似锦纹;若邪气由咽喉要道直入里,出现气血凝滞不通,阳气无法到达头面四肢,所以头面四肢失去阳气的温煦,出现面目青,周身疼痛等症状。《金匮要略》采用升麻鳖甲汤治疗"阴阳毒",阳毒加用蜀椒之辛热之品,阴毒反而将其去除。一些医家认为是因为错简,以徐大椿、王孟英为代表。但也有医家并不那样认为,以赵以德、尤怡为代表。笔者认为并不是错简,张仲景在"阴阳毒"这一治疗上,体现的是辨病结合辨证来治疗,以"升麻鳖甲汤加减"贯穿前后,阴阳毒总为"毒邪"侵犯机体,用升麻为君药解百毒,当归、鳖甲养阴、活血,行瘀。甘草清热解毒。阳毒用蜀椒、雄黄之阳性同气相求引上犯之火热邪气下行。阴毒去之在于其二者的辛热之性恐让阴气受损。体现了一病用一方的原则。The pathogenesis of ＂yin-yang toxin＂ is that toxic pathogen enters the body through the mouth, nose and throat, and ac- cumulates in the throat, leading to sore throat. If pathogen retains in the superficies, excessive yang qi will be accumulated and move upward, leading to spots like brocade pattern. If pathogen enters directly into the inside body through the throat, blood stag. nation will make yang qi failing to reach the head, face and limbs losing the warm of yang qi, giving blue complexion and eyes and pain all over the body. In terms of treating ＂yin-yang toxin＂ ,the original text follows the principle of one prescription treating two syndromes, showing the theory that TCM disease differentiation and syndrome differentiation are connected. Traditionally, Cimicifu- ga and Carapaeis Trionycis Decoction is used, but the difference is the dosage change of Xionghuang （Realgar） and Shujiao （Fructus Capsici）. The differing view is that in terms of treating ymag toxin, Shujiao as a pungent herb should be used,but when treating yin toxin,it should be removed. Some physicians with XU Da-chuan and WANG Meng-ying as the representatives think it is wrong, but some other physicians with ZHAO Yi-de and YOU Yi as the representatives think it is correct. The author of the the- sis approve the latter opinion. The reason is as follows：In terms of treating ＂yin-yang toxin＂ , ZHANG Zhong-jing adopts combina- tion of disease differentiation and syndrome differentiation by using Cimicifuga and Carapacis Trionycis Decoction. Yin toxin and yang toxin are regarded as toxin pathogen invading the body ,so Shengma （Rhizoma Cimicifugae） as the monarch drug is used to remove all kinds of toxin;Danggui （Radix Angelicae Sinensis） and Biejia （Carapax Trionycis） are used to nourish yin, activate blood circulation and remove blood stasis;Gancao （Radix et Rhizoma Glycyrrhizae） can expel toxin by cooling. Xionghuang （Re- algar） and Shujiao （Fructus Capsici） are used to drive uprising fire downward

关 键 词：《金匮要略》 “阴阳毒” 升麻鳖甲汤 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]