《伤寒论》四逆散证病机辨识  

Syndrome Differentiation and Understanding the Pathogenesis of Sini Powders

作　　者：张宏邈 谷松[2] 

机构地区：[1]辽宁中医药大学基础医学院 [2]辽宁中医药大学基础医学院伤寒教研室,沈阳110847

出　　处：《实用中医内科杂志》2017年第2期67-69,共3页Journal of Practical Traditional Chinese Internal Medicine

基　　金：教育部高等学校博士学科点专项科研基金新教师类课题项目(No:20122133120009)~~

摘　　要：张仲景为少阴阳郁而设四逆散,放在《伤寒论》少阴篇,以"少阴病"冠首,病机当为少阴枢机不利,气机壅滞,阳气内遏不能外达四末,阳郁内闭。因论述简洁引发争议,后世医家未从仲景六经出发,从药物组成、脏腑辨证法推测四逆散证病机,分别提出四逆散证属少阴、厥阴、少阳经。病在少阴:系少阴阳虚相对较少,从方剂组成、临床实践角度,都不太被后世认可;少阴邪热内郁:成无己首提邪热内郁,解释四逆产生原因,得到后世医家认同,但观其或然证加减用药多具温热之性,如干姜、桂枝、附子等,用温热药治疗邪热内郁证有欠稳妥。病在厥阴:"此方原系治厥阴热厥主方,后人不识其旨,烟没已久,今表出之","四逆"是"少厥二阴热邪为本",现代医家对此观点多有继承与发展,也有医家认为四逆散证病在少阳。随着四逆散广泛应用及发展,在六版教材《方剂学》《方剂大辞典》《中医大辞典》等,四逆散被作为调和肝脾的基础方,以"肝脾不调"为基础来解释四逆散证病机变化是确切可行的。以四逆散为基础方化裁、创造出了诸如逍遥散、柴胡疏肝散等方剂,因而四逆散被誉为"疏肝祖方"。[Objective] ZHANG Zhongjing created Sini Powders according to the theory of yang qi of Shao Yin channel stagnated, and put it into Treatise on Exogenous Febrile Diseases. The pathogenesis is that Shao Yin channels is stagnated and yang qi can＇t end. Because of the simple, it cause controversy. The physicians are based from the theory of syndrome-differentiation of the six meridians proposed by Zhang zhongjing, conjecture syndrome of Sini Powerds according to medicine composition and viscera syndrome differentiation, then propose the points of Sini Powerds belong to Shaoyin, Jueyin or Shaoyang channels. Disease of Shaoyin channel： deficiency of yang of Shaoyin channel accepted less, not recognized by the future generations; Stagnation of pathogenic heat in Shaoyin channel： the point is the first mentioned by Cheng wuji, and agreed extensively. But properties of drugused by Cheng wuji was warm or hot, example Ginger, cassia twig and aconite, whose are not recognized. Disease of Jueyin channel： ＂This is the main treatment of Jueyin heat syncope, people did not know the purpose, the cigarette is not long, the table out of the＂. The four ＂inverse＂ is ＂less heat evil is the two Jueyin＂. This view is inherited and developed by modern medicine. Disease of Shaoyang channel： the view of Sini Powerds belong to Shaoyang is approved. With the application and development of the Sini Powerds, it is treated as the basic prescription of regulating the function of the liver and spleen in ＂prescription＂, ＂the big dictionary of Chinese medicine＂ and ＂Chinese Dictionary of traditional Chinese medicine＂. And on the basis of it, many prescriptions are created, such as Xiaoyao Powerds, CHSGS and so on. So Sini powerds is known as ancestor＇s prescription of soothing the liver.

关 键 词：四逆散 疏肝祖方 张仲景 伤寒论 六经辨证 少阴病 病机 少阴阳郁 少阴枢机不利 气机壅滞 阳气内遏 少阴阳虚 少阴邪热内郁 厥阴 肝脾不调 方剂学 方剂大辞典 中医大辞典 

分 类 号：R222.2[医药卫生—中医基础理论]