真武汤不用桂枝反用芍药探析  

Exploration of True Warrior Decoction Using Rhizoma Atractylodis Macrocephalae Instead of Cinnamon Twig

作　　者：马家驹 冯世纶[2] 李乐愚[3] MA Jia-ju;FENG Shi-lun;LI Le-yu(Zhongshan Hospital Affiliated to Guangzhou University of TCM,Zhongshan,Guangdong,China,528400;Sino-Japanese Friendship Hospital,Beijing,China,100029;Beijing Hospital of TCM Affiliated to Capital Medical University,Beijing,China,100010)

机构地区：[1]广州中医药大学附属中山医院,广东中山528400 [2]中日友好医院,北京100029 [3]首都医科大学附属北京中医医院,北京100010

出　　处：《河南中医》2019年第6期811-813,共3页Henan Traditional Chinese Medicine

摘　　要：真武汤证为水饮内停兼有表邪未解的外邪里饮证,其病性为阴证,为少阴、太阴合病。真武汤方中生姜一方面解少阴表证,一方面温化水饮;炮附子既可以助白术、茯苓化饮,也可助生姜解表,故真武汤不用桂枝而用生姜。真武汤证与桂枝去桂加茯苓白术汤证的病机均为外邪里饮,可以认为真武汤是桂枝去桂加茯苓白术汤去炙甘草、大枣、加炮附子而成。芍药主治邪气腹痛,利小便,真武汤方证的一个主症即是腹痛,白芍敛阴和营,缓急止痛,利小便,使水饮祛而不伤津,故真武汤不用桂枝反用芍药。True Warrior Decoction is a prescription of warming yang and removing retention. Its pathogenesis is yang deficiency and fluid overflowing,but why does True Warrior Decoction use Baishao ( Radix Paeoniae Alba) rather than Guizhi ( Cinnamon Twig)? Based on the analysis of articles and the test of syndrome according to prescription,it is concluded that True Warrior Decoction belongs to syndrome of exogenous pathogenic factor and interior retention. Baizhu ( Rhizoma Atractylodis Macrocephalae), Fuling ( Poria) and Fuzi ( Radix Aconiti Lateralis Praeparata) can warm the middle energizer and remove fluid retention,while Shengjiang ( Rhizoma Zingiberis Recens) and Fuzi can warm yang and relieve exterior syndrome. So it belongs to combination of diseases of Shaoyin and Taiyin meridians. Because it belongs to yin syndrome,Guizhi is removed to avoid hurting fluid;Shengjiang is used to relieve exterior syndrome without hurting fluid. Shaoyao is kept to store yin and harmonize nutrient yin because of deficient fluid,which explains why True Warrior Decoction uses Guizhi instead of Shaoyao from the point of view of body fluid. It can be considered that True Warrior Decoction is made from Cinnamon Twig Decoction Removing Cinnamon Twig plus Poria and Rhizoma Atractylodis Macrocephalae Removing Zhigancao ( Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) and Dazao ( Fructus Jujubae) plus Fuzi. Based on the above ideas,it may be more in line with Zhongjing's original intention.

关 键 词：真武汤 桂枝去桂加茯苓白术汤 外邪里饮证 《伤寒论》 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]