经方中栝楼实和栝楼根应用规律探析  

Application Regularity of Gualoushi(Trichosanthis Fructus)and Gualougen(Trichosanthis Radix)in Classic Prescriptions

作　　者：李涛[1] 曲夷[1] LI Tao;QU Yi(Shandong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]山东中医药大学,山东济南250355

出　　处：《山东中医药大学学报》2021年第4期505-510,共6页Journal of Shandong University of Traditional Chinese Medicine

基　　金：国家中医药管理局齐鲁伤寒流派传承工作室建设项目(编号:LPGZS2012-34)。

摘　　要：依据《伤寒杂病论》原文,从用量用法、主治证候、配伍应用3个方面,总结栝楼实、栝楼根在经方中的应用规律,提出:①栝楼实常与半夏、薤白配伍,主治心胸、胁下的疼痛痞满;栝楼根常配伍桂枝、干姜、附子、牡蛎等药,多用于郁热津伤、水液不布导致的口渴、发热;②胸痹证属痰实结胸者,可用栝楼实与薤白配伍,心痛彻背而不得卧者,需加入大量半夏,阴寒痹阻者,薤白用量大于栝楼实;③结胸、胸痹皆以心胸部位的疼痛为主症,皆可以栝楼实、半夏配伍以化痰散结。结胸乃热邪内陷而成,需重用栝楼实,配伍黄连以辛开苦降,清热泻火。胸痹乃阳虚在上焦,需配伍薤白,重用半夏,加用白酒以通阳散寒、化痰开痹;④栝楼实先煎取其厚味以清热导痰下行,后下“煮数沸”取其气薄以通阳宣痹;⑤炮附子和栝楼根配伍应用属后世“十八反”之禁忌,经方中两药同用见于丸散剂,单日用量不超过3 g。According to the original text of Treatise on Cold Pathogenic and Miscellaneous Diseases,this paper summarizes the application regularity of Gualoushi(Trichosanthis Fructus)and Gualougen(Trichosanthis Radix)in classic prescriptions from the dosage and administration,indications and compatibility,and puts forward:①Gualoushi is often combined with Banxia(Pinelliae Rhizoma Praeparatum)and Xiebai(Allii Macrostemonis Bulbus)to treat pain and fullness in the heart,chest and hypochondrium.Gualougen is often compatible with Guizhi(Cinnamomi Ramulus),Ganjiang(Zingiberis Rhizoma),Fuzi(Aconti Lateralis Radix Praeparaia)and Muli(Concha Ostreae),etc.which may be mostly used for thirsty and fever caused by heat stagnation and fluid consumption,impairment of fluid distribution.②Patients with chest impediment belonging to phlegm excess of thoracic accumulation may be treated with combination of Gualoushi and Xiebai.Patients with heart pain failing to lie flat,large dosage of Banxia should be used.For patients with yin cold impediment,the dosage of Xiebai should be larger than that of Gualoushi.③The main symptom of thoracic accumulation and chest impediment is pain of the heart and chest,the combination of Gualoushi and Banxia can resolve phlegm and dissipate mass.Thoracic accumulation is caused by inward invasion of heat pathogen,so large dosage of Gualoushi should be used,combined with Huanglian(Coptidis Rhizoma),for pungent dispersing and bitter descending,clearing heat and purging fire.Chest impediment is caused by yang deficiency in the upper energizer,which should be compatible with Xiebai and large dosage of Banxia,together with liquor to activate yang,dissipate cold,resolve phlegm and diffuse impediment.④Gualoushi being decocted first can get the thick flavor to clear heat and conduct phlegm to flow downward.Gualoushi being decocted later,“boiling several times”,can get the thin flavor to activate yang and diffuse impediment.⑤The compatibility of Paofuzi and Gualougen is forbidden in“eighteen antagonisms�

关 键 词：《伤寒杂病论》 栝楼实 栝楼根 经方 结胸 胸痹 郁热津伤 半夏 薤白 

分 类 号：R282.71[医药卫生—中药学]