从黄芩汤的演变规律探析升麻葛根汤的用药逻辑  

Probing into the medication logic of Shengma Gegen Decoction from the evolution rule of Huangqin Decoction

作　　者：马林 王明炯[2] 王润鹏 戴瑜娉 舒兰[3] MA Lin;WANG Mingjiong;WANG Runpeng;DAI Yuping;SHU Lan(Graduate School,Hunan University of Chinese Medicine,Changsha410208,China;School of Traditional Chinese Medicine,Changsha Medical University,Changsha410219,China;Department of Pediatrics,the First Hospital of Hunan University of Chinese Medicine,Changsha410000,China)

机构地区：[1]湖南中医药大学研究生院,湖南长沙410208 [2]长沙医学院中医学院,湖南长沙410219 [3]湖南中医药大学第一附属医院儿科,湖南长沙410000

出　　处：《中国现代医生》2021年第28期188-192,共5页China Modern Doctor

基　　金：湖南省高等学校“双一流”建设项目(湘教通〔2018〕469号)。

摘　　要：笔者从《伤寒论》中对比两阳合病的方证入手,认为芍药四物解肌汤乃是黄芩汤基于儿科生理特点的化裁,而升麻葛根汤所治为疮疹,是针对伤寒发热疮疹的特殊病症及患者群演变而来,其理论源于太阳与阳明合病,但又与典型的太阳与阳明合病有所差异,其病机为“五脏毒秽”结于阳明,并受外感寒邪引动,这与钱乙在《小儿药证直诀》中疮疹的证治论述完全一致;芍药四物解肌汤去黄芩加炙甘草化裁升麻葛根汤的演变规律是必要的,符合小儿疮疹的病理特点。以经典的角度解释升麻葛根汤的方证较历史上对升麻葛根汤的认识更为准确。Starting from comparing the prescriptions and syndromes of the two-yang syndrome in“Treatise on Febrile Diseases Caused by Cold(Shanghan Lun)”,this paper indicated that Shaoyao Siwu Jieji Decoction is a modification of Huangqin decoction based on the physiological characteristics of pediatrics diseases.The Shengma Gegen Decoction is used to treat rash,which evolves based on the special symptoms and patient population of typhoid fever and rash.Its theory originates from the combined disease of the Taiyang and Yangming but is different from the typical combined disease of the Taiyang and Yangming.Its pathogenesis is that the"poisons and filth in the five Zang organs"are formed in Yangming,and it is induced by external cold.This is exactly the same as Qian Yi′s exposition on the treatment of rash in“Keys to Therapeutics of Children′s Diseases”;the evolution rule of removing Huangqin and adding Zhigancao is necessary for the modification from Shaoyao Siwu Jieji Decoction to Shengma Gegen Decoction,conforming to the pathological characteristics of children′s rashes.It is more accurate to explain the prescription of Shengma Gegen Decoction from a classic perspective than the historical understanding of Shengma Gegen Decoction.

关 键 词：黄芩汤 葛根汤 芍药四物解肌汤 升麻葛根汤 张仲景 孙思邈 钱乙 小儿药证直诀 

分 类 号：R256.3[医药卫生—中医内科学]