经典名方桃核承气汤的历史沿革和处方考证  

Historical Evolution and Textual Research on Classical Prescription Taohe Chengqitang

作　　者：王进宝[1] 张磊[2] 佟琳[2] 贾思琪 曾子玲 贾紫涵 郑丹平 李兵[4] 张华敏[4] 刘思鸿[2] WANG Jinbao;ZHANG Lei;TONG Lin;JIA Siqi;JIA Zihan;ZHENG Danping;LI Bing;ZHANG Huamin;LIU Sihong(Wang Jing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China;Institute of Information on Traditional Chinese Medicine(TCM),China Academy of Chinese Medical Sciences,Beijing 100700,China;Hebei University of Chinese Medicine,Shijiazhuang 050200,China;Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]中国中医科学院望京医院,北京100102 [2]中国中医科学院中医药信息研究所,北京100700 [3]河北中医学院,石家庄050200 [4]中国中医科学院中药研究所,北京100700

出　　处：《中国实验方剂学杂志》2022年第18期135-143,共9页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：中国中医科学院科技创新工程项目(CI2021A03702);国家中医药管理局委托办事经费项目(GZY-KJS-2019-011);中央级公益性科研院所基本科研业务费项目(ZZ13-027,ZZ13-YQ-131,ZZ140310)。

摘　　要：桃核承气汤为《古代经典名方目录(第一批)》发布的经典名方,通过系统梳理桃核承气汤的中医古籍及现代临床文献,对其出处、组成、基原与炮制要求、剂量、制法用法、功能主治等历史沿革进行考证,发现桃核承气汤主要在药物基原、饮片炮制及药物剂量折算等方面存在疑义。在充分文献考证基础上,考虑经典名方制剂开发实际需求及现代临床实践使用习惯,该研究建议桃仁选用桃Prunus persica或山桃P.davidiana的干燥成熟种子,桂枝选用肉桂Cinnamomum cassia的干燥嫩枝,甘草选用豆科植物甘草Glycyrrhiza uralensis蜜炙用,大黄选用大黄Rheum palmatum或唐古特大黄R.tanguticum或药用大黄R.offìcinale生用,芒硝选用硫酸盐类矿物芒硝;药物用量方面,直接以汉代度量衡折算用量较大,结合现代临床常用剂量按桂枝6 g、芒硝6 g、甘草6 g、大黄12 g进行折算,桃仁的质量根据实测确定,制法服法为将药物置于锅中,加入水1400 mL,加热煮取药液500 mL,滤除药渣后加入芒硝,再将汤剂微微煮沸即可。饭前温服100 mL左右,一日3次。该方古籍记载主治太阳表证已解,热入膀胱、蓄结于里之证,经后世医家临证灵活应用,常用于治疗糖尿病肾病、便秘及慢性肾衰等疾病。Taohe Chengqitang is a classical prescription published in The Catalogue of Ancient Classic Recipes(The First Batch).This study systematically summarized traditional Chinese medicine(TCM) ancient books and modern clinical reports on Taohe Chengqitang and investigated its origin,composition,basis,and historical evolution in processing requirements,dosage,preparation and administration,and functions.The findings indicated different opinions on drug basis,preparation of decoction pieces,and drug dosage conversion.Based on sufficient literature review,the actual development needs of classical prescriptions,and the usage habits of modern clinical practice,this study recommended dried mature seeds of Prunus persica or P.davidiana for Persicae Semen,dried twigs of Cinnamomum cassia for Cinnamomi Ramulus,honey-fried Glycyrrhiza uralensis for Glycyrrhizae Radix et Rhizoma,raw Rheum palmatum,R.tanguticum,or R.offìcinale for Rhei Radix et Rhizoma,and mirabilite for Natrii Sulfas.In terms of drug dosage,the doses directed converted from weights and measures in the Han dynasty were large.According to the common doses in modern clinical practice,conversion was carried out based on 6 g of Cinnamomi Ramulus,6 g of Natrii Sulfas,6 g of Glycyrrhizae Radix et Rhizoma,and 12 g of Rhei Radix et Rhizoma.The weight of Persicae Semen should be determined according to the actual measurement.In terms of preparation and administration,the drugs in the pot were decocted with1 400 mL of water to obtain 500 mL of decoction,which was filtered and slightly boiled in the presence of Natrii Sulfas.About 100 mL of warm decoction was taken before meals,three times a day.It was recorded in the ancient books that Taohe Chengqitang was indicated for the syndromes of heat invading the bladder and accumulating inside in the case of released exterior syndrome in Taiyang.After symptom-based flexible application by doctors,it is currently commonly used in the treatment of diabetic nephropathy,constipation,chronic renal failure,and other diseases.

关 键 词：桃核承气汤 经典名方 文献考证 主治病证 剂量 

分 类 号：R289[医药卫生—方剂学] R22[医药卫生—中药学] R2-031[医药卫生—中医学] R33