试论温胆汤之“温”  

Discussion on "Wen" in Wendan Decoction

作　　者：苗晓光 高嫆 郭斌[1] 刘建国 MIAO Xiaoguang;GAO Rong;GUO Bin;LIU Jianguo(Shaanxi University of Chinese Medicine,Xianyang Shaanxi China 712046;Shaanxi Provincial Hospital of Chinese Medicine,Xi′an Shaanxi China 710003)

机构地区：[1]陕西中医药大学,陕西咸阳712046 [2]陕西省中医医院,陕西西安710003

出　　处：《中医学报》2023年第2期248-253,共6页Acta Chinese Medicine

基　　金：国家自然科学基金项目(82174387);陕西省卫健委项目(2022D003);陕西省中医药管理局项目(2021-GJ-JC006)。

摘　　要：温胆汤源于南北朝时期姚僧垣《集验方》,历代医家对其主治应为“胆寒”还是“胆热痰扰”众说纷纭。胆虚寒证在《黄帝内经》中初见端倪,温胆汤的创设既遵循“寒者温之”原则,也是秦汉时期对胆认识的总结升华,更受同时期“脏热腑寒”理论影响。少阳属胆,应于春,乃阳气初生,枢转阳气,决断有权。胆肾相联,胆内寄相火,主持相火温煦脏腑功能。若少阳枢机不利,失于升发疏泄,初生之阳转输受阻,加之相火衰减,不得升发输布,致胆虚生寒。温胆汤组方以温热药为主,促胆气之升发。因而,温胆汤应为恢复胆之升发之性、固护决断之权所设,温之含义应为“温寒、温养”,并非“温和”。Wendan Decoction is originated from Yao Sengyuan′s Ji Yan Fang,which was written in the Southern and Northern Dynasties.Physicians of all dynasties have different opinions on whether it should be used for "Gallbladder cold" or "Gallbladder Heat with disturbing Phlegm".Gallbladder deficiency and cold syndrome was first described in Huang Di Nei Jing.The creation of Wendan Decoction not only followed the principle of "warming the cold",but also a summary and sublimation of the understanding of Gallbladder in the Qin and Han Dynasties.It was also under the influence of the theory of "when Zang is hot the Fu is cold" at the same time.Shaoyang belongs to the Gallbladder and is like spring,which is the primary and pivoting of Yang Qi,and functions in making decisions.The Gallbladder and the Kidney are connected,and the Gallbladder contains ministerial Fire,which warms the Zang and Fu.If Shaoyang pivot is in dysfunction and fails to ascend,dredge,conveyance and disperse,the transfer of the primary Yang is blocked and the ministerial Fire decays,so it cannot ascend,dredge and distribute well,resulting in Gallbladder deficiency and cold syndrome.However,the prescription of Wendan Decoction is composed of warm and hot natured medicines,which promotes the ascending and dredging of gallbladder Qi.Therefore,Wendan Decoction should be designed to restore the Gallbladder′s ability to ascend,dredge and protect the function of making decisions.The meaning of "Wen" should be "warming and nourishing" but not be "gentle".

关 键 词：温胆汤 胆虚寒证 温热药 《集验方》 “脏热腑寒” 温寒 温养 温和 

分 类 号：R222.16[医药卫生—中医基础理论]