基于“芍药甘草基”重探《伤寒论》黄芩汤  

New Study on Scutellaria Decoction in Treatise on Cold Damage Diseases Based on "Shaoyao-Gancao"

作　　者：史光伟 郭宏明 SHI Guang-wei;GUO Hong-ming(Jiuquan Hospital of Traditional Chinese Medicine,Jiuquan,Gansu,China,735000;Nanyang Medical College,Nanyang,Henan,China,473000)

机构地区：[1]酒泉市中医院,甘肃酒泉735000 [2]南阳医学高等专科学校,河南南阳473000

出　　处：《河南中医》2023年第4期487-491,共5页Henan Traditional Chinese Medicine

基　　金：上海市杨浦区2019—2022年度重点学科项目(yp19ZB09)。

摘　　要：《伤寒论》黄芩汤中的“芍药甘草基”有育阴解痉止痛和育阴清热利水两大功用,基于“芍药甘草基”可以更好地解释《伤寒论》黄芩汤条文和方证的内涵。黄芩汤所涉的两条条文,一为正治,一为误治:误治是由于医家问诊未问及先前之“厥”,脉诊未按及刻下之“迟”,未能够将“发热下利”准确地辨证为“虚寒厥利”,或“相对斯须,便处汤药”,而犯“虚虚、寒寒”之戒;正治则是能够充分认识到太阳内陷之热或少阳胆腑郁热迫三焦津液,借阳明谷道合出利下的病机,而处以“芍药甘草基”加黄芩、大枣而成的黄芩汤,共奏清热育阴利小便、缓急解痉止痛之功。以“芍药甘草基”利小便,不仅能够育阴以恢复阴营之滋润,尚可以补虚损、存津液,而无渗利、通利等攻伐之品损伤正气的弊端,足以显现张仲景组方时“顾护胃气”的思想。黄芩汤为治热泻、热痢之方,只能说“发热下利”之热泻、热痢可用黄芩汤,但并不是见“发热下利”就用黄芩汤。另外,虽然黄芩汤方证之外症可能有“腹痛”,但只有“热利”的腹痛才能用黄芩,“中寒”的腹痛则不能用。"Shaoyao(Radix Paeoniae Alba seu Rubra)-Gancao(Radix Glycyrrhizae)pair"in Scutellaria Decoction has two major functions:nourishing yin,relieving spasms and stopping pain,and nourishing yin,clearing heat,and promoting diuresis.Based on"Shaoyao-Gancao pair",the connotation of the provisions and formula-syndromes of Scutellaria Decoction in Treatise on Cold Dam­age Diseases can be better explained.The two provisions involved in Scutellaria Decoction:one is the correct treatment,while the other is the mistreatment treatment.Mistreatment is due to the doctor's failure to inquire about the previous"syncope",the pulse diagnosis not being pressed to the slow pulse,and the failure to accurately dialectical"fever with diarrhea"as"deficiency and cold and syncope and diarrhea",or violating the precepts of"deficiency deficiency,cold cold"by quickly priscribing certain de­coction because of misunderstanding of mutual reinforcement.The correct treatment refers to the ability to fully recognize the heat of the greater yang sinking or the stagnation of heat in the lesser yang gallbladder and internal organs that affects the fluid in the three energizer.With the help of the yang brightness grain path combined with the pathogenesis of diarrhea,"Shaoyao-Gancao pair"is added by Huangqin(Radix Scutellariae)and Dazao(Fructus Jujubae)to form Scutellaria Decoction,which play the role of clearing heat,nourishing yin,promoting urination,relieving spasms and stopping pain."Shaoyao-Gancao pair"for promoting uri­nation can not only nourish yin and restore yin nutrient moistness,but also replenish deficiency and retain body fluids,without the drawbacks of damaging the healthy qi caused by attacking products with draining dampness and dredging stagnation.This can fully demonstrate Zhang Zhong-jing's idea of"protecting stomach qi"when formulating the formula.Scutellaria Decoctionis a formula for treating heat diarrhea and heat dysentery,only for the type with feature of"fever with diarrhea",not for any"fever with diarrhea"type.In addition,alt

关 键 词：“芍药甘草基” 黄芩汤 《伤寒论》 张仲景 娄绍昆 

分 类 号：R222.2[医药卫生—中医基础理论]