《金匮要略》杏子汤所治当为脾胀  

Discussion About Apricot Decoction in Synopsis of the Golden Chamber for Treating Spleen Distension

作　　者：王明炯 匡仁青 姚盛元 宋易寒 欧阳峰松[2] WANG Mingjiong;KUANG Renqing;YAO Shengyuan;SONG Yihan;OUYANG Fengsong(Hunan Aerospace Hospital,Changsha,Hunan,China,410205;Changsha Medical University,Changsha,Hunan,China,410219)

机构地区：[1]湖南航天医院,湖南长沙410205 [2]长沙医学院,湖南长沙410219

出　　处：《河南中医》2023年第8期1135-1138,共4页Henan Traditional Chinese Medicine

基　　金：湖南省教育厅质量工程项目{湘教通[2020]301号79};长沙医学院《中医学》校级重点学科科研项目{长医研[2016]3号}。

摘　　要：历代医家对杏子汤主治及药物组成争论颇多,原条文记载,该方治疗水气病,卫气不足、少阴有寒是水气病初始病机,胃热是病理基础,胃气不足是发病关键。不典型水病有以下特点:(1)脉沉与少阴有关;(2)脉浮与风有关。“脉沉者宜麻黄附子汤,浮者宜杏子汤。”可知杏子汤主治为浮肿且脉浮之症。有喘症仲景未必用杏子,但用杏子时若没有大便难的症状,则必定有喘症或欲发喘症。以药测症,杏子汤主治必有喘症。杏子汤主治症状应有:浮肿,脉浮,喘;而《金匮要略·水气病脉证并治》全篇只有一条此类记载,即原文第4条:“此为风水……咳而喘,不渴者,此为脾胀,其状如肿,发汗即愈。”可见脾胀发生的根本原因是结寒所致的气上冲,病机为外感风寒,触动体内结寒,引发气上冲,出现咳喘症状。故杏子汤主治当属脾胀,其药物组成为麻黄、杏仁、甘草。There are many arguments about the indications and composition of Apricot Decoction,which is used to treat edema.Insuffi⁃cient defense qi and cold in lesser yin meridians are the initial pathogenesis of edema,and stomach heat is its pathological basis,which is closely related to the loss and deficiency of stomach qi.There are two kinds of atypical edema:(1)Pulse sinking is related to lesser yin;(2)Pulse floating is related to wind."Ephedra and Aconite Decoction is suitable for those with deep pulse,while Apricot Decoction is suitable for those with floating pulse.It can be seen that Apricot Decoction′s indication is edema with floating pulse.Zhang Zhongjing may not use Xingren(Semen Armeniacae Amarum)if there is asthma,but if he uses Xingren(Semen Armeniacae Amarum),there must be asthma or tendency towards asthma without difficulty in stool.If disease symptoms are measured by medicine,Apricot Decoction must be used to mainly treat edema.The symptoms of Apricot Decoction must include edema,floating pulse,and asthma.However,there is only one such record in the related chapter of Synopsis of the Golden Chamber,that is the 4th article of the original text:"This is wind e⁃dema...Cough and asthma,without thirst,this is spleen distension,its shape is like swelling.If there is sweating,the disease will be healed."It can be seen that the root cause of spleen distension is qi uprush caused by accumulated cold,and the pathogenesis is exter⁃nal wind and cold,leading to accumulated cold inside the body and qi uprush,cough and asthma symptoms.Therefore,Apricot Decoction mainly treats spleen distention,and its drug ingredients include Mahuang(Herba Ephedrae),Xingren(Semen Armeniacae Amarum),and Gancao(Radix Glycyrrhizae).

关 键 词：《金匮要略》 杏子汤 脾胀 水气病 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]