基于五脏生克制化辨证模式探析柴胡桂枝干姜汤的病机及组方思路  

Analysis of Bupleurum chinense based on the syndrome differentiation model of restraint of five Zang organs Pathogenesis and Recipe of Guizhi Ganjiang Decoction

作　　者：宋博涵 杜武勋[2] 都芮 苏宇情 周德颖 李晓凤[2] SONG Bo-han;DU Wu-xun;DU Rui;SU Yu-qing;ZHOU De-ying;LI Xiao-feng(Tianjin University of Traditional Chinese Medicine,Tianjin,300383,China;Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin,300150,China)

机构地区：[1]天津中医药大学,天津300383 [2]天津中医药大学第二附属医院,天津300150

出　　处：《时珍国医国药》2023年第8期1944-1946,共3页Lishizhen Medicine and Materia Medica Research

基　　金：天津市中医药管理局天津市名中医传承工作建设项目;国家中医药管理局全国名老中医药专家传承工作室建设项目杜武勋全国名老中医药专家传承工作室项目;天津市教委科研计划项目(2019SK025);国家自然科学基金(82004329)。

摘　　要：柴胡桂枝干姜汤是《伤寒论》的经典名方。五脏生克制化辨证模式在传统中医的基础上,结合四时、阴阳、五行对人体五脏的影响,全面辨识人体的病因病机。本文通过文献书籍阅读、医家经验总结、理论逻辑推理与临床实践相结合,运用五脏生克制化辨证模式分析柴胡桂枝干姜汤的核心病机及其组方思路。分析得出该方病机为少阳枢机开合不利所致的肝胆郁滞,火热亢盛,脾胃失和。组方思路为枢转气机以调和风木、泄热疏肝、补脾和胃。柴胡桂枝干姜汤作为伤寒柴胡剂六方之一,不仅局限于少阳病症,同时还需兼顾中焦脾胃,理解组方用意,随证化裁可灵活运用于各类肝胆郁滞,火热亢盛,脾胃失和之症。以五脏生克制化为切入点与辨证论治、临床实际相结合,可为疾病治疗原则与选方用药提供新思路,新发展。Chaihu Guizhi Ganjiang Decoction is a classic prescription in Treatise on Febrile Diseases.On the basis of traditional Chinese medicine,the syndrome differentiation model of restraint of five internal organs combined with the influence of four sea⁃sons,yin and yang and five elements on the five internal organs of human body can comprehensively identify the etiology and path⁃ogenesis of human body.Through reading literature and books,summarizing doctors'experience,combining theoretical and logical reasoning with clinical practice,this paper analyzes the core pathogenesis and prescription ideas of Chaihu Guizhi Ganjiang De⁃coction by using the syndrome differentiation model of restraint of five internal organs.It is concluded that the pathogenesis of this prescription is stagnation of liver and gallbladder,excessive heat and disharmony of spleen and stomach caused by unfavorable o⁃pening and closing of shaoyang cardinal.The idea of the prescription is to pivot the qi-moving machine to reconcile wind and wood,dispel heat and soothe the liver,and tonify the spleen and stomach.Chaihu Guizhi Ganjiang Decoction,as one of the six prescriptions of typhoid Bupleurum,is not only limited to shaoyang syndrome,but also needs to take into account the spleen and stomach of middle energizer,and understand the intention of the prescription.It can be flexibly applied to all kinds of diseases such as stagnation of liver and gallbladder,hyperactivity of fire and disharmony of spleen and stomach with syndrome differentia⁃tion.Combining the restraint of five internal organs with syndrome differentiation and clinical practice can provide new ideas and new developments for the principles of disease treatment and the selection of prescriptions and drugs.

关 键 词：五脏生克制化辨证模式 柴胡桂枝干姜汤 少阳枢机 病机 组方思路 

分 类 号：R289.5[医药卫生—方剂学] R285.5[医药卫生—中药学]