基于各家见解探讨《伤寒论》第28条病因病机的理解分歧及桂枝去桂加茯苓白术汤的实际内涵  

Exploring Differences in Understanding Cause and Mechanism of Article 28 in Treatise on Febrile Diseases Based on Various Insights and Actual Connotation of Guizhi Qugui Jia Fuling Baizhu Decoction(桂枝去桂加茯苓白术汤)

作　　者：张康钧 黄贵华[2] ZHANG Kangjun;HUANG Guihua(The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530000,Guangxi,China;Guangxi University of Chinese Medicine,Nanning 530000,Guangxi,China)

机构地区：[1]广西中医药大学第一附属医院,广西南宁530000 [2]广西中医药大学,广西南宁530000

出　　处：《实用中医内科杂志》2024年第8期25-27,共3页Journal of Practical Traditional Chinese Internal Medicine

基　　金：国医大师黄瑾明学术思想与临床诊疗传承发展研究中心建设项目(桂中医大党[2022]24号);黄贵华广西名中医传承工作室项目(桂卫中医发[2017]2号)。

摘　　要：对于《伤寒论》第28条条文的理解,历代医家观点分歧较大。主要分歧点有二,其一此条文所描述的病证是外感还是内伤,其二桂枝去桂加茯苓白术汤中桂枝和芍药的去留。该文结合历代医家观点及有类似病证记载的文献考究,推导论证28条主要病因病机是劳役导致阳气外越,误用汗下伤津,饮水过多阳虚失运所致,进一步解释了原文去桂留芍的意义在于收敛阳气,同时举例探讨桂枝去桂加茯苓白术汤在临床的扩展应用。For the understanding of Article 28 of Treatise on Febrile Diseases,the views of ancient physicians are quite different. There are two main differences. One is whether the disease described in this article is exogenous or internal injury. The other is the removal of Guizhi(Cinnamomi Ramulus) and Shaoyao(Paeoniae Radix) in Guizhi Jia Fuling Baizhu Decoction(桂枝去桂加茯苓白术汤). In this paper, combined with the views of doctors in the past dynasties and the literature with similar diseases and syndromes, it is deduced that the etiology and pathogenesis of Article 28 are labor, which leads to the deficiency of Yangqi, misuse of sweating method to cause damage to the body, excessive drinking of water leading to Yang deficiency. It further explained that the significance of removing Guizhi(Cinnamomi Ramulus) and leaving Shaoyao(Paeoniae Radix) in the original text is to converge Yangqi. At the same time, an example was given to explore the extended application of Guizhi Qugui Jia Fuling Baizhu Decoction in clinical practice.

关 键 词：伤寒论 桂枝去桂加茯苓白术汤 病机 临床应用 

分 类 号：R289.1[医药卫生—方剂学]