从“五脏六腑皆以受气”解构四逆散证治  

Diagnosis and Treatment of Sini Powder Syndrome Based on Theory of"Five Zang and Six Fu Being Nourished with Qi"

作　　者：李奕 庞博[1] LI Yi;PANG Bo(Guang′anmen Hospital Affiliated to China Academy of Chinese Medical Sciences,Beijing China 100053)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《中医学报》2024年第10期2085-2088,共4页Acta Chinese Medicine

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目(HLCMHPP2023005);首都卫生发展科研专项自主创新项目(首发2022-2-4155);中国中医科学院科技创新工程肿瘤学重大攻关项目(CI2021A01805,CI2021B009);国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-C-202205)。

摘　　要：四逆散见于《伤寒论》第318条,是全书引起争议较多的方剂之一。古今伤寒注家多将四逆散证病机视为肝气不畅、阳郁不达、郁而致厥,言四逆散为疏肝解郁、开达疏散之良方。然纵观《伤寒论》,加之充分体悟《黄帝内经》“五脏六腑皆以受气”理论可知,四逆散之逆可从“人无胃气曰逆”解,胃气当为《伤寒论》第318条病机的核心着眼点,其下述或然五症虽看似毫无关联,却皆与胃气相关:肺不受气则咳,心不受气则悸,膀胱不受气则小便不利,脾不受气则腹中痛,大肠不受气则泄利下重。故临证时当明辨少阴病虚实真假,须从胃气升降、津液还复入手,揆度四逆散四药本意。Sini Powder was first proposed in article 318 of Shang Han Lun,which is one of the many perplexing items in the whole book.In ancient and modern times,most exegetists or annotators believed that this article was aimed to explain the following cases:the depressed Liver Qi and the Yang stagnation cause faint.It was said that Sini Powder was an effective prescription for soothing the Liver Qi depression as well as expelling and dissipating the evil factors.However,through a comprehensive review of Shang Han Lun and a full understanding of the theory that"The Five Zang and Six Fu being nourished with Qi"in Huang Di Nei Jing,the word"Ni"in Sini Powder can be explained as"a man without stomach Qi"from the theory of"Ren Wu Wei Qi Yue Ni".Therefore,Stomach Qi is the key to understand the pathogenesis stated in article 318 in Shang Han Lun.Besides,the following five probable symptoms are all related to Stomach Qi although they seem to be unrelated to each other.Cough occurs when the Lung fails to be nourished with Qi.Palpitate occurs when the Heart fails to be nourished with Qi.Dysuria occurs when the Bladder fails to be nourished with Qi.Abdominal pain occurs when the Spleen fails to be nourished with Qi.Diarrhoea occurs when the large intestine fails to be nourished with Qi.In this case,in clinical practice,we should distinguish the reality of Shaoyin disease,and try to restore the descending function of stomach Qi and generate liquid or fluid of body to treat the disease,by understanding the fundamental intention in applying the prescription of Sini Powder.

关 键 词：四逆散 四逆散证 “五脏六腑皆以受气” 胃气 《伤寒论》 《黄帝内经》 

分 类 号：R222[医药卫生—中医基础理论]