基于组方结构探讨《金匮要略》分层次补中寓通论治虚劳  

Study of the hierarchical treatment of consumptive diseases with the method of supplementing the center and unblocking in Jingui Yaolue based on the structure of prescription composition

作　　者：刘骐瑞 李国祥 李新康 齐子熠 吴佳玥 邹源宜 安卓佳 李永浩 鲁艺 LIU Qirui;LI Guoxiang;LI Xinkang;QI Ziyi;WU Jiayue;ZOU Yuanyi;AN Zhuojia;LI Yonghao;LU Yi(Beijing University of Chinese Medicine,Beijing 100029;Institute of Information on Traditional Chinese Medicine, China Academy of Chinese Medical Sciences;School of Traditional Chinese Medicine, Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院信息研究所 [3]北京中医药大学中医学院

出　　处：《现代中医临床》2024年第5期77-81,96,共6页Modern Chinese Clinical Medicine

基　　金：国家重点研发计划(No.2017YFC1700106);第七批全国老中医药专家学术经验继承工作项目(国中医药人教函[2022]76号);北京中医药大学大学生创新创业训练计划项目(No.X202310026089)。

摘　　要：《金匮要略》中论述的“虚劳病”是一系列复杂慢性虚损性疾病的总称,桂枝汤在治疗虚劳中有重要作用。虚劳诸证有其虚损共性,又有病机层次的特性,其处方虽针对不同病机用药殊异,却均源于桂枝汤而具备共性结构。虚劳的病前失调状态为营卫失和的易感状态,以桂枝汤早期调和即可预防疾病。虚劳的失调与虚损状态即气血失调或轻微虚损状态,可予桂枝加龙骨牡蛎汤、小建中汤、黄芪建中汤。虚劳的阳气虚损状态,或格拒日久而阳气散脱,或持续消耗而阳气虚衰,设天雄散、肾气丸和薯蓣丸3方以救其虚。虚劳的阴血亏损状态,因虚致瘀,设酸枣仁汤、大黄[庶虫]虫丸以治之。虚劳的阴阳俱损危重状态,以炙甘草汤阴阳双补。针对虚劳病不同病机层次,在调补基础上重视补中寓通,采用通调营卫、通引阳气、通利阴血和通达阴阳等通法治疗。The concept of xulao(consumptive diseases) outlined in the Jingui Yaolue(Essentials from the Golden Cabinet) encapsulates a spectrum of intricate chronic deficiency ailments,where Guizhi Decoction(Cinnamon Twig Decoction) plays an pivotal role in their treatment.The myriad manifestations of consumptive diseases share a commonality of deficiency and damage,yet exhibit distinct characteristics in the pathogenesis.Although various prescriptions are tailored to diverse pathogenesis,they all trace their roots back to Guizhi Decoction and retaining a unified structural basis.The precursor state of imbalance in consumptive diseases signifies a vulnerability due to disharmony between ying qi and wei qi.Proactive intervention with Guizhi Decoction in the early stages can forestall the progression of the ailment.The imbalance and deficiency damage state of consumptive diseases marks a state of imbalance or mild deficiency between qi and blood,warranting treatments like Guizhi Jia Longgu Muli Decoction(Cinnamon Twig Decoction Plus Os Draconis and Oyster Shell),Xiao Jianzhong Decoction(Minor Center-Fortifying Decoction) and Huangqi Jianzhong Decoction(Astragalus Center-Fortifying Decoction).The state of yang qi deficiency in consumptive diseases may arise from the prolonged separation of yin qi and yang qi,causing the dissipation of yang qi.Another possibility is that the continuous consumption of yang qi leads to a depletion.These can be addressed through remedies such as Tianxiong Powder(Aconite Root Powder),Shenqi Pill(Kidney Qi Pill),and Shuyu Pill(Dioscoreae Root Pill).The conditions marked by yin qi and blood deficiency of consumptive diseases stem from weakness leading to blood stasis,which can be treated with Suanzaoren Decoction(Sour Jujube Decoction) and Dahuang Zhechong Pill(Rhubarb and Ground Beetle Pill).The critical state of concurrent yin qi and yang qi deficiency in consumptive diseases is a severe stage and the use of Zhigancao Decoction(Honey-Fried Licorice Decoction) to supplement both yin qi and yang qi s

关 键 词：金匮要略 虚劳 通法 层次 补中寓通 

分 类 号：R255.5[医药卫生—中医内科学]