《伤寒论》名方抵当汤的信息考证及临证机制探讨  

Textual Research and Clinical Mechanism of Famous Prescription Didangtang in Treatise on Febrile Diseases

作　　者：马俊杰[1] 王婉冰 李佳欣 贾亚菲 王晶菊 MA Junjie;WANG Wanbing;LI Jiaxin;JIA Yafei;WANG Jingju(College of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Nanjing 210023,China;Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Experimental Research Center,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]南京中医药大学中医学院,南京210023 [2]中国中医科学院中医基础理论研究所,北京100700 [3]中国中医科学院医学实验中心,北京100700

出　　处：《中国实验方剂学杂志》2025年第5期248-259,共12页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家中医药管理局监测统计中心2024年度深化医改中医药政策研究自选课题(YGZXKT2024103);南京中医药大学2024年研究生优质教学资源(课程〔医经条解-伤寒琢融合课程〕);江苏省中医药科技发展计划项目(MS2021007);江苏省社科应用研究精品工程社会教育(社科普及)专项(24SJA-60);国家中医药管理局高水平中医药重点学科建设项目(国中医药人教函〔2023〕85号)。

摘　　要：抵当汤是《伤寒论》所载攻下瘀热的经典名方,备受后世历代医家推崇,在诸多中医典籍中皆有相关记载,一直沿用至今。该文通过挖掘梳理有关抵当汤的古代医籍及现代文献,全面考证了抵当汤在不同古传版本《伤寒论》中的记载,及该方在历代医籍中的剂量单位计量、制法和服法内容,并详细总结并探讨了方中大黄、桃仁、水蛭、虻虫的基原和炮制方法。同时该研究还梳理了历代医家在相关医籍中对抵当汤的临证实践发挥,主要包括剂型的调整、药味药量的增减、临床运用的充拓、类方的创制与阐发三方面的内容,对于上述信息历代医家虽可能有所不同,但攻下瘀热的基本思路却一脉相承。此外,笔者结合临床实践,坚持抵当汤临证时当首参瘀热病机,提出该方在治疗瘀热互结之蓄血证时应行血而不宜止血,同时认为用攻下瘀热之法调治脑病精神诸疾是由于祛瘀生新可养心神之故,为抵当汤治疗此类疾病提供了思路。在此基础上,现代临床实验和动物实验表明抵当汤在改善微循环障碍、调节血液流变学及血流动力学水平、改善胰岛素抵抗、抑制炎症反应等方面具有一定作用,此可能为该方“攻下瘀热”的重要作用机制。该文通过对抵当汤信息考证及临证机制的探讨,摆事实讲依据,以期为抵当汤的临床应用和其他经方的研究提供参考。Didangtang is a classic formula for treating blood stasis and heat,as recorded in the Treatise on Febrile Diseases,and it has been highly praised by medical practitioners throughout history.It has been recorded in many traditional Chinese medical texts and used to this day.This article comprehensively examined the records of Didangtang in different ancient versions of Treatise on Febrile Diseases by excavating and sorting out related ancient medical books and modern literature.It also investigated the dosage unit measurement,preparation method,and content of the formula in medical books throughout history.The article provided a detailed summary and exploration of the origins and processing methods of rhubarb,peach kernels,leeches,and flies in the formula.At the same time,it reviewed the clinical practice of Didangtang by medical practitioners throughout history in relevant medical books,mainly including the adjustment of dosage forms,the increase or decrease in medicinal taste and dosage,the expansion of clinical application,and the creation and elucidation of similar formulas.Although there may be differences in the above information among medical practitioners throughout history,the basic idea of attacking blood stasis and heat is consistent.In addition,based on clinical practice,the author adhered to the principle of treating stasis and heat disease as the first reference when using Didangtang.It was suggested that blood should be circulated instead of stopping in the treatment of stasis and heat accumulation syndrome.At the same time,it was believed that the use of the method of attacking stasis and heat to regulate brain diseases and mental illnesses derives from the fact that removing stasis and generating new energy can nourish the heart and mind,providing ideas for the treatment of such diseases with Didangtang.On this basis,modern clinical and animal experiments have shown that Didangtang has certain effects in improving microcirculation disorders,regulating blood rheology and hemodynamics,enhancing insu

关 键 词：抵当汤 经方 《伤寒论》 信息考证 临证思路 药理机制 

分 类 号：R256[医药卫生—中医内科学] R287[医药卫生—中医学] R285.5