从“苦欲补泻”探析孙思邈《千金翼方》中调治脾脏方剂的用药特点  

Exploring the Characteristics of Medication Used in SUN Simiao's Wings of the Thousand Gold Pieces Formulary(《千金翼方》)for Regulating the Spleen:from the Principle of"Supplementing or Draining by Preference and Aversions"

作　　者：李岩[1] 曹洪欣[2] LI Yan;CAO Hongxin(Heilongjiang University of Chinese Medicine,Harbin,150040;Institute of Basic Theory for Chinese Medicine,China Academy of ChineseMedical Sciences)

机构地区：[1]黑龙江中医药大学,黑龙江省哈尔滨市150040 [2]中国中医科学院中医基础理论研究所

出　　处：《中医杂志》2025年第4期427-431,共5页Journal of Traditional Chinese Medicine

基　　金：北京市中医基础理论重点学科建设项目(KJX202201);中央科研院所基本科研业务费专项资金(YZX-202326);中央科研院所基本科研业务费专项资金(YZX-202326)。

摘　　要：“五脏苦欲补泻”认为配伍组方须以药之五味,参合五脏之苦欲,气味相合为补,气味相反为泻。从“苦欲补泻”角度分析《千金翼方》中调治脾脏诸方,总结孙思邈调治脾脏病变的用药特点。药物性味配伍规律方面,补脾汤以甘温配苦燥,泻脾诸方以辛温配苦寒,温脾诸方以辛热配甘温,建脾汤以甘温配酸苦,转脾丸以辛温配甘温,柔脾汤以甘温配甘苦。用药气味方面,四气以温为主,五味以甘、苦、辛为主。临证时应运用甘苦同济法、辛甘化阳法、辛开苦降法、寒温并用法、补泻兼施法等综合疗法,总以补益脾气、顾护中焦为基础治法,同时根据病情、病位、病性和药物特点等选择适宜的剂型与服用方法。The principle of"supplementing or draining by the preference and aversions of the the five zang organs"emphasizes that prescriptions should align the five flavors of medicinals with the needs of the five organs,achieving supplementation through harmonizing flavors and drainage through opposing flavors.This paper analyzed the formulas for regulating the spleen found in Wings of the Thousand Gold Pieces Formulary(《千金翼方》)from the perspective of"supplementing or draining by the preference and aversions",to summarize SUN Simiao's prescription characteristics for treating spleen-related disorders.In terms of the combination rule of medicinal properties and flavors,formulas like Bupi Decoction(补脾汤)for supplementing the spleen use sweet and warm medicinals paired with bitter and drying medicinals;those for draining the spleen use acrid and warm medicinals paired with bitter and cold medicinals;those for warming the spleen employs acrid and hot medicinals with sweet and warm medicinals;those like Jianpi Decoction(建脾汤)for strengthening spleen combines sweet and warm with sour and bitter medicinals;Zhuanpi Pill(转脾丸)pairs acrid and warm medicinals with sweet and warm medicinals;and Roupi Decoction(柔脾汤)uses sweet and warm medicinals with sweet and bitter medicinals.Regarding the medicinal flavors,warm dominates the four qi(the four properties),while sweet,bitter,and acrid are the main among the five flavors.Clinical practice involves applying comprehensive therapy methods such as the combination of sweet and bitter to harmonize,acrid and sweet to transform yang,pungent to disperse and bitter to descend,balancing cold and warm,and combining supplementation and drainage.The foundational principle is to tonify spleen qi and protect the middle jiao,and treatment is tailored based on the disease condition,location,nature,and the characteristics of the medicinals,with careful selection of suitable dosage forms and administration methods.

关 键 词：苦欲补泻 《千金翼方》 脾脏 药物配伍 

分 类 号：R259[医药卫生—中西医结合] R289[医药卫生—中医内科学]