文章摘要
石曼皓,陈佳丽,夏永良.张锡纯大气理论视域下桂枝汤代汗法探析[J].浙江中医药大学学报,2020,44(8):803-806.
张锡纯大气理论视域下桂枝汤代汗法探析
Analysis of Guizhi Decoction Replacing Perspiration Method Based on ZHANG Xichun's Theory of Pectoral Qi
投稿时间:2020-04-02  
DOI:10.16466/j.issn1005-5509.2020.08.017
中文关键词: 张锡纯  医学衷中参西录  大气理论  汗法  加味桂枝代粥汤  临床运用  医案
英文关键词: ZHANG Xichun  Records of Traditional Chinese and Western Medicine in Combination  theory of pectoral Qi  perspiration method  revised Guizhi Daizhou Decoction  clinical application  medical records
基金项目:
作者单位E-mail
石曼皓 浙江中医药大学第一临床医学院 杭州 310053  
陈佳丽 浙江中医药大学第一临床医学院 杭州 310053  
夏永良 浙江中医药大学附属第一医院 xiayongliangl@sina.com 
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中文摘要:
      [目的]基于张锡纯先生大气理论,探析加味桂枝汤以药代粥的理论基础及临床拓展运用。[方法]通过查阅《黄帝内经》《伤寒论》以及后世医药典籍,分析服用桂枝汤后啜热粥助汗的理论依据,结合《医学衷中参西录》的大气理论,探讨大气与营卫的关系、热粥对大气的影响,分析加味桂枝代粥汤的理法方药,进而归纳总结加味桂枝代粥汤以药代粥的理论依据,并通过对两则验案的分析,拓展该理法方药的临床运用。[结果]《伤寒论》桂枝汤后文通过啜热粥调养,化生精微,以资汗源,益气固卫,达到助邪外出之效;张锡纯认为大气有主持全身之功,与营卫之气息息相通,啜粥可滋养大气,从而达到调营养卫、助汗御邪的效果;加味桂枝代粥汤取桂枝汤合升陷汤之意,尤以黄芪益气固卫、代粥助汗为特点,适用于大气亏虚、卫气不固之虚人外感。夏永良老师演绎张氏之法,临床以加味桂枝汤法,加减治疗虚人外感,具有颈项不适、荨麻疹等表现者。如配伍益气升津、活血通络之品,治疗颈椎病脾胃亏虚、风寒外束之证;配伍祛风散寒、行气消滞之品,治疗咳嗽外感风寒、营卫不和致肺气不得敛降之证等,疗效颇佳。[结论]加味桂枝代粥汤以药代粥,基于张锡纯大气理论,以一味黄芪补养大气,调营养卫,滋源达邪,弥补了现代人服药少粥之憾,施之临床,疗效可观,值得借鉴。
英文摘要:
      [Objective] To explore the theoretical basis of revised Guizhi Decoction replacing porridge with medicine and its clinical application, based on ZHANG Xichun's theory of pectoral Qi.[Methods] By referring to "Huangdi Neijing""Treatise on Febrile Diseases" and later medical classics, the theoretical basis for sipping hot porridge to perspire after taking Guizhi Decoction was analyzed, combined with the theory of pectoral Qi in "Records of Traditional Chinese and Western Medicine in Combination", the relationship between hot porridge and the effect of hot porridge on the pectoral Qi was explored, the rationale prescription of revised Guizhi Daizhou Decoction, and the theoretical basis of revised Guizhi Daizhou Decoction with medicine instead of porridge were summarized, and the clinical application of rational prescriptions was expanded through presenting two cases as proof. [Results] Guizhi Decoction in "Treatise on Febrile Diseases" was rearranged by sipping hot porridge, subtling metamorphosis, providing the source of sweat, benefiting Qi and strengthening the Wei Qi, so as to achieve the effect of nourishing the source and eliminating pathogenic factors. ZHANG Xichun believed that pectoral Qi had the power to preside over the whole body, and connected closely with Ying Qi and Wei Qi, and sipping porridge could nourish pectoral Qi, in order to achieve the effect of regulating Ying and Wei, and helping perspiration and resisting pathogenic factors. Flavoring Guizhi Daizhou Decoction takes combination of Guizhi Decoction and Shengxian Decoction, especially characterized by Astragalus membranaceus, benefiting Qi and strengthening health, and substituting porridge for helping perspiring, and it is suitable for the diseases caused by external factors of the weak patient with deficiency of pectoral Qi and instability of Wei Qi. Teacher XIA Yongliang interpretates ZHANG's method, using Guizhi Decoction for the diseases caused by external factors of the weak patient,with neck discomfort, urticaria and other manifestations, such as compatibility with herbs which can benefit Qi, promote body fluid,invigorate blood circulation and unblock collaterals products, to treat syndrome of deficiency of spleen and stomach and wind-cold external tract in cervical spondylosis; compatibility with herbs which can dispel wind and disperse cold, remove stagnation of Qi,to treat cough with exogenous wind chill and syndrome of lung Qi not being restrained due to disharmony of Ying and Wei, and the effects were quite good.[Conclusion] Flavoring Guizhi Daizhou Decoction replacing porridge with medicine, it is based on ZHANG Xichun's theory of pectoral Qi, replenishing pectoral Qi with Astragalus membranaceus,it adjusts nutrition and health, and nourishes the source and eliminates pathogenic factors. It makes up for the regret that modern people take less porridge, and the clinical effect is considerable and it is worth learning.
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