文章摘要
徐新宇,应志康,沈泽铖,等.桂枝加龙骨牡蛎汤方证病机男科应用探讨[J].浙江中医药大学学报,2022,(6):597-601, 606.
桂枝加龙骨牡蛎汤方证病机男科应用探讨
Discussion on Guizhi Jia Longgu Muli Decoction‘s Pathogenesis and Prescription Syndrome and Its Application in Male Department
DOI:10.16466/j.issn1005-5509.2022.06.003
中文关键词: 桂枝加龙骨牡蛎汤  方证  病机  男科病  脾胃  失精  中虚精变  经方
英文关键词: Guizhi Jia Longgu Muli Decoction  prescription syndrome  pathogenesis  male diseases  spleen and stomach  seminal emission  middle deficiency causing seminal changes  classical prescription
基金项目:浙江省自然科学基金项目(LY21H270015);国家中医药管理局第六批全国老中医药专家学术经验继承工作项目(国中医药人教发[2017]29号);浙江省名老中医专家传承工作室建设计划项目(GZS20120030);宁波市医疗卫生品牌学科资助项目(PPXK2018-07)
作者单位
徐新宇 浙江中医药大学第三临床医学院 杭州 310053 
应志康 浙江中医药大学第三临床医学院 杭州 310053 
沈泽铖 浙江中医药大学第三临床医学院 杭州 310053 
崔云 浙江中医药大学附属宁波中医院 
管鹏飞 浙江中医药大学第三临床医学院 杭州 310053 
钱文君 浙江中医药大学第三临床医学院 杭州 310053 
闫译 浙江中医药大学第三临床医学院 杭州 310053 
刘磊 浙江中医药大学第三临床医学院 杭州 310053 
叶有骏 浙江中医药大学第三临床医学院 杭州 310053 
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中文摘要:
      [目的] 讨论桂枝加龙骨牡蛎汤方证病机,并阐发其男科应用。[方法] 以《金匮要略》桂枝加龙骨牡蛎汤条文为研究对象,结合《内经》《血证论》《金匮悬解》《订正仲景全书金匮要略注》等相关著作论述,从经方方证的不同见解、脾胃虚衰角度的经方条文内涵讨论、“失精”男科涵义与应用拓展以及方证内涵与中虚精变理论的契合性等方面,阐发其男科应用。[结果] 桂枝加龙骨牡蛎汤方证病机以阴阳俱虚为前提,历代医家具有肝肾亏损、心肾失交、脾胃不足等不同见解,但经过方药功效的反推后,提示其根本病机应在于阴阳俱虚之脾胃不足,经方条文诸症可分别对应到脾虚不摄、不运和不温中。经方所治“失精”虽有广义与狭义之分,但皆可从脾虚角度解释,桂枝加龙骨牡蛎汤借助于补益脾胃,对“失精”起到治疗作用。同时,立足桂枝加龙骨牡蛎汤方证内涵与中虚精变理论的契合性,可将其纳入中虚精变理论指导下的方剂范畴,并用以临床治疗。 [结论] 桂枝加龙骨牡蛎汤立足补益中焦、兼顾收敛固摄,从而达到治疗“失精”的目的,对男科临证的理解和经方运用,具有启发价值。
英文摘要:
      [Objective] To discuss the prescription syndrome and pathogenesis of Guizhi Jia Longgu Muli Decoction‘s, and elucidate its application in male application. [Methods] Taking Guizhi Jia Longgu Muli Decoction‘s clauses of Synopsis of Golden Chamber as the research object, combined with relevant works‘ expounds of The Inner Canon of Huangdi, Blood Syndrome Theory, Golden Solution and Revised and Noted ZHONG Jing‘s Golden Chamber Synopsis. This paper expounded Guizhi Jia Longgu Muli Decoction‘s application in male department from the perspectives of different views on prescription syndrome of the classical prescription, connotation discussion of clauses of the classical prescriptions from the perspective of deficiency of the spleen and stomach, connotation and application expansion of “seminal emission” of male department and the compatibility between the connotation of prescription syndrome and the theory of middle deficiency causing seminal changes. [Results] The prescription syndrome and pathogenesis of Guizhi Jia Longgu Muli Decoction is based on the premise of deficiency of both Yin and Yang, and there are different opinions on liver and kidney deficit, heart-kidney disjunction and deficient spleen and stomach. However, after reversely deduced by the prescription effect, it is believed that the fundamental pathogenesis should be deficient spleen and stomach due to deficiency of both Yin and Yang. According to the prescriptions, all symptoms can be respectively corresponding to deficiency of the spleen, which include being unable to perform controlling and consolidating function, transportation and transformation function, and warming function. Although there are broad and narrow differences in the treatment of “seminal emission”, both can be explained from the perspective of the spleen deficiency. Guizhi Jia Longgu Muli Decoction plays a therapeutic role in the treatment of “seminal emission” by tonifying the spleen and stomach. At the same time, based on the compatibility between the connotation of Guizhi Jia Longgu Muli Decoction prescription syndrome and the theory of middle deficiency causing seminal changes, it can be included in the category of prescription under the guidance of middle deficiency causing seminal changes theory, and used in clinical treatment. [Conclusion] Guizhi Jia Longgu Muli Decoction is based on supplementing middle-Jiao and taking into account both convergence and fixation, so as to achieve the purpose of treating“seminal emission”, which is of enlightening value to the understanding and application of clinical prescription in male department.
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