《金匮要略》论治风湿病
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摘要
分析和总结《金匮要略》对风湿病的病因病机、治则治法、方药等的认识。《金匮要略》对风湿病病因病机的认识在继承《黄帝内经》的风寒湿邪为致病外因的观点基础上,突出正气亏虚(肝肾亏虚,脾胃气血亏虚,阳气亏虚)的内因;对风湿病的治则治法及方药的认识如下:对实证为主的风湿病有微汗法(代表方为麻黄加术汤、麻杏苡甘汤)、利小便祛湿法(代表方为五苓散)、祛风寒湿法(代表方为桂枝芍药知母汤)、清热利湿活血法(代表方为茵陈蒿汤);病情缓解期以虚为主,有补肾法(代表方为八味肾气丸)、补气调血法(代表方为黄芪桂枝五物汤);虚实夹杂型的风湿病的治法有温阳祛风湿法(代表方为附子汤类)、温中祛寒湿法(代表方为甘姜苓术汤)。《金匮要略》奠定了风湿病证治规律的基础,对现代风湿病的中医药治疗具有重要的临床指导意义。
Thoughts of etiology and pathogenesis,therapeutic principles and methods,and herbal prescriptionfor rheumatism in Synopsis of Golden Chamber were summarized and analyzed. It is showed that Synopsis of Golden Chamber has inherited the etiological thoughts of exogenous wind,cold and damp inducing rheumatism issued in Yellow Emperor's Internal Classic,and also emphasized internal endogenous factors of liver-kidney insufficiency,spleen-stomach Qi-blood deficiency, and Yang-Qi deficiency; therapeutic methods for rheumatism mainlymanifested as excess syndrome included mild-diaphoresis therapy[representative recipe being Mahuang Decoctionwith Baizhu(Rhizoma Atractylodis Macrocephalae)added,Ma Xing Yi Gan Decoction],diuresis-inducing anddampness-draining therapy(representative recipe being Wuling Powder),therapy for dispelling wind,cold anddampness(representative recipe being Guizhi Shaoyao Zhimu Decoction),and therapy for clearing heat,drainingdampness and activating blood(representative recipe being Yinchenhao Decoction); therapeutic methods forrheumatism at remission stage mainly manifested as deficiency syndrome included kidney-tonifying therapy(representative recipe being Eight-ingredient Pills for Warming and Tonifying Kidney-Yang),and therapy forstrengthening Qi and regulating blood(representative recipe being Huangqi Guizhi Wuwu Decoction);therapeutic methods for rheumatism mainly manifested as excess interweaved with deficiency syndrome included therapy forwarming yang and dispelling wind-dampness(representative recipe being Fuzi Decoction and its modificationrecipes),and therapy for warming middle-energizer and dispelling cold-dampness(representative recipe being Gan Jiang Ling Zhu Decoction). In a word,Synopsis of Golden Chamber is of a great clinical directive significancefor the modern Chinese medicine treatment of rheumatism, which lays a foundation for the law of syndromedifferentiation and treatment for rheumatism.
Thoughts of etiology and pathogenesis,therapeutic principles and methods,and herbal prescriptionfor rheumatism in Synopsis of Golden Chamber were summarized and analyzed. It is showed that Synopsis of Golden Chamber has inherited the etiological thoughts of exogenous wind,cold and damp inducing rheumatism issued in Yellow Emperor's Internal Classic,and also emphasized internal endogenous factors of liver-kidney insufficiency,spleen-stomach Qi-blood deficiency, and Yang-Qi deficiency; therapeutic methods for rheumatism mainlymanifested as excess syndrome included mild-diaphoresis therapy[representative recipe being Mahuang Decoctionwith Baizhu(Rhizoma Atractylodis Macrocephalae)added,Ma Xing Yi Gan Decoction],diuresis-inducing anddampness-draining therapy(representative recipe being Wuling Powder),therapy for dispelling wind,cold anddampness(representative recipe being Guizhi Shaoyao Zhimu Decoction),and therapy for clearing heat,drainingdampness and activating blood(representative recipe being Yinchenhao Decoction); therapeutic methods forrheumatism at remission stage mainly manifested as deficiency syndrome included kidney-tonifying therapy(representative recipe being Eight-ingredient Pills for Warming and Tonifying Kidney-Yang),and therapy forstrengthening Qi and regulating blood(representative recipe being Huangqi Guizhi Wuwu Decoction);therapeutic methods for rheumatism mainly manifested as excess interweaved with deficiency syndrome included therapy forwarming yang and dispelling wind-dampness(representative recipe being Fuzi Decoction and its modificationrecipes),and therapy for warming middle-energizer and dispelling cold-dampness(representative recipe being Gan Jiang Ling Zhu Decoction). In a word,Synopsis of Golden Chamber is of a great clinical directive significancefor the modern Chinese medicine treatment of rheumatism, which lays a foundation for the law of syndromedifferentiation and treatment for rheumatism.
引文
[1]夏淑洁,王义军.从《金匮要略》虚实异治思想论治风湿病[J].中国中医基础医学杂志,2017,23(9):1323.
[2]清·尤在泾.金匮要略心典[M].上海:上海科学技术出版社,1958:35.
[3]清·陈修园.金匮要略浅注[M].上海:上海科学技术出版社,1958:42.
[4]陈纪藩,赵会芳,廖世煌,等.通痹灵治疗类风湿性关节炎137例临床研究[J].新中医,1997,29(9):13.
[5]童娟,陈光星,刘清平,等.通痹灵对胶原诱导型关节炎大鼠关节破坏的影响[J].广州中医药大学学报,2007,24(4):293.
[6]郑春雷.《金匮要略》含芍药方在风湿病中的运用举隅[J].国医论坛,2016,31(3):4.
[2]清·尤在泾.金匮要略心典[M].上海:上海科学技术出版社,1958:35.
[3]清·陈修园.金匮要略浅注[M].上海:上海科学技术出版社,1958:42.
[4]陈纪藩,赵会芳,廖世煌,等.通痹灵治疗类风湿性关节炎137例临床研究[J].新中医,1997,29(9):13.
[5]童娟,陈光星,刘清平,等.通痹灵对胶原诱导型关节炎大鼠关节破坏的影响[J].广州中医药大学学报,2007,24(4):293.
[6]郑春雷.《金匮要略》含芍药方在风湿病中的运用举隅[J].国医论坛,2016,31(3):4.