探讨叶天士、吴鞠通对附子粳米汤方证的发挥

Exploring the use of YE Tianshi and WU Jutong on the prescription of Fuzi Jingmi Decoction

关键词:  附子粳米汤  叶天士  吴鞠通  理胃阳法

Key words:  Fuzi Jingmi Decoction  YE Tianshi  WU Jutong  activating stomach yang method

摘要:

附子粳米汤所治病证的病机特点为阳虚寒盛，胃失通降导致的腹中雷鸣切痛，胸胁逆满呕吐。叶天士根据附子粳米汤的特点，去甘壅守补的甘草、大枣，加辛散温降的生姜汁，或干姜、生姜同用以理胃阳，弥补了大半夏汤通补阳明时偏于补气的不足，此外叶天士还将附子粳米汤化裁合四逆汤法重剂温通阳气，于治中防变。吴鞠通《温病条辨》对叶天士运用附子粳米汤进一步总结为自利不渴者属太阴，甚则哕，冲气逆，急救土败，附子粳米汤主之，此附子粳米汤与张仲景原方不同，系附子粳米汤化裁合四逆汤法：人参、附子、炙甘草、粳米、干姜。

Abstract:

The characteristics of the pathogenesis of the disease syndrome of Fuzi Jingmi Decoction are explained:the yang deficiency and coldness,the thundering and pain in the abdomen caused by the stomach loss,and the chest full of vomiting. YE Tianshi was according to the characteristics of Fuzi Jingmi Decoction,YE Tianshi removed the licorice,jujube which were sweet and protectable,added ginger juice which were spicy,warm and decending,or ginger and dried gingerthat is used to treat the stomach yang,which made up for the deficiency of the spleen qi with Dabanxia Decoction to supplement yangming. In addition,YE Tianshi changed the Fuzi Jingmi Decoction and combined the Sini Decoction to warm yang qi and preventpathological changes. Finally,combined with Identification of Warm Disease by WU Jutong and YE Tianshi's clinical experience,the application of Fuzi Jingmi Decoction was summarized that people belonged to taiyin is corresponding with Fuzi Jingmi Decoction who shows urinelong but not thirsty,even vomiting with qi disorder. This prescription of Fuzi Jingmi Decoction is different from that of ZHANG Zhongjing which comes from Fuzi Jingmi Decoction and Sini Decoction including ginseng,aconite,licorice,glutinous rice,dried ginger.