《金匮要略》橘枳姜汤异文考

Textual research on the text variants of Juzhijiang Decoction recorded in the Synopsis of the Golden Chamber

关键词:  金匮要略  宋校医书  橘枳姜汤  文献考证

Key words:  Synopsis of the Golden Chamber  medical books collated in Song Dynasty  Juzhijiang Decoction  textual research

摘要:

在《金匮要略》等5种中医古籍中，橘枳姜汤的方证、药量、药用单位存在诸多差异。文章融合版本学、文字学以及中医理法方药的研究方法，对各书异文进行全面考证，提出：橘枳姜汤的方证包括胸中证、咽喉证、口中证，胸中证表现为胸中气塞，甚者有胀满之感，同时可兼有短气；咽喉证表现为噎塞，咽喉部的痒与干涩；口中证表现为燥唾，吐涎沫，其中又以“胸中气塞”为核心。药量以“橘皮一斤，枳实三两，生姜半斤”最为可靠。根据古今度量衡折算标准及方后煎服法，从古代文献角度为本方的现代应用提供用量参考：陈皮110 g，枳实21 g，生姜55 g。橘枳姜汤错综复杂的异文现象，显示了传世方书文本的复杂性和不确定性。应扎实做好文字辨析、医理推敲、判断取舍的文本考释，为临床应用及相关研究提供有益的参考。

Abstract:

Among five ancient medical books including the Synopsis of the Golden Chamber,records of patterns,doses,and units in Juzhi jiang Decoction are quite different. In this study,multi-disciplinary knowledge of traditional Chinese medicine,edition,and philology were used for comprehensively conducting a textual research on the text variants of Juzhijiang Decoction. The put forward that Juzhijiang Decoction pattern could be further divided into three aspects including patterns related to chest,throat,and mouth. Chest pattern is manifested as qi suffocation,even with the sensation of distension and fullness,sometimes accompanied with shortage of breath. Throat-related pattern is presented with choking and dry and itchy throat. Mouth-related pattern is characterized by dry spit and spitting of saliva. Among these symptoms,fullness and suffocation in the chest is critical. The drug doses of "one Jin of Citri Reticulatae Pericarpium (one Jin is 16 Liang in the East Han Dynasty,and approximately equals 220 g nowadays),three Liang of Aurantii Fructus Immaturus,and half a Jin of Zingiberis Rhizoma Recens" in Juzhijiang Decoction are most reliable. According to the conversion of weights and measures from East Han Dynasty to nowadays and decocting method recorded after the formula,the daily doses of citri reticulatae pericarpium,aurantii fructus immaturus and zingiberis rhizoma recens were 110,21 and 55 g,respectively in clinic. Complex text variants of Juzhijiang Decoction imply the uncertainty of these handed-down medical books. Therefore,a solid job in text discrimination,medical reasoning and judgement of the interpretation is necessary,so as to provide useful references for clinical application and related research.