张锡纯与孔伯华运用麻杏石甘汤辨析

Analysis of the application of Maxing Shigan Decoction by ZHANG Xichun and KONG Bohua

关键词:  张锡纯  孔伯华  四位一体  麻杏石甘汤  临床经验

Key words:  ZHANG Xichun  KONG Bohua  four-in-one theory  Maxing Shigan Decoction  clinical experience

摘要:

对比张锡纯和孔伯华运用麻杏石甘汤心法，以助临床灵活运用麻杏石甘汤，促进名家学术经验的活态传承。通过阅读张锡纯和孔伯华两人医著及相关文献，以“四位一体”理论归纳各自遣方化裁特点。麻杏石甘汤方性属辛苦微寒；方位在全身，以上焦和广义之胸为主；方势为辛开苦降，升降相因，气轻宣透，味厚降泻，甘缓守中；方证系风热侵袭证和气机失调及其继发证，两位医家均强调麻杏石甘汤对肺痨、风疹、咳嗽、痰喘等肺系疾病的治疗，异在张锡纯善以其治烂喉痧、虾蟆瘟等外感温病，而孔伯华善用其治悬饮、中风等内伤杂病。在麻杏石甘汤化裁上，张锡纯药简力专，创清解汤，多以薄荷代麻黄，倡加阿司匹林；孔伯华方宏量轻，常加桃仁去甘草。张锡纯与孔伯华运用麻杏石甘汤存在学术传承，又各有发挥，对临床具有极高的指导价值。

Abstract:

To compare the methods of ZHANG Xichun and KONG Bohua in the use of Maxing Shigan Decoction，to facilitate the flexible clinical use of Maxing Shigan Decoction，and to promote the living transmission of the academic experience of the famous masters. Through reading ZHANG Xichun and KONG Bohua’s medical writings and related literature，we summarized the characteristics of their respective formulae using the “four-in-one” theory. The nature of Maxing Shigan Decoction is hard and slightly cold；its orientation is in the whole body，mainly in the upper focal area and the chest in the broad sense；the formula is pungent and bitter，elevating and lowering each other，the qi is light and transmissive，the taste is thick and descending and diarrhoeal，and the sweetness is slow to guard the middle；the formula is based on the wind-heat invasion evidence and qi dysfunctionality and its secondary evidence，and the two emphasize on the treatment of the lung system of Maxing Shigan Decoction for lung consumption，rubella，cough，phlegm asthma and other lung diseases. The difference is that ZHANG Xichun was good at using it to treat external diseases such as rotting throat cholera and shrimp toad plague，while KONG Bohua was good at using it to treat internal diseases such as hanging drinks and stroke. In the hemp，apricot，stone，and glycyrrhizic acid soup on the cut，ZHANG Xichun’s medicine simple force specialization，the creation of clear soup，more than mint instead of ephedra，advocating the addition of aspirin；KONG Bohua’s square macro-quantity of light，and often add peach kernel to licorice. ZHANG Xichun and KONG Bohua’s use of the Maxing Shigan Decoction has an academic heritage but also has their play，which is of great value to clinical guidance.