《辅行诀五脏用药法要》五脏苦欲补泻理论及五脏病症方解读

An interpretation of the theory of “five zang-organs’ preferences，tonification，and purgation” and the formulas for five-zang patterns in Essential Medicinal Methods for the Five Organs from the Auxiliary Stream of Life

关键词:  《辅行诀脏腑用药法要》  五脏苦欲补泻  陶弘景

Key words:  Essential Medicinal Methods for the Five Organs from the Auxiliary Stream of Life  theory of five zang-organs’ preference,tonification,and purgation  TAO Hongjing

摘要:

《辅行诀五脏用药法要》（简称《辅行诀》）与张仲景《伤寒杂病论》均源自《汤液经法》，是敦煌医书中重要的一本。其组方理论与当下的君臣佐使、功效主治不同，是采用该书五味应五脏理论，根据五脏苦欲补泻选择相应气味的中药进行组方。五脏苦欲补泻理论指出了五脏补用、泻用和急食中药的性味，其论述较《黄帝内经》更有规律。在该理论的指导下，《辅行诀》创制了五脏相应的大小补泻方，其组方思路严谨，如小泻方严格按照“二泻一补”组成；小补方由“二补一泻一急食”组成；大泻方是在相对应脏腑的小泻方基础上，加入1味该脏急食之品，再加入2味治疗“我生”之脏的小泻方中药味不同的2味药；大补方则是在相应的小补方基础上，加入治疗其所生之脏的2味补药和1味泻药。另外，其书多用子母同治的方法进行组方，补中有泻，泻中有补；补方均使用了相应脏所对应的主药，以芍药、黄芩、甘草、姜、大黄为五脏大泻方的基础；大补方均为7味药，大泻方均为6味药。可见，《辅行诀》组方严谨，规律可循，分析其五脏苦欲补泻理论及五脏病症方组方思路有助于解读古代经典方剂，并为古方的当代临床运用提供新思路。

Abstract:

Essential Medicinal Methods for the Five Organs from the Auxiliary Stream of Life(abbreviated as Fu Xing Jue),like ZHANG Zhongjing's Treatise on Cold Damage and Miscellaneous Diseases,originated from the Canon of Decoctions(Tangye Jing Fa) and is a crucial text among the Dunhuang medical manuscripts. Its formula-constructing theory differs from contemporary principles such as "monarch,minister,assistant,and envoy" or those based on efficacy and indications. Instead,it employs the text's theory of "five flavors corresponding to the five zang-organs",selecting herbs with specific flavors and properties according to the theory of "Preferences,Tonification,and purgation for the five zang-organs". This theory systematically specifies the nature and flavors of herbs used for tonifying,purging,and for urgent use("urgent eating") for each of the five zang-organs,and its exposition is more systematic than that found in the Huangdi Neijing(Yellow Emperor's Inner Canon). Guided by this theory,Fu Xing Jue established corresponding major and minor tonifying and purging formulas for the five zang-organs,with a rigorous compositional logic. For instance,the Minor Purging Formula strictly follows a "two purging,one tonifying" structure;the Minor Tonifying Formula consists of "two tonifying,one purging,and one urgent-use" herb. The Major Purging Formula is constructed by adding one "urgent-use" herb of the affected organ to its corresponding Minor Purging Formula,plus two herbs from the Minor Purging Formula of the "child" organ(the organ generated by the affected one),ensuring these two herbs are different from those already used. The Major Tonifying Formula is created by adding two tonifying herbs and one purging herb for the "child" organ to its corresponding Minor Tonifying Formula. Furthermore, the text frequently uses the method of "simultaneously treating the mother and child organs" in formulations,creating a structure where tonification incorporates purgation,and vice versa. All tonifying formulas include the primary herb associated with the respective organ. Peony,Scutellaria baicalensis,licorice,ginger,and rhubarb serve as the foundational herbs for the Major Purging Formulas of the five zang-organs. All Major Tonifying Formulas consist of seven herbs,while all Major Purging Formulas comprise six herbs. The demonstrates that the composition of formulas in Fu Xing Jue is rigorous and follows discernible patterns. Analyzing its "five zang-organs' Preferences,Tonification, and Purgation" theory and the formula-constructing for five-zang patterns can aid in interpreting classical ancient formulas and provide new ideas for the contemporary clinical application of classical prescriptions.