《伤寒杂病论》中姜之应用规律研究

发布时间：2018-09-01 17:45

【摘要】：《伤寒杂病论》是东汉医家张仲景所著的一部临床经典著作,传承中遭受散佚,幸由晋代王叔和辑成《伤寒论》单行,北宋校正医书局林忆等校翰林学士王洙偶然所得《金匮玉函要略方》而成《金匮要略方论》,得以传世。经千年历代诸家临证校验,尊《伤寒杂病论》为集古方之大成,仲景亦为后世诸家尊称为“医圣”。后世得以存经方一脉兴盛至今。姜为仲景常用之药,随着姜生与干的选用、配伍、剂量及煎煮的不同,其功效也相应的发生了变化。虽然本草仅以姜的鲜与干进行分辨,但其功效随配伍等原因所表现出的差别也是非常大的。加之现代煎药机的广泛使用,生姜常为医患所轻视。晚生遵“勤求古训,博采众方”之旨,揣度仲景所思,探究姜的应用规律。1功效生姜,取其温性与散性;干姜,用其温性与存性。生姜的散性有三:其一,解表散寒,如桂枝、新加汤;其二,温中散水止呕,如旋覆代赭、小半夏汤;其三,散水(湿),如防己黄芪、黄芪桂枝五物汤。干姜的温性有三:一者,温肺化饮,如小青龙、苓甘五味姜辛汤;二者,温中散寒,如甘草干姜、大建中汤;三者,回阳救逆,如干姜附子、四逆汤。2配伍、剂量及煎煮配伍之说源于《神农本草经》,诸药共用,或扩大其应用范围,或增强其疗效,或消除其毒副作用。经方以短小精悍见长,诸药配伍拿捏至极,常一剂而知,二剂而已。用姜之时,虽用量大小与病的轻重,素体的强弱有关,但诸医“不思求经旨,以演其所知”,大多随喜而用,事倍功半。晚生寻《伤寒杂病论》,以及历代经方诸家共识姜的配伍,探究其理、法、方、药,以揣度仲景用姜思路。如:干姜与炙甘草、干姜与附子、干姜合细辛与五味子、干姜与半夏、生姜与大枣、生姜与半夏。煎煮之法,亦应予以重视。煎煮法多为古今医家所轻视,经方仅一煮之法,变作数次,使煎药变得更加繁杂,甚至会让患者厌恶汤药。尤其当今社会追求简单易行,若依照时方的煎药法,恐难兴经方之学。3姜的弃用与禁忌经方极尽工巧,依辨证而定度药的选用。禁弃之因可为没有相应症状,或用后加重病情,或用后有碍病情恢复。如小青龙不用生姜,因为生姜会加重咳嗽。本文揣度仲景的思想,探究姜的取用、配伍、剂量及煎煮,以便临证。
[Abstract]:The theory of typhoid fever and miscellaneous diseases is a classic clinical work written by Zhang Zhongjing, a doctor of the Eastern Han Dynasty. It was lost in the course of inheritance and was fortunately compiled by Wang Shuhe of the Jin Dynasty into a single line of the Treatise of febrile Diseases. In the Northern Song Dynasty, Lin Yi and other schools, such as Hanlin, Wang Su, accidentally obtained "Jinkui Jade letter" and become "synopsis of the Golden Chamber", which can be handed down to the world. After a thousand years of clinical verification of the families, respect for the "typhoid miscellaneous diseases" for the collection of the great square, Zhongjing is also known as the later generations as "medical saint." Later generations have been able to preserve the one pulse of the prosperity of the Sutra to this day. Ginger is commonly used medicine, with the selection of ginger and dry, compatibility, dosage and decoction of different, its efficacy has changed accordingly. Although this herb can only be distinguished by fresh and dry ginger, its efficacy varies greatly with compatibility and other reasons. In addition to the extensive use of modern decoction machine, ginger is often despised by doctors and patients. According to the aim of "asking for the ancient admonition and collecting many prescriptions", this paper explores the application law of ginger, takes its warmth and dispersal, and uses it to warm and keep. There are three scattered properties of ginger: first, release the table to disperse cold, such as Guizhi, new add soup; second, warm in the water to stop vomiting, such as rotations, ochre, small Pinellia decoction; third, water (wet), such as Fangji Astragalus, Huangqi Guizhi Wu Wu Tang. There are three warmness of dried ginger: one is to warm the lung, such as small Azure Dragon, Linggan Wuwei Jiang Xin Tang; the two, warm and cold dispersing, such as liquorice ginger, Dajianzhong decoction; three, back yang to save the inverse, such as dried ginger aconite, Sini decoction .2 compatibility, The theory of dosage and decoction compatibility comes from "Shennong Herbal Medicine", the use of various drugs, or expand its application scope, or enhance its efficacy, or eliminate its toxic side effects. The prescriptions are short and tough, the combination of the drugs to the extreme, often one dose and know, only two. When using ginger, although the dosage is related to the severity of the disease and the strength of the body, but the doctors "do not think about the Sutra, in order to act as they know," most of the use with joy, half the result. The late birth search "typhoid miscellaneous disease", as well as the past dynasties of traditional prescriptions of the common understanding of the compatibility of ginger, to explore its theory, law, prescription, medicine, to estimate Zhongjing with ginger ideas. Such as: dried ginger and grilled licorice, dried ginger and aconite, dried ginger and Schisandra, ginger and Pinellia, ginger and jujube, ginger and Pinellia ternata. The method of decoction should also be taken seriously. Most of the decoction method is despised by the ancient and modern doctors, the prescription only one boil method, change several times, make the decoction more complicated, even make patients hate soup medicine. Especially in today's society, the pursuit of simple and easy, if according to the prescription of the decoction method, I am afraid that difficult to promote the prescription of the abandonment of ginger and contraindications Jingfang extremely skillful, according to syndrome differentiation and according to the choice of medicine. Forbidding can be caused by no corresponding symptoms, or aggravated after use, or hinder the recovery of the disease. For example, little Azure Dragon does not need ginger, because ginger will aggravate the cough. In this paper, Zhongjing's idea of taking, compatibility, dosage and decoction of ginger is explored.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R222

【参考文献】