《金匮要略》厚朴七物汤与厚朴三物汤方证考辨

摘要

[目的]考辨《金匮要略》厚朴七物汤、厚朴三物汤方证原文,明确经方方证,指导临床应用.[方法]参考《脉经》《小品方》《千金要方》等晋唐医书,厘正《金匮要略》厚朴七物汤与厚朴三物汤原文讹误,并结合《伤寒论》《诸病源候论》《肘后备急方》等,探讨二方病机,阐释二方方义.[结果]厚朴七物汤证应为"腹满痛",其病机为冷气搏于肠胃,致饮食不消、肠胃挟实而成之干霍乱,治当行气除满、温中止痛、推陈致新;厚朴三物汤证应为"腹满,发热数十日,脉浮而数,饮食如故",其病机为酒客停饮,或素有痰水停积者饮酒不消、酒与痰相搏于腹而成痞,治当消痰除满、逐饮泻热.[结论]《金匮要略》厚朴七物汤与厚朴三物汤方证错简,应重新审视二方证治,并验之于临床.%[Objective]To investigate the original texts of the Syndrome of Houpo Qiwu Decoction and Houpo Sanwu Decoction in Jingui Yaolve so as to define the syndrome of these two classical prescriptions and guide clinical application.[Methods]Revised the mistakes of the original texts of Houpo Qiwu Decoction and Houpo Sanwu Decoction in Jingui Yaolve by referring to medical books written between Jin Dynasty to Tang Dynasty such as Mai Jing, Xiaopin Fang and Qianjin Fang.Shanghan Lun,Zhubing Yuanhou Lun,Zhouhou Beiji Fang and other medical books were also consulted when exploring the pathogenesis and explanation of these two prescriptions.[Results]The syndromes of Houpo Qiwu Decoction should be abdominal fullness and pain,whose pathogenesis is that indigestion caused by pathogenic cold attacking intestine and stomach will lead to cholera sicca.It should be treated by using the therapy of promoting qi,relieving abdominal fullness and pain,warming spleen and stomach,and weeding through the old to bring forth the new.The syndromes of Houpo Sanwu Decoction intend to treat should be abdominal fullness,lasting fever,floating and rapid pulse but normal intake of food,whose pathogenesis is that interaction between wine and phlegm caused by fluid retention in drinkers or undigested wine in people with dysfunctional fluid metabolism will lead to abdominal fullness.It should be treated by using the therapy of eliminating phlegm-fluid,relieving abdominal fullness,and discharging internal heat. [Conclusion]The Syndromes of Houpo Qiwu Decoction and Houpo Sanwu Decoction are converse in Jingui Yaolve,therefore re-examination of these two prescriptions and further clinical experiments are required.