张仲景运用黄芩的规律研究

【作者】 郭理想；

【导师】 肖相如；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2012， 硕士

【摘要】 黄芩为多年生草本植物黄芩的干燥根,主要分布于北方各省区,其中热河黄芩最负盛名；黄芩始载于《神农本草经》,列为中品。曰：“黄芩味苦,平。主治诸热,黄疸,肠澼泄痢,逐水,下血闭,恶疮,疽蚀,火疡。”现代药理研究证明黄芩具有解热抗炎镇痛作用、抗变态反应作用,有较广的抗菌、抗病毒谱,能抑制多种微生物,抗肿瘤作用,免疫作用,还有降压、利尿、利胆、镇静等作用,并且毒性极低。黄芩是临床常用的药物,先师张仲景的在《伤寒杂病论》中,根据辨证论治原则,运用黄芩配伍组方者众多,为求完美展现仲景黄芩的用药规律,本论文选取了《伤寒论》、《金匮要略》中所有含黄芩的方剂,附方除外。《伤寒论》和《金匮要略》中用黄芩共25首方剂,其中汤剂20首,丸剂2首,散剂3首。主要相关条文记载有50条。1.性味归经、功效、主治：性寒味苦,归肺胆、脾胃、大肠、小肠经。其功效有五：清热燥湿,代表方剂：葛根芩连汤；清热养阴,代表方剂：黄连阿胶汤；泻火解毒止血,代表方剂：大黄黄连泻心汤；利膈消痰,代表方剂：泽漆汤,清热安胎,代表方剂：当归散。2.配伍规律：《伤寒杂病论》中25首有关黄芩方剂中使用65种药物,其中频率十次及以上的药物有5种,包括：甘草16次、半夏12次、芍药11次、人参11次、大枣10次；五次及以上的药物有6种：生姜9次、干姜9次、黄连8次、柴胡7次、桂枝7次、大黄6次。《伤寒杂病论》中,与黄芩剂量比为1：1的药物频次分别是：半夏10次、人参9次、甘草7次、芍药6次、桂枝5次、干姜5次、生姜4次、黄连4次、大黄2次3.黄芩的剂量规律：《伤寒杂病论》中的黄芩剂量最常用的是三两,也是黄芩汤剂中的最大量,共12首黄芩方剂,占25首黄芩方剂的48%。用量最小的是王不留行散为二分,汤剂中黄芩最小量是麻黄升麻汤中十八株；用量最多的是当归散为一斤。4.黄芩方剂的主治规律：通过分析25首黄芩方剂所涉及的50条《伤寒论》和《金匮要略》原文,统计出黄芩的主治频次主要为：吐利证12次、寒热类10次、心区证8次、情志类6次、胸胁腹部病6次、血证4次、饮食二便4次、四肢、头面、颈项、身4次、汗证3次、咳喘2次等。5.黄芩汤的煎服法25首黄芩方剂中有6首方剂去滓再煎,使药性更加醇和,有利于调和脾胃,和解表里。6首方剂分别是：三首柴胡剂和半夏、生姜、甘草三泻心汤,均是煮取六升,去滓,再煎取三升。温服一升,日三服。最终都是煮取三升,温服一升,其不同的是最初的加水量,20首汤剂中,有17首方剂一次服药量是一升。泽漆汤一次服药为五合,黄连阿胶汤一次服药量为0.7升,黄土汤一次服药量为1.5升。大黄黄连泻心汤、附子泻心汤两方,煎法是只用沸水冲泡,取其轻扬之气,迅泄心下热结。6.后世医家在经方运用黄芩的基础上,加减成方者数不胜数,如：黄芩清肺饮、蒿芩清胆汤、黄芩黄连汤、芍药汤、黄连解毒汤、清胃散、甘露消毒丹、黄芩滑石汤、黄芩泻肺汤、黄芩泻白散等。更多还原

【Abstract】 The herb Huangqin is the dry root of huangqin, which is widely distributed in northern provinces, in which the most famous one is in Rehe. Huangqin is firstly written in "Shen Nong’s Herbal Classic". It is said that Huangqin has the characteristic of flavor bitterness, functioning as clearing the heat syndrome, curing jaundice, loose stool, the edema and bleeding, et, al. Modern pharmacological research proved that Huangqin has the effect of antipyretic anti-inflammatory analgesia, anti-allergic, antibiosis, depressurization, diuresis, cholagogic, depressant and low toxicity.Huangqin is commonly used in clinic, in Treatise on Cold Pathogenic Diseases, the use of Huangqin to make compatibility is seen many times. This study is to show the perfect law of Huangqin application. The formulae with Huangqin in Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber are chosen to be studied.A total of25formulae with Huangqin are found in Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber, including20decoction,2pills and3powder,, There are50records of Huangqin in the both books.1. The tropism of taste:bitter, cold. In the lung and gallbladder, spleen and stomach, large and small intestine. The5functions are clearing heat and moistening dryness with the representative decoction of Gegen qinlian decoction, and indications of Huangqin.; nourishing yin and clearing heat with the representative decoction of Huanglian ejiao decoction; clearing heat, removing toxic substance and stop bleeding with the representative decoction of Dahuang huanglian xiexin decoction; removing the phlegm with the representative decoction of Zexie decoction and clearing heat to preventing miscarriage with the representative decoction of Danggui powder,,2. The compatibility law.The25decoctions with Huangqin used65kinds of drugs, including5kinds of drugs which were used more than ten times, that is, Gancao,16times; Banxia,12times; Shaoyao,11times; Renshen,11times; Dazao,10times; and6kinds with more than5times:Shengjiang,9times; Ganjiang,9times; Huanglian,8times; Chaihu,7times; Guizhi,7times; Dahuang,6times. In Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber, the frequency of the compatibility ratio1:1with Huangqin is:Banxia,10times; Renshen,9times; Gancao,7times; Shaoyao,6times; Guizhi,5times; Shengjiang,4times; Huanglian,4times; Dahuang,2times.3. The dose law of Huangqin.The mostly used dose of Huangqin in Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber is san Hang, which is also the maximum dose in the decoctions with Huangqin. There are12decoctions of such dose, accounting for48%of the decoctions with Huangqin. The minimum dose is er fen in Wangbu liuxing powder, and in decoctions, the minimum dose is shiba zhu in Mahuangshenma decoction, the maximum use is one jin in Dangdui powder.4. The indication law of Huangqin.The indications are:vomiting and diarrhea,12times; cold and heat syndrome,10times; the heart problems,8times; the emotional problems,6times, bleeding syndrome,4times; cough,2times; sweating,4times, et, al.5. The decoction method of the decoctions with Huangqin.There are6decoction in25decoction with Huangqin require" qu za zai jian", which can be benefit for the regulating the spleen and stomach and reconciling exterior and interior. The6decoctions are:three decoctions with Chaihu and three xiexin decoctions.There are17decoctions in20decoctions require the taken-dose of yi sheng, it is wu he in Zexie decoction,2/3sheng in Huanglian ejiao decoction,3/2sheng in Huangtu decoction. In Dahuang huanglian xiexin decoction and Fuzi xiexin decoction, the decoction method is brewed with boiling water in order to clear the heat quickly.6. There are large numbers of the doctors born after Zhongjing who add or subtract drugs on the basis of using Huangqin, such as:Qingjin pill, Huangqin qingfei yin, Haoqin qingdan decoction, Huangqin huanglian decoction, Shaoyao decoction, Huanglian jiedu decoction, Sanhuang pill, Qingwei powder, Qianghuo huangqin decoction, Ganlu xiaodu dan, Huangqin huashi decoction, Huangqin xiefei decoction and Huangqin xiebai powder, et, al.更多还原