桃核承气汤类方临床证治规律研究

【作者】 李炎坤；

【导师】 李家庚；

【作者基本信息】 湖北中医学院 ， 中医临床基础， 2007， 硕士

【摘要】 桃核承气汤类方是指以大黄、桃仁为主配伍组成的一系列方剂而言，如桃核承气汤、抵当汤、抵当丸，是中医临床上运用得较为广泛的方剂。因此，有深入整理、挖掘的必要。桃核承气汤、抵当汤、抵当丸均源出于《伤寒论》太阳病脉证并治篇蓄血证，为治疗下焦蓄血证的常用方剂。《伤寒论》在太阳病篇以较大篇幅探讨了太阳病，太阳病为六经之首，统摄营卫，主人体一身之表，固护于外，故为六经之藩篱。外邪侵犯人体，太阳首当其冲，故太阳病最为常见。太阳表证多表现为发热，脉浮，头项强痛而恶寒，根据感受外邪之不同又分为太阳中风、太阳伤寒。太阳中风治用桂枝汤，临床表现为恶寒，发热，汗出，头痛，脉浮缓；太阳伤寒治用麻黄汤，临床表现为恶寒，发热，无汗，身疼，腰痛，骨节疼痛，脉浮紧。太阳里证包括蓄水及蓄血证。蓄水证的临床表现为发热，烦渴或渴欲饮水，水入则吐，小便不利，或恶风自汗，或头目眩晕，苔白，脉浮或浮数。蓄水证治用五苓散，蓄血证治用桃核承气汤、抵当汤、抵当丸。蓄血证的临床表现为少腹急结，硬满疼痛，如狂或发狂，小便自利，脉沉涩或沉结。后世医家对本类方的应用范围较广。如《儒门事亲》：用桃核承气汤治妇人月事沉滞，数月不行，肌肉不减；《柯氏方论》用桃核承气汤治女子月事不调，先期作痛与经闭不行者最佳；《伤寒总病论》：用桃核承气汤治产后恶露不下，喘胀欲死，服之十瘥十；《类证治裁》用桃核承气汤治血结胸膈，燥渴谵语；《直指方》：用桃核承气汤治下焦蓄血，漱水迷妄，小腹急痛，内外有热，加生蒲黄；《证治大还》：治胸中气塞，上吐紫黑血，属瘀血内热盛者，或打扑内损，有瘀血者，本方(桃核承气汤)加减下之；《脉因证治》用桃核承气汤治血热夜发热；《传信尤易方》：治血淋，桃仁承气汤空心服效；《妇人良方大全》：本方(桃核承气汤)治瘀血，少腹急痛，大便不利或谵语，口干水不欲咽，遍身黄色，小便自利，或血结胸中，手不敢近腹，或寒热昏迷，其人如狂；《济世纲目》：桃核承气汤治下痢紫黑色者，热积瘀血也，腹痛后重异常，以此下之；《血证论》用抵当汤治实证经闭，小腹结痛，大便黑色，亦治癥瘕，跌打损伤；《瘟疫论》：太阳病不解，从经传腑，热结膀胱，其人如狂，血自下者愈，血结不行者，宜抵当汤；《类聚方广义》用抵当丸治产后恶露不尽。本文搜集了近几十年来有关桃核承气汤类方的临床文献报道，并对桃核承气汤类方治疗病证进行了分析，并从中归纳。虽然桃核承气汤类方在《伤寒论》中是治疗太阳蓄血证的主要方剂，但我们在临床上只要抓住“瘀热互结”这一病机，就可以不必拘泥于其病变的部位——下焦，而可以广泛应用于全身。其临床运用规律如下：活血化瘀，兼以泻热以治疗上焦头痛、心脑血管、神志类疾病；泻热通腑，活血散瘀，兼以解毒利湿以治疗中焦黄疸、肠痈、外伤便秘、积聚类疾病；活血祛瘀，泻热通腑以治疗下焦石淋、血尿、癥瘕类疾病。桃核承气汤类方在现代临床上可用于神经系统、泌尿系统、免疫系统、消化系统及其他疾病，如妇产科、外科、骨伤科、五官科等疾病。适用范围极为广泛。近几十年来对桃核承气汤类方的实验研究结果表明，桃核承气汤类方有延长凝血时间、降血脂、抑制血栓形成和血小板凝集、降血糖、利尿、改善肾功能、抗惊厥、促进肠蠕动及泻下、改善脑缺氧状况、免疫调节、解热等药理作用。更多还原

【Abstract】 Tao He Cheng Qi Tang class prescriptions refers to a series of prescriptions which are mainly constit of Da Hang, Tao Ren, such as Tao He Cheng Qi Tang, Di Dang Tang, Di Dang Wan. They are widely used in traditional Chinese medicine clinic. Therefore, they are really necessary to deeply sort and dig.Tao He Cheng Qi Tang, Di Dang Tang, Di Dang Wan are derived from Blood Stasis Syndrome of Tai Yang Disease chapter of "Shang Han Lun", they are frequently used to heal Blood Stasis Syndrome of Lower Eyelid. Tai Yang Disease is discussed by large length of writing, it is the first of six meridians, which generally commands Ying Qi and Wei Qi, controls all the external syndromes of the body to prevent the exopathogen. Thus, it is called the hedge of all the meridians. Tai Yang will be the first to be affect, so that Tai Yang Disease is one of the most common diseases. Tai Yang Exterior Syndrome reflect that generate heat, floating puls, nape rigidity and chills, which is dividatured Tai Yang wind stroke andTai Yang exogenous febrile disease ccording to the difference of being invaded by exogenous pathogen. Tai Yang wind stroke is treating by Gui Zhi Tang which’s clinical manifestation is chills, generate heat, sweating, headache, floating and slow puls; Tai Yang exogenous febrile disease is treating by Ma Huang Tang which’s clinical manifestation is chills, generate heat, body pain, lumbago, scleromere pain, floating and tight puls. Interior syndrome of Tai Yang comprise syndrome of water-retention and syndrome of blood stasis. The clinical manifestation of syndrome of water-retention is generate heat, dipsesis, dipsa to long for drinking water, aquaefer afferens expectorate, difficulty in micturition, aversion to wind and spontaneous perspiration, chief circumgyration, music alba, floating and cipher puls. syndrome of water-retention is treat by Wu Ling San, syndrome of blood stasis is treat by Tao He Cheng Qi Tang, Di Dang Tang, Di Dang Wan. The clinical manifestation of syndrome of blood stasis is acute spasm of lower abdomen, hard and full pain, as if madness or abalienatio mentis, normal urination, deep and unsmooth puls or deep and tie puls.Later medical physicians use the class prescriptions widely, such as "Ru Men Shi Qin", in which Tao He Cheng Qi Tang is use to treat woman delayed menorrhea, months no go, muscle undeducting; "Ke Shi Fang Lun", in which Tao He Cheng Qi Tang is use to treat irregular menses, amenorrhea; in "Shang Han Zong Bing Lun", Tao He Cheng Qi Tang is use to treat lochiostasis, dyspneal distention long for mortuus, drinking it anastate literally; in"Lei Zheng Zhi Cai", Tao He Cheng Qi Tang is use to treat hemonode chest and diaphragm, dryness dipsia babbing; in"Zhi Zhi Fang", Tao He Cheng Qi Tang is use to treat blood stasis of lower energizer, rinse water vague absurd, hypogastrium pain, heat in exterior and interior, adding raw cat-tail pollen; in"Zheng Zhi Da Huan", Tao He Cheng Qi Tang is use to treat thorax cavity air lock, regurgitate violet black blood belong to stagnated blood calor internus, or pounce on interior slowed pulse, having stagnant blood; in"Mai Yin Zheng Zhi", Tao He Cheng Qi Tang is use to treat heat in blood and generate heat in night; in"Chuan Xin You Yi Fang", Tao He Cheng Qi Tang is use to treat bloody stranguria; in"Fu Ren Da Quan Liang Fang", Tao He Cheng Qi Tang is use to treat stagnant blood, lower abdomen acu-algia, sedes disadvantage or babbing, no drinking, all over yellow, urine easy and smooth, or blood thoracic retention, dare not touching abdomen, madness; in"Ji Shi Gang Mu", Tao He Cheng Qi Tang is use to treat alo laxata violet black, pyretic accumulation stagnant blood, abdominal pain tneesmus; in "Xue Zheng Lun",Di Dang Tang is use to treat sthenia syndrome amenia, hypogastrium pain, black sedes,mass in abdomen, injury from fall; in "Wen Yi Lun", Di Dang Tang is use to treat taiyang disease syndrome not relieved, from scripture to organs, cystic retention of heat,human madness, blood fall, hemonode no go;in "Lei Ju Fang Guang Yi", Di Dang Wan is use to treat unexhausted lochia after parturition.The text collected clinical literature of Tao He Cheng Qi Tang class prescriptions in recent decades,and analyzed and summarized from Syndrome treatment. Although Tao He Cheng Qi Tang class prescriptions is the main prescriptions that treat Tai Yang syndrome of blood stasis in "Shang Han Lun", but we get the pathogenesis of "stagnated heat mutually knotting", we could widely use them all over the body and do not care about the affection locum——lower energizer. Its regular rules of clinical application as follow: 1.treat headache, heart and cerebral vessels, of upper warmer by means of activating blood and resolving stasis; 2.treat aurigo, acute appendicitis, accumulation, etc by means of expelling heat with purgatives, activating blood and resolving stasis with relieving toxin and promoting urination; 3. treat constipation cause by surgical trauma, tranguria caused by urinary stone, blood urine, mass in abdomen, etc by means of expelling heat with purgatives, activating blood and resolving stasis. Tao He Cheng Qi Tang class prescriptions can also be used to treat diseases of nervous system, urinary system, immune system, alimentary system and other diseases, such as gynecological disease, surgical diseases, department of orthopaedics disease, disease of five sense organs.Its applicability is very extensive.In recent decades the finding of empirical study of Tao He Cheng Qi Tang class prescriptions indicated that they have the pharmacologic action of extending clotting time, degrading blood fat, containmenting Throe and platelet agglutination, degrading blood glucose, diuresising, improving renal function, resisting cony, promoting enterokinesia and decanta, improveing cerebral anoxia, immunological regulation, relieve fever.更多还原