名医类案三部中《伤寒论》热利三方案例分析

王倩，傅延龄*

(北京中医药大学，北京 100029)

摘要：对名医类案三部中以葛根芩连汤、黄芩汤或白头翁汤为主方的临床医案进行统计分析，三方方证同中有异，主治同为热性下利，葛根芩连汤证多在气分，可由表邪入里而见下利兼表证者，治疗可辅以解表之品；黄芩汤证可及血分，常以气机郁滞为重而见少阳枢机不利的表现，治疗多加用理气行滞之品；白头翁汤证热毒最甚，且易化燥，病入血分而多见便下脓血，组方常配伍清热凉血之品。药量方面，对于病重势急者，各药味除甘草外均有大剂量应用者。临床需明辨主证以对三方鉴别选用，并根据具体病情、病势及兼证予以配伍及施量。

关键词：名医类案三部;热利;《伤寒论》;葛根芩连汤;黄芩汤;白头翁汤

DOI:10.13463/j.cnki.jlzyy.2015.02.036

中图分类号：R249.1文献标志码： A

文章编号：1003-5699(2015)02-0208-04

基金项目：国家重点基础研究发展计划(973计划)中医理论基础研究专项:以量-效关系为主的经典名方相关基础研究子课题—基于文献及临床经验挖掘的中医方药剂量理论研究(2010CB530604)。

作者简介:王倩(1983-)，女，博士研究生，主要从事方药量效关系的文献研究。

收稿日期:(责任编辑：赵玉芝2014-10-13)

*通信作者:傅延龄，电话-13901304512，电子信箱-fuyanling@bucm.edu.cn

Analysis on medical cases of three heat diarrhea prescription ofTreatiseonFebrileDisease

in three series of Ming Yi Lei An

WANG Qian,FU Yanling*

(Beijing University of Chinese Medicine,Beijing 100029,China)

Abstract:Statistically analyse medical cases that take Ge Gen Qin Lian Decoction,Huang Qin Decoction or Bai Tou Weng Decoction as main prescription in the three series of Ming Yi Lei An,there were both similarities and differences among the three prescription: they were all used to treat heat diarrhea,meanwhile,Ge Gen Qin Lian Decoction was mainly qi aspect located,it could be used for dual disease of the exterior and interior with additional exterior-resolving medicine.Huang Qin Decoction was qi or blood located,inhibited qi dynamic was significant for it,consequently the qi-rectifying medicine was frequently-added.Bai Tou Weng Decoction was mainly blood located with intense heat and exuberant toxin,and was easily damage yin;heat-clearing and blood-cooling medicine were added more to enhance curative effect.Every medicine except Gan Cao had been used with large dose or even overdose toward severe cases.In conclusion,identification of the three prescription is crucially by the main pattern type,and the dosage and combination are determined in accordance with the specific condition,dynamic of disease and secondary pattern.

Keywords:three series of Ming Yi Lei An;heat diarrhea;Treatise on Febrile Disease;Ge Gen Qin Lian Decoction;Huang Qin Decoction;Bai Tou Weng Decoction

葛根芩连汤、黄芩汤与白头翁汤原载于仲景《伤寒论》。葛根芩连汤主治太阳病误下所致协热下利，黄芩汤主治太阳与少阳合病下利，白头翁汤主治厥阴下利。从基本病机来看，三方所主均为热利，属热证、实证，其主要病位均在肠。……