张玉鑫 周冉冉 陶晓华 郑丰杰

摘要  桃核承气汤《伤寒论》用治膀胱蓄血证，然后世医家对其方证特点、配伍意义认识不一。现立足于《伤寒论》原文，从“彰表里同病治则，示气血同调治法”“遵六经分证之规，明太阳膀胱所指”“依方证相对之论，析方药配伍要义”3个方面解读桃核承气汤方证特点，并附医案佐证，以期为临床提供借鉴。

关键词  桃核承气汤;组方配伍;方证相应;桂枝;肉桂;表里同治;蓄血证;临床应用

Clinical Application and Essence of Taohe Chengqi Decoction

ZHANG Yuxin，ZHOU Ranran，TAO Xiaohua，ZHENG Fengjie

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

Abstract  Taohe Chengqi Decoction in Treatise on Cold Pathogenic Diseases was used to treat bladder blood storage syndrome.Then the medical masters had different understandings on the characteristics of prescriptions and syndromes and the significance of compatibility.Based on the original text of Treatise on Cold Pathogenic Diseases，this paper interprets the characteristics of Taohe Chengqi Decoction from the following 3 aspects：“the principle of treating the same disease in superficies and interior，the method of regulating qi and blood in the same way”，“complying with the rules of the six meridians and understand what the Taiyang and bladder refer to” and “according to the theory of relativity of the prescription and syndromes，analyzing the essentials of prescription and medicine compatibility”.The case evidence is also attached to provide reference for clinical practice.

Keywords  Taohe Chengqi Decoction; Compatibility of prescription; Correspondence between prescription and syndrome; Ramulus Cinnamomi; Cortex Cinnamomi; Treatment from superficies and interior; Blood accumulation syndrome; Clinical application

中图分类号：R289.4 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.033

《伤寒论》桃核承气汤有桃核、大黄、桂枝、炙甘草、芒硝五味药组成，在《伤寒论》中用于太阳蓄血轻证，现今临床广泛应用于治疗癫狂、腰腹部挫伤、闭经、恶露不尽、胬肉攀睛等各科病证[1]。因对其方证特点、组方配伍关系认识不一，对理解掌握，并恰当使用桃核承气汤带来一定困难。著名伤寒学家刘渡舟教授曾言[2]：“凡是学习《伤寒论》需要讲求方法，然后得其門而入，才能做到登堂入室，事半而功倍。……要想穿入《伤寒论》这堵墙，必须从方证的大门而入”。如此，方不至有“寻思旨趣，莫测其致”和“览之者造次难悟”之感。

“方与证乃是伤寒学的关键，而为历代医家所重视”[2]。掌握经方证候特点最有效的方法就是立足《伤寒论》原文，学深悟透其内涵，并在临床实践中加以印证。桃核承气汤证见于《辨太阳病脉证并治中第六》第106条（条文编号据《伤寒论校注》，下同），文曰“太阳病不解，热结膀胱，其人如狂，血自下，下者愈。其外不解者，尚未可攻，当先解其外。外解已，但少腹急结者，乃可攻之，宜桃核承气汤。