曾凤珊 许珊华 彭柏钊 黄仕营

〔摘要〕 “气血水”学说由日本古方派医家吉益南涯提出，认为疾病为气毒、血毒、水毒之变。痹证气、血、水三毒夹杂，毒乘于气，则关节疼痛、发热、肌肉萎缩;毒乘于血，则疼痛固定，肌肤紫暗、结节;毒乘于水，关节肿胀变形，酸楚重着，病情缠绵。桂枝芍药知母汤以祛气、水二毒为主，祛血毒力度薄弱。陈宝田教授将此方与乌头汤、小续命汤合用，简称小乌桂汤。乌头汤加强祛气、水二毒之功，小续命汤善祛血毒，三方合用契合痹证病机。并附医案两则，以供参考。

〔关键词〕 气血水;桂枝芍药知母汤;痹证;合方;小乌桂汤

〔中图分类号〕R229       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.04.020

〔Abstract〕 "Qi-blood-water theory" was put forward by Yoshimasu Nangai， a Japanese physician of ancient formula school， who believed that diseases were the changes of qi， blood and water. Bi syndrome contains three kinds of poison of qi， blood and water. If the poison hits the qi， it will occur joint pain， fever and muscle atrophy. If the poison hits the blood， it will occur pain fixed， dark purple skin， nodules. If the poison hits the water， it will occur joint swelling deformation， heavy， lingering illness. Guizhi Shaoyao Zhimu Decoction is mainly used to remove qi and water poison and has weak ability to remove blood poison. Professor Chen Baotian jionted Wutou Decoction and Xiaoxuming Decoction， which called Xiaowugui Decoction. Wutou Decoction strengthen effects to remove qi and water poison and Xiaoxuming Decoction is good at removing blood poison. Combination of three decoctions correspond to the pathogenesis of Bi syndrome. Two medical cases were attached for reference.

〔Keywords〕 qi-blood-water; Guizhi Shaoyao Zhimu Decoction; Bi syndrome; combined decoction; Xiaowugui Decoction

桂枝芍药知母汤出自《金匮要略》，被用于治疗风寒湿兼有化热之痹证。然其组方药味少，散寒除湿力度较为薄弱，难以应对临床上复杂痹证。陈宝田教授常用桂枝芍药知母汤、乌头汤、小续命汤合用，简称小乌桂汤，治疗风、寒、湿三气所致之痹证，在临床取得较好的疗效。本文基于日本古方派医家吉益南涯的“气血水”学说，分析痹证和小乌桂汤的气血水辨证关系，探讨陈教授的合方思路，以期从中得到启示，为临床提供指导和帮助。

1 “气血水”学说与痹证

吉益南涯是日本古方派著名医家吉益东洞之子。“气血水”学说是吉益南涯在其父吉益东洞“万病一毒”学说的基础上加以改进而来的。“万病一毒”学说认为人体由于某种原因，导致后天“毒”之产生，强调“毒”乃发病之根本原因。“凡入口者，不出乎饮食之二，化为三物”[1]，即化生为构成人体的基本物质——气、血、水，一旦毒乘之则为病，强调“万病一毒”中的“气血水”之辨。……