马林 王明炯 王润鹏 戴瑜娉 舒兰

[摘要] 笔者从《伤寒论》中对比两阳合病的方证入手，认为芍药四物解肌汤乃是黄芩汤基于儿科生理特点的化裁，而升麻葛根汤所治为疮疹，是针对伤寒发热疮疹的特殊病症及患者群演变而来，其理论源于太阳与阳明合病，但又与典型的太阳与阳明合病有所差异，其病机为“五脏毒秽”结于阳明，并受外感寒邪引动，这与钱乙在《小儿药证直诀》中疮疹的证治论述完全一致;芍药四物解肌汤去黄芩加炙甘草化裁升麻葛根汤的演变规律是必要的，符合小儿疮疹的病理特点。以经典的角度解释升麻葛根汤的方证较历史上对升麻葛根汤的认识更为准确。

[关键词] 黄芩汤;葛根汤;芍药四物解肌汤;升麻葛根汤;张仲景;孙思邈;钱乙;小儿药证直诀

[中图分类号] R256.3          [文献标识码] A          [文章编号] 1673-9701（2021）28-0188-05

Probing into the medication logic of Shengma Gegen Decoction from the evolution rule of Huangqin Decoction

MA Lin1   WANG  Mingjiong2   WANG Runpeng1   DAI Yuping1   SHU Lan3

1.Graduate School， Hunan University of Chinese Medicine， Changsha   410208， China; 2.School of Traditional Chinese Medicine， Changsha Medical University， Changsha   410219， China; 3.Department of Pediatrics， the First Hospital of Hunan University of Chinese Medicine， Changsha   410000， China

[Abstract] Starting from comparing the prescriptions and syndromes of the two-yang syndrome in “Treatise on Febrile Diseases Caused by Cold （Shanghan Lun）”， this paper indicated that Shaoyao Siwu Jieji Decoction is a modification of Huangqin decoction based on the physiological characteristics of pediatrics diseases.The Shengma Gegen Decoction is used to treat rash， which evolves based on the special symptoms and patient population of typhoid fever and rash. Its theory originates from the combined disease of the Taiyang and Yangming but is different from the typical combined disease of the Taiyang and Yangming. Its pathogenesis is that the "poisons and filth in the five Zang organs" are formed in Yangming， and it is induced by external cold. This is exactly the same as Qian Yi′s exposition on the treatment of rash in “Keys to Therapeutics of Children′s Diseases”;the evolution rule of removing Huangqin and adding Zhigancao is necessary for the modification from Shaoyao Siwu Jieji Decoction to Shengma Gegen Decoction， conforming to the pathological characteristics of children′s rashes.It is more accurate to explain the prescription of Shengma Gegen Decoction from a classic perspective than the historical understanding of Shengma Gegen Decoction.

[Key words] Huangqin Decoction; Gegen Decoction; Shaoyao Siwu Jieji Decoction; Shengma Gegen Decoction; Zhang Zhongjing; Sun Simiao; Qian Yi; Keys to Therapeutics of Children′s Diseases

升麻葛根湯出自《小儿药证直诀·附阎氏小儿方论》[1]：“治伤寒、温疫、风热壮热，头痛肢体痛，疮疹已发未发，并宜服之”，是钱乙学生阎孝忠收集整理钱乙论述和经验而得。方剂学[2]书中录其功用为辛凉解肌，解毒透疹，主治麻疹初起未发，或发而不透，身热头痛等症。张梦迪[3]认为升麻葛根汤对系统性红斑狼疮具有防治作用，而乔桂[4]以升麻葛根汤对免疫清除期慢性乙型肝炎进行治疗，可以使患者的临床症状及肝功能相关指标得到显著改善，临床可推广应用。秦汝兰等[5-6]认为升麻葛根汤具有良好的抗炎镇痛作用及体外抑菌活性，甚至其可能通过提高机体抗氧化酶活性，清除自由基，抑制自由基脂质过氧化反应而发挥保护肝脏的作用。……