本文目錄
1 【大(da)建中(zhong)(zhong)(zhong)湯(tang)組成(cheng)】2 【大(da)建中(zhong)(zhong)(zhong)湯(tang)方(fang)歌(ge)】3 【大(da)建中(zhong)(zhong)(zhong)湯(tang)方(fang)解】4 【大(da)建中(zhong)(zhong)(zhong)湯(tang)主治】5 【大(da)建中(zhong)(zhong)(zhong)湯(tang)醫案】6 【醫案分(fen)析】7 《鄧中(zhong)(zhong)(zhong)甲(jia)方(fang)劑學講稿》中(zhong)(zhong)(zhong)關于大(da)建中(zhong)(zhong)(zhong)湯(tang)的論述(shu)
【大建中湯組成(cheng)】花(hua)椒(jiao)6g 干姜12g 生曬參(另(ling))6g 飴糖(烊)30g
【大(da)建(jian)中湯方歌】大(da)建(jian)中湯建(jian)中陽,蜀(shu)椒干姜參飴糖(tang),陰盛(sheng)陽虛腹冷痛,溫補中焦止痛強(qiang)。
【大(da)(da)建中(zhong)(zhong)(zhong)湯方解】本證多由中(zhong)(zhong)(zhong)陽(yang)衰弱,陰寒(han)內(nei)盛所致,治(zhi)療以溫(wen)(wen)中(zhong)(zhong)(zhong)補(bu)虛,降逆止(zhi)痛(tong)(tong)為(wei)主。寒(han)性收引,陰寒(han)內(nei)盛,陽(yang)失(shi)溫(wen)(wen)煦,故心胸中(zhong)(zhong)(zhong)大(da)(da)寒(han),拘急作(zuo)痛(tong)(tong),甚(shen)則上沖皮起有(you)頭足,手(shou)不(bu)可觸近。中(zhong)(zhong)(zhong)寒(han)內(nei)盛,胃(wei)(wei)失(shi)和降,故嘔而不(bu)能食。方中(zhong)(zhong)(zhong)蜀椒溫(wen)(wen)脾胃(wei)(wei),助命火,散寒(han)止(zhi)痛(tong)(tong),為(wei)君藥(yao)(yao)。以辛熱之(zhi)(zhi)干姜辛熱,溫(wen)(wen)中(zhong)(zhong)(zhong)散寒(han),助蜀椒散寒(han)之(zhi)(zhi)力;飴糖溫(wen)(wen)補(bu)中(zhong)(zhong)(zhong)虛,緩(huan)急止(zhi)痛(tong)(tong),助蜀椒止(zhi)痛(tong)(tong)之(zhi)(zhi)功,共為(wei)臣藥(yao)(yao)。人(ren)參補(bu)脾益氣,配合飴糖重建中(zhong)(zhong)(zhong)臟,為(wei)佐藥(yao)(yao)。
運用
本方用于(yu)中(zhong)(zhong)陽衰弱,陰寒內盛之脘(wan)腹(fu)劇痛(tong)證,臨床應用以心胸中(zhong)(zhong)大寒痛(tong),嘔不能食,腹(fu)中(zhong)(zhong)寒,手足厥(jue)冷,舌(she)質(zhi)淡,苔白滑(hua),脈沉伏(fu)而遲(chi)為辨證要點。
加減化裁
咳嗽者,加款冬花,咳血者,加阿膠;便精遺泄者,加龍骨;怔(zheng)忡(chong)者,加茯(fu)神。
禁忌
本方辛甘溫熱(re)之(zhi)性較強,素體陰虛者(zhe)慎用(yong),寒凝氣滯者(zhe)亦不宜應用(yong)。
【大建中湯主(zhu)治】中陽(yang)衰(shuai)弱,陰(yin)寒內盛(sheng)之(zhi)脘腹(fu)劇(ju)痛證。腹(fu)痛連及(ji)胸脘,痛勢(shi)劇(ju)烈,其痛上(shang)下走竄無定(ding)處(chu),或(huo)腹(fu)部時見(jian)塊狀物上(shang)下攻撐作痛,嘔(ou)吐劇(ju)烈,不能飲食,手足厥冷,舌質淡,苔(tai)白滑,脈(mo)沉(chen)伏而(er)遲(chi)。
【大(da)(da)建中湯(tang)(tang)醫(yi)案】趙某,女,64歲,農民,左上(shang)腹痛(tong)(tong)5天,于2006年(nian)12月(yue)5日(ri)來診。5天前患(huan)(huan)(huan)者(zhe)進食(shi)冷剩飯后引起左上(shang)腹痛(tong)(tong),疼痛(tong)(tong)較重(zhong),來我(wo)院急診,按“急性胃炎”給解痙(jing)止痛(tong)(tong)、抗生素輸液治(zhi)(zhi)療(liao),連續4天,疼痛(tong)(tong)未見(jian)明顯緩解。遂停用西藥(yao)(yao),來門診治(zhi)(zhi)療(liao)。目前患(huan)(huan)(huan)者(zhe)左上(shang)腹疼痛(tong)(tong)呈(cheng)陣發(fa)性,并時(shi)(shi)有連及背部疼痛(tong)(tong),疼痛(tong)(tong)時(shi)(shi)腹部起包(bao)塊,攻撐(cheng)作(zuo)痛(tong)(tong),按之(zhi)可移動,疼痛(tong)(tong)過后包(bao)塊消失,遇冷后加重(zhong)。舌質(zhi)淡紅,苔(tai)白膩,脈沉(chen)細滑,兩尺脈弱。史教(jiao)授辨證為虛寒性腹痛(tong)(tong),治(zhi)(zhi)以(yi)溫中散寒,以(yi)大(da)(da)建中湯(tang)(tang)加減變化:蜀椒(jiao)12g,干姜15g,細辛3g,黨參10g,炙(zhi)甘草10g。水煎服3劑(ji),每日(ri)1劑(ji),早晚分服。并對(dui)患(huan)(huan)(huan)者(zhe)說:“如無(wu)意外,當藥(yao)(yao)后見(jian)效(xiao),愈后不必再服。”約(yue)1個月(yue)后,患(huan)(huan)(huan)者(zhe)因感冒又來診,追(zhui)問(wen)上(shang)次(ci)病情(qing),述藥(yao)(yao)后左上(shang)腹疼痛(tong)(tong)即(ji)大(da)(da)減,服完(wan)3劑(ji),疼痛(tong)(tong)完(wan)全消失,遂停藥(yao)(yao),至今未再腹痛(tong)(tong)。 (摘自《史載祥教(jiao)授應用大(da)(da)建中湯(tang)(tang)治(zhi)(zhi)療(liao)腹痛(tong)(tong)驗案》)
【醫(yi)案分析(xi)】患者左上腹(fu)(fu)痛(tong)(tong)乃(nai)因冬(dong)天“進食冷(leng)剩飯后(hou)(hou)(hou)引起”,病史相當明(ming)確(que),實(shi)寒(han)(han)無(wu)疑。“疼痛(tong)(tong)時(shi)(shi)腹(fu)(fu)部起包塊(kuai),攻撐作痛(tong)(tong),按之可(ke)移(yi)(yi)動(dong)(dong),疼痛(tong)(tong)過后(hou)(hou)(hou)包塊(kuai)消(xiao)失,遇冷(leng)后(hou)(hou)(hou)加重(zhong)”,明(ming)顯寒(han)(han)凝氣滯(zhi)之重(zhong)證。其疼痛(tong)(tong)除寒(han)(han)凝血脈所致(zhi)外,繼發氣滯(zhi)之攻撐(包塊(kuai),可(ke)移(yi)(yi)動(dong)(dong))亦(yi)是一大原因。舌象(xiang)示(shi)寒(han)(han)象(xiang),脈象(xiang)示(shi)里寒(han)(han)欲遏伏陽氣之外達。苔(tai)膩應是其食積難化之象(xiang)。全案為寒(han)(han)、食相結(jie)于中焦,并阻滯(zhi)氣機,當無(wu)疑問。如此(ci)重(zhong)證數日(ri),可(ke)能已傷脾(pi)胃。治(zhi)當溫散、消(xiao)食、理氣、健脾(pi)并舉。實(shi)寒(han)(han)導致(zhi)“腹(fu)(fu)部時(shi)(shi)見塊(kuai)狀物上下攻撐作痛(tong)(tong)”,正是仲景的大建(jian)中湯。
史(shi)老(lao)用(yong)(yong)此方大(da)散其(qi)寒(han)(han)。人參(can)改(gai)為(wei)(wei)黨參(can)(現臨床常例,因慮(lv)其(qi)為(wei)(wei)農(nong)民,必須(xu)為(wei)(wei)其(qi)考(kao)(kao)慮(lv)價格)。未用(yong)(yong)飴糖,是(shi)(shi)考(kao)(kao)慮(lv)腹痛并非持續,無(wu)需(xu)緩(huan)急(ji)止痛?還(huan)是(shi)(shi)非虛之痛?或者沒(mei)有購到(dao)?加細(xi)辛(xin),仲景喜用(yong)(yong)此藥(yao)溫散諸(zhu)實寒(han)(han)積(ji)滯(zhi),也是(shi)(shi)史(shi)教(jiao)授活用(yong)(yong)仲景經驗。并未加直接消食、理氣藥(yao)。考(kao)(kao)慮(lv)到(dao)4天住院(yuan)(yuan),住院(yuan)(yuan)部已約束(shu)其(qi)為(wei)(wei)極(ji)少(shao)飲(yin)食?氣滯(zhi)包塊本(ben)因寒(han)(han)觸發,服藥(yao)時暫未見到(dao),故暫只需(xu)祛寒(han)(han)治本(ben),而無(wu)須(xu)理氣?服藥(yao)3劑而愈(yu),效甚速。不過筆者認為(wei)(wei),加消食、理氣藥(yao)不能說效果會更好,加上是(shi)(shi)否(fou)也無(wu)妨礙?史(shi)老(lao)言“如無(wu)意外(wai),當藥(yao)后(hou)見效”,是(shi)(shi)對仲景方吃透后(hou)的底(di)氣,方與證果然若合符(fu)節。又言“愈(yu)后(hou)不必再(zai)服”,一是(shi)(shi)鄉下不便復(fu)診,二是(shi)(shi)此以實證為(wei)(wei)主,實證一去,正氣傷之輕者可(ke)自(zi)我(wo)康復(fu)。
——本段摘自《方劑學(xue)案例分析》
《鄧中甲方劑學講稿》中關于大建中湯的論述大建中湯?三類方
建中湯在溫里方(fang)面(mian),還有(you)(you)一個教材還有(you)(you)三類方(fang),大(da)建中。大(da)、小建中的(de)區別,小建中虛為主(zhu)(zhu),都有(you)(you)寒,大(da)建中實(shi)證(zheng)為主(zhu)(zhu)。疼痛(tong),小建中是腹痛(tong),喜(xi)溫喜(xi)按,大(da)建中是寒實(shi),寒實(shi)證(zheng)。所以(yi)大(da)建中像蜀椒這一些,它(ta)還有(you)(you)一個散的(de)作用。臨床(chuang)發(fa)生往往外寒直中,本身陽(yang)氣不足,內(nei)外之寒結(jie)合(he),由(you)外寒引(yin)動。所以(yi)他描述主(zhu)(zhu)證(zheng)當中,腹中寒可有(you)(you)胃氣上(shang)逆(ni)(ni),嘔逆(ni)(ni),由(you)腹中寒上(shang)沖皮(pi)起,出見有(you)(you)頭足,臨床(chuang)一般兩(liang)種情況。一個由(you)于內(nei)外之寒結(jie)合(he),造成(cheng)陰寒內(nei)盛(sheng),寒性收(shou)引(yin),形成(cheng)一些像腹肌痙攣,古人說(shuo)叫陰凝成(cheng)像,陰寒凝滯重了就產生有(you)(you)形的(de)這個,出現按之有(you)(you)包塊。
還有(you)一(yi)(yi)類(lei)更多的(de)是本來陰寒(han)內盛,又加上外(wai)寒(han)直中,比如蛔蟲引起(qi)腹痛(tong),蛔蟲成團引起(qi)腹痛(tong),藥少力專,溫里散寒(han),又結合建(jian)中氣的(de)飴糖(tang)。所以(yi)這(zhe)(zhe)兩(liang)個虛證、實證,一(yi)(yi)個實證為主,一(yi)(yi)個虛證為主。這(zhe)(zhe)個是不(bu)同(tong)的(de)。
了解(jie)一下(xia)大、小建中湯的區別,重點提示一下(xia),這個(ge)是三類方。
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大建中(zhong)湯加減治療虛寒腹痛(tong)
大建(jian)中湯(tang)方歌(ge)方解,臨床(chuang)運用醫案
目錄(lu)1拼(pin)音(yin)(yin)2英文參考(kao)3概述4《金匱要(yao)略方(fang)(fang)(fang)(fang)(fang)(fang)(fang)論(lun)》卷(juan)(juan)(juan)(juan)上方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 4.1大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)別(bie)名(ming)(ming)4.2處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)4.3功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)4.4大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)4.5方(fang)(fang)(fang)(fang)(fang)(fang)(fang)解4.6大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)藥理作用(yong)(yong)(yong)(yong)(yong)4.7用(yong)(yong)(yong)(yong)(yong)藥禁忌(ji)4.8大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)臨床(chuang)應用(yong)(yong)(yong)(yong)(yong)4.9各(ge)(ge)家論(lun)述4.10附注(zhu) 5《嚴氏濟(ji)(ji)生(sheng)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》卷(juan)(juan)(juan)(juan)一方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 5.1方(fang)(fang)(fang)(fang)(fang)(fang)(fang)名(ming)(ming)5.2組成(cheng)(cheng)5.3制(zhi)法(fa)(fa)(fa)5.4大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)5.5功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)5.6加減(jian) 6《全(quan)(quan)生(sheng)指迷方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》卷(juan)(juan)(juan)(juan)二方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 6.1處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)6.2制(zhi)法(fa)(fa)(fa)6.3大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)6.4功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)6.5加減(jian) 7《丹溪(xi)心(xin)法(fa)(fa)(fa)》卷(juan)(juan)(juan)(juan)二方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 7.1處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)7.2制(zhi)法(fa)(fa)(fa)7.3大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)7.4功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi) 8《重訂嚴氏濟(ji)(ji)生(sheng)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 8.1處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)8.2制(zhi)法(fa)(fa)(fa)8.3功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)8.4大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)8.5摘(zhai)錄(lu) 9《備急千金要(yao)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》卷(juan)(juan)(juan)(juan)十(shi)九(jiu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 9.1大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)別(bie)名(ming)(ming)9.2處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)9.3功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)9.4大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)9.5摘(zhai)錄(lu) 10《外臺秘要(yao)》卷(juan)(juan)(juan)(juan)十(shi)七(qi)引(yin)《深師(shi)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 10.1大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)別(bie)名(ming)(ming)10.2處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)10.3制(zhi)法(fa)(fa)(fa)10.4功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)10.5大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)10.6注(zhu)意(yi)10.7各(ge)(ge)家論(lun)述10.8摘(zhai)錄(lu) 11《宣明論(lun)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》卷(juan)(juan)(juan)(juan)一方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 11.1大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)別(bie)名(ming)(ming)11.2處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)11.3制(zhi)法(fa)(fa)(fa)11.4功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)11.5大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)11.6摘(zhai)錄(lu) 12《普濟(ji)(ji)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》卷(juan)(juan)(juan)(juan)二一七(qi)引(yin)《定齋(zhai)未(wei)病(bing)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 12.1處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)12.2功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)12.3大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)12.4摘(zhai)錄(lu) 13《臨證指南醫(yi)案(an)》卷(juan)(juan)(juan)(juan)一方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 13.1處(chu)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)13.2功(gong)(gong)能(neng)(neng)主(zhu)治(zhi)(zhi)(zhi)13.3大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)13.4摘(zhai)錄(lu) 14《圣(sheng)濟(ji)(ji)總錄(lu)》卷(juan)(juan)(juan)(juan)五(wu)十(shi)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 14.1方(fang)(fang)(fang)(fang)(fang)(fang)(fang)名(ming)(ming)14.2組成(cheng)(cheng)14.3主(zhu)治(zhi)(zhi)(zhi)14.4大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)14.5制(zhi)備方(fang)(fang)(fang)(fang)(fang)(fang)(fang)法(fa)(fa)(fa) 15《女(nv)科百(bai)問》卷(juan)(juan)(juan)(juan)上方(fang)(fang)(fang)(fang)(fang)(fang)(fang)之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 15.1方(fang)(fang)(fang)(fang)(fang)(fang)(fang)名(ming)(ming)15.2組成(cheng)(cheng)15.3主(zhu)治(zhi)(zhi)(zhi)15.4大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)15.5制(zhi)備方(fang)(fang)(fang)(fang)(fang)(fang)(fang)法(fa)(fa)(fa) 16《醫(yi)方(fang)(fang)(fang)(fang)(fang)(fang)(fang)類聚》卷(juan)(juan)(juan)(juan)一五(wu)○引(yin)《管(guan)見(jian)大(da)(da)(da)(da)(da)(da)(da)全(quan)(quan)良方(fang)(fang)(fang)(fang)(fang)(fang)(fang)》之(zhi)(zhi)(zhi)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 16.1方(fang)(fang)(fang)(fang)(fang)(fang)(fang)名(ming)(ming)16.2組成(cheng)(cheng)16.3主(zhu)治(zhi)(zhi)(zhi)16.4大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)法(fa)(fa)(fa)用(yong)(yong)(yong)(yong)(yong)量(liang)(liang)16.5制(zhi)備方(fang)(fang)(fang)(fang)(fang)(fang)(fang)法(fa)(fa)(fa) 17參考(kao)資料附:1古籍(ji)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)的(de)(de)(de)(de)(de)(de)大(da)(da)(da)(da)(da)(da)(da)建(jian)(jian)(jian)(jian)(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)(tang)(tang)(tang)(tang)(tang) 1拼(pin)音(yin)(yin) dà jiàn zhōng tāng
2英文參考 dajianzhong decoction [中(zhong)醫藥(yao)學(xue)名詞(ci)審定委員會.中(zhong)醫藥(yao)學(xue)名詞(ci)(2004)]
Da Jianzhong Tang [21世(shi)紀雙(shuang)語科技詞典]
Large Jianzhong Decoction [湘雅(ya)醫學專業詞(ci)典(dian)]
3概(gai)述 大(da)建中湯為(wei)方劑名,其(qi)同名方劑約有兩十三首。
4《金匱要略方論》卷上方之大建中湯
蜀椒二合(去汗(han)),干姜四兩(liang),人參二兩(liang)[2]。
蜀椒3克(ke)(ke)(炒去汗)干姜(jiang)12克(ke)(ke) 人參6克(ke)(ke)
補心(xin)(xin)脾,祛寒(han)氣。溫(wen)中(zhong)補虛(xu),降逆止(zhi)痛(tong)。中(zhong)陽虛(xu)衰,陰寒(han)內盛,或(huo)蛔蟲為(wei)患(huan),脘腹(fu)寒(han)痛(tong),嘔(ou)不能(neng)食(shi),腹(fu)皮高起(qi),出現頭足(zu)狀(zhuang)包塊,痛(tong)而拒按,或(huo)腹(fu)中(zhong)漉漉有聲,舌苔白(bai)滑,脈細緊,甚則(ze)肢厥脈伏。心(xin)(xin)胸中(zhong)大(da)寒(han)痛(tong),嘔(ou)不能(neng)飲(yin)食(shi),腹(fu)中(zhong)寒(han),上(shang)沖(chong)皮起(qi),出見有頭足(zu),上(shang)下痛(tong)而不可觸近。飲(yin)食(shi)下咽,自知偏從一面下流,有聲決決然(ran)。心(xin)(xin)腹(fu)寒(han)痛(tong),嘔(ou)不能(neng)食(shi),腹(fu)中(zhong)蟲物乘之而動。陰黃(huang)。厥逆,脈伏。寒(han)飲(yin)升降,心(xin)(xin)腹(fu)劇(ju)痛(tong)而嘔(ou);疝(shan)瘕腹(fu)中(zhong)痛(tong)者(zhe);又治挾(xie)蛔蟲者(zhe)。
以水四升(sheng),煮取二升(sheng),去滓,納膠飴一(yi)升(sheng),微火煎(jian)取一(yi)升(sheng)半,分溫再服,如一(yi)炊頃,可飲粥二升(sheng),后更服,當一(yi)日食(shi)糜,溫覆之[2]。
上(shang)三(san)味,用水400毫(hao)升,煮取200毫(hao)升,去(qu)滓;納膠胎70毫(hao)升,微火煎取150毫(hao)升,分二次(ci)溫服,每次(ci)相(xiang)隔約(yue)一(yi)小時。藥后可飲粥適量。當一(yi)日(ri)食糜(mi),溫覆(fu)之。
方中蜀椒味辛大熱,溫(wen)脾胃(wei),助(zhu)(zhu)命(ming)火,并能散積殺(sha)蟲;干姜辛熱,溫(wen)中助(zhu)(zhu)陽,散寒(han)降逆;人參(can)補益脾胃(wei),扶(fu)助(zhu)(zhu)正(zheng)氣;重(zhong)用(yong)飴糖建中緩急,并能緩和椒、姜燥烈之(zhi)性。諸藥合(he)用(yong),共奏溫(wen)中補虛,降逆止痛之(zhi)功。
2.蛔(hui)(hui)蟲(chong)(chong)性(xing)腸梗(geng)阻(zu)(zu):楊某(mou),男(nan),6歲。患(huan)蛔(hui)(hui)蟲(chong)(chong)性(xing)腸梗(geng)阻(zu)(zu),臍腹絞痛(tong),嘔吐不(bu)能食,嘔出(chu)蛔(hui)(hui)蟲(chong)(chong)一(yi)條。患(huan)兒(er)面色萎黃有蟲(chong)(chong)斑,身體瘦弱,手腳清冷,按其腹部有一(yi)腫塊如(ru)繩團狀,舌(she)苔薄白,脈沉(chen)細。此中(zhong)氣(qi)虛寒(han),蛔(hui)(hui)蟲(chong)(chong)內阻(zu)(zu)。治以溫(wen)中(zhong)散寒(han),祛蟲(chong)(chong)止痛(tong),用大建中(zhong)湯。西黨(dang)10g、川(chuan)椒3g、干姜3g、飴糖30g,加檳榔10g、使(shi)君(jun)子10g,囑服2劑(ji)。因患(huan)兒(er)哭鬧不(bu)休(xiu),進城買藥緩不(bu)濟急,乃先用青蔥(cong)、老姜切碎搗爛,加胡椒末拌勻,白酒(jiu)炒熱,布包揉(rou)熨腹部,冷則加熱再熨。腸鳴轉(zhuan)氣(qi),腹痛(tong)漸減。藥買到后(hou)急煎成湯,分(fen)小量多次服,一(yi)劑(ji)嘔吐已止,再劑(ji)腹痛(tong)消失(shi),并排出(chu)蛔(hui)(hui)蟲(chong)(chong)一(yi)百多條。
3.嗜睡(shui)(shui)(shui):劉(liu)某,女(nv),18歲(sui)。患病半年。起初胸脘悶痛(tong)(tong),漸次困頓(dun)喜臥,多眠(mian)睡(shui)(shui)(shui)。近一月余來(lai),無(wu)論上(shang)課或進餐行(xing)路時均不自主地(di)入(ru)睡(shui)(shui)(shui),以致輟(chuo)學。神(shen)經科(ke)診斷為(wei)“發(fa)作(zuo)性睡(shui)(shui)(shui)病”。刻診精神(shen)困頓(dun)、時時入(ru)睡(shui)(shui)(shui)、呼之蒙(meng)昧、胸腹時時竄(cuan)痛(tong)(tong),余無(wu)所苦。舌(she)質(zhi)淡(dan),苔白潤(run),脈(mo)沉緩。此乃脾(pi)胃陽(yang)衰(shuai),中焦寒甚(shen),陽(yang)為(wei)陰困,不得舒展,陽(yang)入(ru)于陰則寐;中陽(yang)虛衰(shuai),陰寒之氣攻沖(chong)則胸腹竄(cuan)痛(tong)(tong)。治擬溫中健(jian)脾(pi),大健(jian)中陽(yang)。人參(can)、蜀椒各9k,干(gan)姜12k,飴糖30k,水(shui)煎(jian)服。眼藥(yao)(yao)五(wu)劑后,胸腹竄(cuan)痛(tong)(tong)消失,嗜睡(shui)(shui)(shui)稍減,舌(she)質(zhi)淡(dan),苔薄白,脈(mo)沉緩。原方(fang)繼進五(wu)劑,嗜睡(shui)(shui)(shui)大減,精神(shen)振(zhen)作(zuo),舌(she)質(zhi)淡(dan),苔薄,脈(mo)沉。更以原法(fa)加減服藥(yao)(yao)十余劑,諸(zhu)恙悉平。半年后隨訪無(wu)復發(fa)。
2.《千金(jin)(jin)(jin)方(fang)(fang)衍義(yi)》:虛寒積聚之(zhi)(zhi)治(zhi),此方(fang)(fang)最力,故《備急(ji)千金(jin)(jin)(jin)要(yao)方(fang)(fang)》效(xiao)《金(jin)(jin)(jin)匱要(yao)略方(fang)(fang)論(lun)》用之(zhi)(zhi),其方(fang)(fang)中(zhong)人參(can)輔椒、姜溫散之(zhi)(zhi)法,人皆得之(zhi)(zhi)。至于膠飴(yi)為助滿(man)之(zhi)(zhi)首列,而(er)反用以治(zhi)病嘔不能食,是(shi)專用助滿(man)之(zhi)(zhi)味(wei),引(yin)領椒、姜、人參(can)為泄(xie)滿(man)之(zhi)(zhi)通使。
3.《醫方(fang)論》:非(fei)人參不能大補心脾,非(fei)姜、椒不能大祛寒氣,故曰(yue)大建中。又有(you)飴糖之甘緩以(yi)殺姜、椒之辛燥。非(fei)圣于醫者(zhe),不辨(bian)有(you)此。
4.《金匱要略釋義》:《本草經》謂蜀(shu)椒(jiao)主(zhu)邪氣(qi)(qi)(qi),溫(wen)(wen)中(zhong)(zhong)(zhong),逐痹痛,下(xia)氣(qi)(qi)(qi)。夫大(da)(da)寒(han)乃邪氣(qi)(qi)(qi)也。心胸中(zhong)(zhong)(zhong)大(da)(da)寒(han)痛,嘔(ou)(ou)而(er)不(bu)(bu)(bu)(bu)能食,法(fa)當溫(wen)(wen)中(zhong)(zhong)(zhong)。寒(han)氣(qi)(qi)(qi)上(shang)(shang)沖皮起,出(chu)見有(you)頭(tou)足,又宜(yi)(yi)下(xia)氣(qi)(qi)(qi),故(gu)舍蜀(shu)椒(jiao)莫與,從(cong)而(er)可知中(zhong)(zhong)(zhong)不(bu)(bu)(bu)(bu)受溫(wen)(wen),痛痹之(zhi)(zhi)(zhi)不(bu)(bu)(bu)(bu)必下(xia)氣(qi)(qi)(qi)者,則非蜀(shu)椒(jiao)所宜(yi)(yi)矣。干(gan)姜亦溫(wen)(wen)中(zhong)(zhong)(zhong)之(zhi)(zhi)(zhi)品,此證(zheng)沉寒(han)痼(gu)冷之(zhi)(zhi)(zhi)在(zai)中(zhong)(zhong)(zhong)者,性(xing)動(dong)而(er)猖,其(qi)勢(shi)向上(shang)(shang),因(yin)用(yong)(yong)蜀(shu)椒(jiao)復(fu)佐以(yi)干(gan)姜,鎮以(yi)靜而(er)抑之(zhi)(zhi)(zhi)使平(ping)。有(you)謂附子驅(qu)寒(han)止(zhi)痛,何(he)以(yi)舍而(er)不(bu)(bu)(bu)(bu)用(yong)(yong)?曰:夫向上(shang)(shang)者,陰(yin)中(zhong)(zhong)(zhong)有(you)陽(yang),實中(zhong)(zhong)(zhong)有(you)虛(xu),何(he)則?嘔(ou)(ou)為(wei)實而(er)有(you)火之(zhi)(zhi)(zhi)證(zheng),嘔(ou)(ou)而(er)不(bu)(bu)(bu)(bu)能飲食,中(zhong)(zhong)(zhong)氣(qi)(qi)(qi)大(da)(da)傷,自不(bu)(bu)(bu)(bu)得以(yi)附子攻也。愛用(yong)(yong)人參(can)、飴糖補(bu)其(qi)虛(xu)乏。方名大(da)(da)建中(zhong)(zhong)(zhong)湯(tang)者,宜(yi)(yi)矣。
5《嚴氏濟生方》卷一方之大建中湯
每服4錢,水(shui)1盞半(ban),加(jia)生姜(jiang)5片,煎至7分,去滓溫服,不(bu)拘時候。
6《全生指迷方》卷二方之大建中湯
7《丹溪心法》卷二方之大建中湯
8《重訂嚴氏濟生方》之大建中湯
咳嗽者(zhe),加(jia)款冬花,咳血者(zhe),加(jia)阿膠;便精遺泄者(zhe),加(jia)龍骨;怔忡者(zhe),加(jia)茯神。
9《備急千金要方》卷十九方之大建中湯
10《外臺秘要》卷十七引《深師方》之大建中湯
11《宣明論方》卷一方之大建中湯
12《普濟方》卷二一七引《定齋未病方》之大建中湯
13《臨證指南醫案》卷一方之大建中湯
14《圣濟總錄》卷五十方之大建中湯
15《女科百問》卷上方之大建中湯
16《醫方類聚》卷一五○引《管見大全良方》之大建中湯
溫中祛寒劑,適用于中焦虛寒證。代表方如理中丸、小建中湯、吳茱萸湯、大建中湯等。
《傷寒論》
【組成】人參 干姜 甘草炙 白術各三兩(各9g)
【用法】上四味,搗篩,蜜和為丸,如雞子黃許大(9g)。以沸湯數合,和一丸,研碎,溫服之,日三四服,夜二服。腹中未熱,益至三四丸,然不及湯。湯法:以四物依兩數切,用水八升,煮取三升,去滓,溫服一升,日三服。服湯后,如食頃,飲熱粥一升許,微自溫,勿發揭衣被(現代用法:上藥共研細末,煉蜜為丸,重9g,每次1丸,小蜜丸則每次9g,溫開水送服,每日2~3次;亦可作湯劑,水煎服,藥后飲熱粥適量)。
【功用】溫中祛寒,補氣健脾。
【主治】1.脾胃虛寒證。脘腹疼痛,喜溫喜按,嘔吐便溏,脘痞食少,畏寒肢冷,口淡不渴,舌質淡、苔白潤,脈沉細或沉遲無力。2.陽虛失血證。便血、吐血、衄血或崩漏等,血色暗淡,質清稀,面色?白,氣短神疲,脈沉細或虛大無力。3.中陽不足,陰寒上乘之胸痹;脾氣虛寒,不能攝津之病后多涎唾;中陽虛損,土不榮木之小兒慢驚;食飲不節,損傷脾胃陽氣,清濁相干,升降失常之霍亂等。
【證治機理】本證系由脾胃虛寒所致。中陽不足,寒自內生,陽虛失溫,則畏寒肢冷;寒凝而滯,則腹痛綿綿喜溫按;脾主運化而升清,胃主受納而降濁,脾胃虛寒致脾不運化、胃不受納,升降納運失職,故見脘腹痞滿,食少倦怠,嘔吐便溏;舌淡苔白潤,口中不渴,脈沉細或沉遲無力,皆為虛寒之象。若脾胃虛寒,統攝失權,血不循經則可見便血、吐血、衄血或崩漏等,但血色暗淡,質清稀;若中陽不足,陰寒上乘而致胸陽不振,則可見胸痹心痛;若久病傷及脾陽,使津無所攝,上溢于口,則可見病后多涎唾,甚則流涎不止;若小兒先天稟賦不足,后天脾胃虛寒,生化無源,致經脈失養,土不榮木,則可見慢驚;若食飲不節,損傷脾胃陽氣,清濁相干,升降失常則致霍亂。法當溫中祛寒,益氣健脾。
【方解】方中干姜大辛大熱,溫脾暖胃,助陽祛寒為君藥。陽虛則兼氣弱,氣旺亦可助陽,故臣以甘溫之人參,益氣健脾,補虛助陽,《內經》云:“脾欲緩,急食甘以緩之。”君臣相配,溫中健脾。脾為中土,喜燥惡濕,虛則濕濁易生,反困脾胃,故佐以甘溫苦燥之白術,既健脾補虛以助陽,又燥濕運脾以助生化。甘草與諸藥等量,一與參、術以助益氣健脾,補虛助陽;二可緩急止痛;三為調和諸藥,是佐藥而兼使藥之用。四藥相伍,可溫中陽,補脾氣,助運化,故曰“理中”。
本方在《金匱要略》中作湯劑,稱“人參湯”。理中丸方后亦有“然不及湯”四字。蓋湯劑較丸劑作用強而迅速,臨床可視病情之緩急酌定劑型。(理中丸與人參湯,兩方組成、用量完全相同。前者為丸劑,治中焦虛寒之脘腹疼痛、自利不渴或病后喜唾;后者為湯劑,主治中、上二焦虛寒之胸痹,癥見心胸痞悶、氣從脅下上逆搶心。前者虛寒較輕,病勢較緩,取丸以緩治;后者虛寒較重,病勢較急,取湯以速治)
【配伍特點】辛熱甘苦合方,溫補并用,補中寓燥。
【運用】本方為治療中焦脾胃虛寒證之基礎方。以脘腹疼痛,喜溫喜按,嘔吐便溏,脘痞食少,畏寒肢冷,舌淡,苔白,脈沉細為辨證要點。本方臨證服后,當“飲熱粥”,且溫覆“勿發揭衣被”。藥后當覺腹中似有熱感,若“腹中未熱”,則應適當加量,“益至三四丸”,或易為湯劑。
【附方】
1.附子理中丸(《太平惠民和劑局方》)?
附子炮,去皮、臍? ?人參去蘆? ?干姜炮? ?甘草炙? 白術各三兩(各9g) 上為細末,煉蜜為丸,每兩作十丸。每服一丸(6g),以水一盞,化開,煎至七分,稍熱服之,空心食前。
功用:溫陽祛寒,補氣健脾。主治:脾胃虛寒較甚,或脾腎陽虛證。癥見脘腹疼痛,下利清谷,惡心嘔吐,畏寒肢冷,或霍亂吐利轉筋等。
2.桂枝人參湯(《傷寒論》)?
桂枝別切,四兩(12g) 甘草炙,四兩(9g) 白術三兩(9g) 人參三兩(9g) 干姜三兩(9g) 上五味,以水九升,先煮四味,取五升,內桂更煮,取三升,去滓,溫服一升,日再,夜一服。
功用:溫陽健脾,解表散寒。主治:脾胃虛寒,復感風寒表證。癥見惡寒發熱,頭身疼痛,腹痛,下利便溏,口不渴,舌淡苔白滑,脈浮虛者。
【鑒別】理中丸為治療中焦脾胃虛寒證之基礎方,附子理中丸、桂枝人參湯均為理中丸加味而成。附子理中丸加用大辛大熱之附子,其溫中散寒之力更強,且能溫腎,適用于脾胃虛寒之重證或脾腎虛寒者;桂枝人參湯即人參湯加桂枝,溫陽健脾,兼解表寒,表里同治,適用于脾胃虛寒而外兼風寒表證者。
【方論選錄】脾胃應土,處在中州,在五臟曰孤臟,屬三焦曰中焦,自三焦獨治在中,一有不調,此丸專治,故名曰理中丸。人參味甘溫,《內經》曰:脾欲緩,急食甘以緩之。緩中益脾,必以甘為主,是以人參為君。白術味甘溫,《內經》曰:脾惡濕,甘勝濕,溫中勝濕,必以甘為助,是以白術為臣。甘草味甘平,《內經》曰:五味所入,甘先入脾。脾不足者,以甘補之,補中助脾,必先甘劑,是以甘草為佐。干姜味辛熱,喜溫而惡寒者,胃也,胃寒則中焦不治,《內經》曰:寒淫所勝,平以辛熱。散寒溫胃,必先辛劑,是以干姜為使。(成無己《傷寒明理論》)
【醫案舉例】曹省初病傷寒,六七日,腹滿而吐,食不下,身溫,手足熱,自利,腹中痛,嘔,惡心。醫者謂之陽多,尚疑其手足熱,恐熱蓄于胃中嘔吐,或見吐利而為霍亂。請予診,其脈細而沉。質之,曰太陰證也。太陰之為病,腹滿而吐,食不下,自利益甚,時腹自痛。予止以理中丸,用仲景云“如雞子黃大”,晝夜投五六枚。繼以五積散,數日愈。(《傷寒九十論》)
【方歌】理中丸主理中鄉,甘草人參術黑姜,嘔利腹痛陰寒盛,或加附子總扶陽。
合六法,方六首。
理中丸
霍亂,頭痛發熱,身疼痛,熱多欲飲水者,五苓散主之;寒多不用水者,理中丸主之。
理中丸方(下有作湯加減法)
人參? 干姜? 甘草炙? 白術各三兩
右四味,搗篩,蜜和為丸,如雞子黃許大。以沸湯數合,和一丸,研碎,溫服之,日三四,夜二服;腹中未熱,益至三四丸。然不及湯,湯法,以四物依兩數切,用水八升,煮取三升,去滓,溫服一升,日三服。
若臍上筑者,腎氣動也,去術加桂四兩;吐多者,去術,加生姜三兩;下多者,還用術;悸者,加茯苓二兩;渴欲得水者,加術,足前成四兩半;腹中痛者,加人參,足前成四兩半;寒者,加干姜,足前成四兩半;腹滿者,去術,加附子一枚。服湯后如食頃,飲熱粥一升許,微自溫,勿發揭衣被。
理中湯
脾胃不和,中寒上沖,胸脅逆滿,心腹 痛,痰逆惡心,或時嘔吐,心下虛痞,隔塞不通,飲食減少,短氣羸困,溫中逐水,止汗去濕。又腸胃冷濕,泄瀉注下,水谷不分,腹中雷鳴,傷寒時氣,里寒外熱,霍亂吐利,手足厥冷,胸痹心痛,逆氣結氣,并皆治之。
人參? ?甘草銼,炒? ?白術? ?干姜炮,各三兩
上為粗末。每三錢,以水一盞半,煎取中盞,去滓,稍熱服,空心、食前。
附子理中圓?
治脾胃冷弱,心腹絞痛,嘔吐泄利,霍亂轉筋,體冷微汗,手足厥寒,心下逆滿,腹中雷鳴,嘔噦不止,飲食不進,及一切沉寒痼冷,并皆治之。
附子(炮,去皮、臍)? 人參(去蘆)? 干姜(炮)? 甘草(炙)? 白術各三兩
上為細末,用煉(lian)蜜和(he)為圓,每(mei)兩作一十圓。每(mei)服一圓,以水一盞(zhan)化(hua)破(po),煎(jian)至七分(fen),稍熱服之(zhi),空心食前。
四妙勇安湯:四妙勇安,組成謹嚴,歸二草一,銀玄各三,脫疽化熱,服之可痊牛蒡解肌湯:牛蒡解肌用荊薄,山梔丹皮石斛翹,玄參夏枯共成方,頭面風熱瘡瘍消透膿散:透膿散治毒成膿,芪歸山甲皂刺芎,程氏又加銀蒡芷,更能速奏潰破功內補黃芪湯:內補黃芪用麥冬,參苓歸地芍川芎,遠志肉桂炙甘草,瘡瘍潰后理虛功陽和湯:陽和湯法解寒凝,內證虛寒色屬陰,熟地鹿膠姜炭桂,麻黃白芥草相承小金丹:小金丹內白膠香,木鱉地龍乳沒當,麝香五靈墨草烏,流注瘰疬服之康。 秦艽鱉甲散:秦艽鱉甲治風勞,地骨柴胡及青蒿,當歸知母烏梅合,止嗽除蒸斂汗高
犀黃丸:犀黃丸內用麝香,乳香沒藥共牛黃,乳巖流注腸癰等,正氣未虛均可嘗
新加香薷飲 新加香薷樸銀翹,扁豆鮮花一起熬;暑溫口渴汗不出,清熱化濕又解表大建中湯建中陽,飴糖人參配椒姜,中陽衰弱胸腹痛,痛而拒按服之康石膏湯:石膏湯用芩柏連,麻黃梔豉七味全,發汗解表清熱毒,壯熱神昏此方煎
五積散:五積散將五積醫,二陳平胃痰食祛,三物枳桔行氣血,麻芷姜桂溫表里完帶湯:中二術陳,車前甘草和人參,柴芍淮山黑芥穗,化濕止帶此方金虎潛丸:虎潛足痿是妙方,虎骨陳皮并鎖陽;龜板干姜知母芍,再加柏地作丸嘗
珍珠母丸: 珍珠母丸參地歸,犀沉龍齒柏茯神,更加酸棗寧神志,鎮心平肝此方推
枳(zhi)實薤(xie)白桂枝湯(tang)(tang)(tang):枳(zhi)實薤(xie)白桂枝湯(tang)(tang)(tang),厚樸瓜(gua)蔞合成方(fang);通陽散(san)結祛(qu)胸痹,胸滿而痛急(ji)煎(jian)嘗(chang)大黃(huang)蟄蟲丸:大黃(huang)蟄蟲丸,桃(tao)杏(xing)虻蛭甘,芩芍與干漆,生地蠐螬全活(huo)絡(luo)丹:活(huo)絡(luo)效(xiao)靈主丹參(can),當(dang)歸乳(ru)香(xiang)沒(mei)藥存; 癥瘕積聚腹(fu)中(zhong)痛,煎(jian)服(fu)此方(fang)可回(hui)春膠艾(ai)湯(tang)(tang)(tang):膠艾(ai)湯(tang)(tang)(tang)中(zhong)當(dang)歸芍,生地川芎(xiong)生甘草(cao),固沖安胎崩漏止,補血(xue)養血(xue)月經(jing)調阿(a)膠雞子(zi)黃(huang)湯(tang)(tang)(tang):阿(a)膠雞子(zi)黃(huang)湯(tang)(tang)(tang)好(hao),地芍鉤藤牡蠣草(cao);決明茯神絡(luo)石藤,陰虛風(feng)動(dong)此方(fang)保羌(qiang)活(huo)勝濕(shi)湯(tang)(tang)(tang) :羌(qiang)活(huo)勝濕(shi)羌(qiang)獨芎(xiong),蔓甘藁本與防風(feng);濕(shi)邪在(zai)表(biao)頭腰(yao)痛,微微發(fa)汗有(you)異功(gong)三子(zi)養親(qin)湯(tang)(tang)(tang): 三子(zi)養親(qin)祛(qu)痰方(fang),芥蘇萊(lai)菔共煎(jian)湯(tang)(tang)(tang),大便實硬加(jia)(jia)熟蜜,冬(dong)寒(han)更可加(jia)(jia)生姜枳(zhi)術(shu)丸:枳(zhi)術(shu)丸是消(xiao)補方(fang),荷葉燒(shao)飯作丸嘗(chang),若加(jia)(jia)麥芽(ya)與神曲(qu),消(xiao)食化滯力更強葛花解酲湯(tang)(tang)(tang):葛花解酲香(xiang)砂仁 二苓參(can)術(shu)蔻青陳 神曲(qu)干姜兼(jian)澤瀉 溫中(zhong)利濕(shi)酒(jiu)傷珍七(qi)里散(san):七(qi)厘散(san)治跌(die)打傷,血(xue)竭紅(hong)花冰(bing)麝香(xiang),乳(ru)沒(mei)兒(er)茶(cha)朱共末,外敷內服(fu)均見長
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