基于开阖枢理论阐述五苓散的方证

文章信息/Info

• Title:基于开阖枢理论阐述五苓散的方证

• 卷期:2024年22卷3期

• 作者:田菲1， 张晓杰2

• 1山东中医药大学第一临床医学院，山东济南，250000； 2山东中医药大学附属医院皮肤科，山东济南，250000

• Author(s):TIAN Fei1，ZHANG Xiao-jie2

• 1.The First Clinical College of Shandong University of Traditional Chinese Medicine ；2.affiliated hospital of Shandong University of Traditional Chinese Medicine

• 关键词五苓散；三阴三阳；开阖枢

• Keywords:Wuling powder；three yin and three yang；opening, closing and pivot

• 摘要:五苓散出自《伤寒杂病论》，是治疗膀胱气化不利的代表方。三阴三阳开阖枢起源于《黄帝内经》，是用来描述阴阳六气运动变化的理论。本文基于三阴三阳开阖枢理论，阐述“太阳为开”的内涵和其生理意义，从开太阳的角度理解五苓散的方证，认为太阳开机不利是五苓散的根本病因病机，与津液代谢失调有关的疾病可以尝试使用五苓散治疗。附验案一则佐证。                                                                                                                                                                                

• Abstract:Wuling powder(五苓散),derived from Treatise on Cold Damage and Miscellaneous Diseases, is a classic prescription commonly used to treat the dysfunction in bladder gasification. The opening closing and pivot of the three Yin and three Yang，which originated from Huangdi Neijing is a theory to describe qi transformation in six meridians. Based on the three yin and three yang opening, closing and pivot theory, this paper expounds the connotation and physiological significance of "Taiyang is opening " and elucidates the prescription of Wuling powder from the perspective of opening of Taiyang, and believes that wuling powder can be used to treat diseases related to the imbalance of tht metabolism of body fluid. Attached a case of evidence.

  五苓散出自《伤寒论》，本是用来治疗太阳蓄水证，多因太阳病发汗不当，邪气由表及里，阻碍膀胱气化引起下焦蓄水。纵观临床，众代医家多从脏腑辩证的角度认识五苓散的方证，如陈明、张静生认为膀胱气化不利是五苓散的核心病机，而鲜有医家从开阖枢角度理解其病因病机[1,2]。笔者尝试从三阴三阳开阖枢的角度理解，认为太阳开机不利是五苓散的根本病因病机，五苓散适用于周身水液代谢障碍的各种疾病，如果仅从膀胱气化不利来分析五苓散则局限了五苓散的主证。