必知的桂枝汤(伤寒论第一方)煎剂、调理及禁忌方法! (改变)
指导
桂枝汤作为《伤寒论》开篇之首,组方之首,在临床上应用广泛。 其实,桂枝汤的使用有一些细节常被人们所忽视。 今天,小编与大家分享著名方剂专家李赛美教授对桂枝汤的解读。 在文中,她特别强调了使用桂枝汤时应注意的问题。 非常鼓舞人心! 一起来看看吧~~
中风虚证主要是指桂枝汤的证候
用桂枝汤舒筋祛风、调和营卫我们都很熟悉。 这里要说的重点是桂枝汤的煎法,在原文末尾有一大段。 这一段要求学生背熟。 仲景时代,字写于简,文贵如墨。 仲景能花这么多笔墨写出这段文字,绝对不是那么简单的。 《汝桂枝法》、《汝前法》均以本文煎法为主,因详写于此,以后再作简略。 这篇课文虽然不是在讲方证伤寒论特殊的服药法,但是讲的是桂枝汤怎么煎,怎么调理,以及桂枝汤治证的禁忌。 这些都是临床医生需要关注的非常重要的问题!
首先,服用桂枝汤后出汗的要求。
首先是服药后“喝热粥”,即喝完桂枝汤后,要趁热喝一碗热粥,有助健胃、补汗之源。 二是“暖身”,即喝完桂枝汤和热粥后,要盖被子,帮助出汗。 三是出汗的时间“约一小时”,一个小时,也就是现在的两个小时。 对出汗也有具体的要求——“看来全身出汗者受益更好,不滴如水,百病不愈”,即全身必出汗,身必出汗,手足不愈。 你要出汗,你出的汗只能是一点点的汗,不能是大汗。 这些是出汗的基本要求。
然后是用量的问题。
据考证,汉代造一两,今为15.625克,一升约合200毫升。 原书用量,桂枝、芍药各三两,即45克以上。 那么大家要想一想,我们是不是经常开45克的桂枝和芍药呢? 当然,很少有人这样做,所以有人会疑惑是不是张仲景用的太多了,还是现在的人的体质比较弱? 再仔细看,煎法上提到“煎三升”和“服一升”,所以每剂的用量只有一剂的三分之一,也就是说桂枝和芍药的用量是15每克。 ,而我们现在开的是10-15克为常量,所以我们现在用的是和中经元方一样的量。 饮三分之一量后,饮粥,温盖,若能微出汗,则“停服,不必全服”,即病即止,而且你不需要喝一剂药。 如果不出汗,那就“按前法多服”,可以再服三分之一,还是要喝粥温热。 如果还是不出汗,就是“短服药后”,即第三次服药的间隔时间要缩短。 如果还是不行,可以再开一剂,“一日一夜服,每周观察”,“连服两三剂”,钟静的一剂相当于今天的三剂,钟静的两剂或三剂也相当于今天的六至九剂。 另一方面,中医治疗感冒往往只是开药方,不再有医嘱。 服药后,患者每天两次煮一药,然后感觉:“中药无效,退烧不退,或西药快”。 那么,我们平时开桂枝汤却不见效的原因是什么? 一是护理方法不到位,不嘱咐病人喝热粥、盖被子; 二是没有嘱咐病人在病情不好的情况下继续服药。 西药有“tid”,为什么中药只能用一天一副呢? 所以,遇到桂枝汤证的病人,我一般开两三剂药,服完药要喝热粥,盖被子,不服就继续喝。出汗,这样效果会很好。 更何况出汗了,不能让它自然风干,要把汗擦掉,否则风一吹又会觉得外感。 因此,调节和保护方法非常重要。 有人说中药不退烧,中药治急性病无效。 这种说法是错误的! 如果能严格按照《伤寒论》中的煎法进行,退烧的效果会很好。 桂枝汤除治风寒邪邪所致之阳中中风、表虚证外之自汗,亦可治疗杂病营卫失和所致之自汗。 桂枝汤重在调和营卫,尤其是恢复卫气,使营阴内卫。 营地和守卫之间的生理关系必须协调。 卫气失位,营阴失位,易出汗。 如果单纯且经常自汗,服药时间不限; 如果是“发汗发汗”,钟景强调“适时出汗,则愈”,提前开门,开门后太阳热不消,如果关上,液体不会被迫漏出,所以出汗停止。 因为它不是用来驱除外邪的,所以不用喝热粥,不用盖被子。
那么,炙汤证与中风虚证有什么关系呢?
真的可以画等号吗? 哪个概念更大? 在我看来,桂枝汤证候的概念更大,中风虚证只是桂枝汤的适应证之一。 还有很多杂病也可以用。 因此,桂枝汤的解表,特别强调治疗中风表虚的两个必要条件:喝热粥和盖被子。 不然这个方子不仅止汗,还可能止汗。 现代对桂枝汤的双向调节研究较多,如调节体温、调节汗腺、调节血压、调节胃肠道、调节免疫等。 出汗多的人可以止汗,不出汗的人可以出汗; 高血压的人可以降血压,低血压的人可以升血压; 脾胃运化过盛者可用,脾胃运化过慢者可用。 这方面有大量论文可供参考。
指保养、休养、保养生活。 即以调阴阳、和气血、护神为原则,调神、导呼吸、调四时、食补、药补、禁欲等诸法,和辟谷用于达到健康长寿的目的。 养生是古代先民抵御恶劣自然环境、调整体力、抵抗疾病、防治疾病的需要而诞生的。 养生是中华民族传统文化的组成部分,养生是先民在长期的生活实践中总结生活经验的结果。
本文选自《李赛梅伤寒论临床十讲》(中国中医药出版社出版,李赛梅主编),最终解释权归原作者所有。
原文中桂枝汤的用法用量和组成注意事项
桂枝汤
伤寒论与金匮要略
【原方用法用量】太阳中风,阳浮阴虚[1],阳浮自热,阴虚自汗,恶寒[2],浙恶风[3],习习 发热[4]、鼻鸣[5]、干呕者,以桂枝汤为主。 (伤寒论:12)桂枝汤
桂枝三两(去皮),芍药二两,甘草三两(炙),姜三两(切),大枣十二枚(破),五味上,咬[6]三味。 取水七公升,小火煮三公升,去渣,冷温宜时取一公升。 服一时[7],饮[8]热稀粥一升,以助药。 暖敷令一会,全身微湿[9],看来出汗者受益更佳。 不让它流如水,病不愈。 如果您在服用一剂后因出汗而生病[10],则停服后不必再服用全部剂量。 不出汗就多服,照前法。 不出汗,短服后[11],约半日,三服而下。 重病者服一日一夜,周内观察[12]。 服用一剂,如果症状仍然存在,则服用更多。 如果您不出汗,最多服用两到三剂。 禁止冷、粘、肉面、五香料[13]酒奶酪[14]和难闻的气味。
笔记:
[1]阳浮阴弱:阴阳指切脉的方法和力量。 脉轻而明显,谓之阳浮,用力按之脉微弱,谓之阴虚。 阳浮阴弱,脉浮而缓。 也有人认为是指病机阳浮,是指卫阳在外浮旺;
[2] 吝寒:吝啬(se,音色)。 形容畏寒畏缩的样子。
[3] 浙浙煞风:浙江(xi,音析)。 形容邪风为寒风雨侵肌肤。
[4] 席席热:席(xi,音席),羽毛的形状。 形容发烧像羽毛覆盖全身一样温暖。
[5] 鼻音:鼻为肺窍,风寒流表,肺窍不利,呼吸之气不利,因窒息。
[6]咬:本义咀嚼,引申为将药物剁成小块。
[7] 旭烨:很短的时间。
[8]啜:啜(蕞,注音)。 喝酒的意思。
[9]絷絷:禁止(z he,音折)。 形容微微出汗,有皮肤湿润之感。
[10] 病差:差(chai,音瘥)。 即恢复。
[11] 小促销期间:缩短服药间隔。
[12] 周时间:一日一夜。
[13] 五辛:《本草纲目》以小蒜、大蒜、韭菜、芸苔、香菜为五辛。 这里泛指各种辛辣刺激性食物。
[14] 奶酪:指用动物奶制成的食品。
【功效配伍】桂枝汤舒筋祛风,和营养生。 此方为《伤寒论》第一方。 方剂名称以桂枝主药命名。 柯云波称其为“仲景方中之冠。 筋发汗总方”(《伤寒论》)。 方中桂枝辛温,温未阳,舒筋祛风; 牡丹味酸苦微寒,收阴调和。 舒缓健脾胃,助芍药敛阴调养; 炙甘草性甘平,调和诸药,能补中益气。 肉桂条、生姜、炙甘草、大枣合用,能散辛甘,调理胃气; 芍药、炙甘草、大枣合用,能酸甘滋阴,调理营气。 组方中桂枝、芍药等量配伍,一散一涩,散收合调营卫。 《医宗金鉴》说:“桂枝之王牡丹,有发汗抑汗之用,牡丹之臣桂枝,有调营养生之功。” 本方五药配伍,共同发挥祛风理肌之功。 此外,桂枝汤还有调和脾胃、调和阴阳、调和气血的作用。 故除治疗太阳病、中风病外,多用于内伤杂病。
桂枝汤对其药物炮制、煎煮方法、用药后护理都有严格的要求。 如:①桂皮去皮,甘草蜜炙,姜切碎,大枣掰碎等。 ②桂枝汤五味水煎,小火去水,温服3次。 ③服桂枝汤后,稍等片刻,喝热粥,既可助汗源,又可防止出汗过多伤身; 但不可暖盖太多,万一出汗过多,汗如水,则病难愈,伤正气。 ④服药后痊愈,微汗者,应停服,即病即止,不必服全药; 如果它不起作用,你可以继续服用它。 病重未出汗者,缩短两剂间隔时间,或半日内服完三剂。 病重者可昼夜连续服药,注意观察病情。 服一剂药未愈者,改变给药方法,连服二剂或三剂药。 ⑤服药期间忌生冷、粘稠、肉食、辛辣、酒类、乳酪、臭秽之物,以免伤胃,不利于邪气排除。
【方证分析】桂枝汤治太阳中风,营卫不和证。 症见发热出汗,恶寒,恶浙浙风,心悸发热,鼾声作呕,脉浮缓。
太阳中风为风寒外感,病机为阳浮阴弱,或卫强营弱。 卫强是指卫阳飘扬在外以抵御邪气,营卫是指阴阴失守外泄。 正常生理在营经,卫经外,卫阳为营阴之使,营阴为卫阳之卫,营卫相和,各司其职,身相安宁,阴阳相调,则病不生。 未阳不足,当风寒侵袭皮毛间纹时,体表之气首当其冲,而未阳浮盛于外,当其升而逆邪时,则致热脉浮,故曰“阳自浮”。 又名韦强; 卫阳浮盛于外,筋骨间质失实密实,营阴不守内而外泄,故汗自出,脉缓,营阴不振。因出汗不足,故称“阴弱”。 “自汗”,又称营虚; 未央辟邪,未央有伤,再加上出汗松筋,是吝啬恶寒,浙浙恶风。 肺与皮毛相和,肺气行于鼻。 风寒外侵,肺气不利,则鼻鸣。 风寒犯胃,胃气上行,引起干呕。 西溪热、浙浙恶风、恶寒,是对发热、恶风、恶寒表现的形象描述。 适用于舒筋祛风,调和营卫,方用桂枝汤。
【原文】太阳是[1]病,脉浮,头颈强痛[2]恶寒[3](《伤寒论》:1)注解:
[1] 知微:知,语气词; 为,动词,意思是产生和形成意义。
[2] 头颈强痛:指背处硬痛,转动俯仰不顺畅。 壮(姜,音姜),刚而不柔。
[3] 恶寒:指畏风寒。 恶(wu,音事),厌恶。
太阳病的基本症状是脉浮数,头颈强痛,恶寒。 阳主周身表,体表受邪,谓之太阳病。 脉浮是外邪攻表,卫气抵抗外邪,也反映病在表表,正气未伤; 外感风寒,阳经受邪,经脉运行受阻。 因为颈部是太阳经脉所走的部位,所以症状包括头颈部剧烈疼痛; 恶寒则未阳压抑,经脉肌肉失养。
【原文】太阳病,发热汗出,恶风[1],脉缓12,谓之中风[3]口(伤寒论:2)注解:
[1] 恶风:指畏寒,较恶寒轻。
[2] 脉缓:指脉象缓、散、弱,较太阳伤寒脉微弱,非滞脉。
[3] 中风:中医证候名。 这里的中风是指感受风寒引起的阳表证; 若突然昏倒,口眼斜斜,肢体麻痹,则为内伤杂病中风。
发热、多汗、恶风、脉缓是太阳病中风证的特有症状,也是桂枝汤的主治。 发热恶风,是风邪所致,正邪相冲; 汗出,因风邪伤身,卫气虚弱,营阴不内守,营卫失调; 脉缓,即脉浮缓,为营阴不足,脉缓。 后世医家称太阳中风汗浮脉缓为太阳中风表虚证。
【原文】太阳病发热出汗,此为荣弱[1],故出汗欲救邪风者[2]宜用桂枝汤。 (《伤寒论》95)
[1] 容弱与卫强:是“阳浮阴弱”的相互表现。 荣弱即营弱,阴弱。 卫强,即阳符,是邪气攻表,卫阳符生抵挡外邪。
[2]欲救风邪:指治风邪所致太阳病中风证。 欲望,欲望; 救援,减轻或治愈的意图; 邪风,即邪风。
太阳病发热汗出,用桂枝汤舒筋祛风,调和营卫。 其“虚强”病机与“阳浮阴虚”相同。 后人常称之为营卫不和,或营卫不和。
【原文】太阳病头痛发热汗出恶风,主治桂枝汤。 (伤寒论13) 太阳病头痛发热汗出恶风,属太阳病中风证,用桂枝汤治疗。 若头痛发热恶风无汗,可服麻黄汤。 本证因发汗,用桂枝汤。
【原文】太阳病,先服[1]桂枝汤,心烦不解者,先刺风池[2]、风府[3],但服桂枝汤可愈。 (《伤寒论》:24)
[1] 初服:桂枝汤煎服,分3次温服。 初始剂量是指第一次剂量。
[2] 风池穴:足少阳穴,在枕骨结节正下方凹陷与乳突之间的中点,两筋凹陷处。
[3]风府:督脉穴,距子孙发际1寸,枕骨与第一颈椎之间。
太阳病中风证,初服桂枝汤者,烦躁不解,多受邪邪之故。 服用桂枝汤后,正气被药力所助。 郁郁不明,阳郁不宣,故恼而病不明。 治法先针刺风池、风府穴,通经泄邪,服桂枝汤,病即愈。
【原文】太阳病,外证[1]未解,脉浮弱,宜以汗解,桂枝汤为宜。 (伤寒论:42)
[1]外卡:这里指的是太阳能表卡。
太阳病,外证未解,发热恶寒,头痛等症犹存,脉浮弱,正气微弱者,宜用桂枝汤发汗,因出汗是微弱的,不会损伤正气。
【原文】太阳病,先发汗,未清,则反复,脉浮不愈。 浮于外,反则不愈。 今脉浮,故在外,须疏之时,自愈。 桂枝汤宜。 (《伤寒论》45)太阳病先用发汗法而病未解伤寒论特殊的服药法,或发汗法不当,或病重药轻,而攻之。误用,脉象浮,则病不愈。 浮脉显之,逆则不愈。 若发作后内虚症状尚未出现,脉象仍浮,表证尚在,可继续用桂枝汤发汗解表。
【原文】伤寒汗出已止,虚复烦半日[1],脉浮数者多汗出,桂枝汤宜。 (伤寒论:57)
[1] 复烦:烦,指表面症状,如发热、恶寒、头痛、脉浮等症状。 反复烦扰是指上述脉象反复出现。
太阳病伤寒证,已用麻黄汤生汗,服半日,反复心烦,脉浮数。 宜用桂枝汤舒筋祛风,调和营卫,以祛除邪气。
【原文】太阳病,降后气升[1],可用[2]桂枝汤服,同前法[3]; 如果它不起来,就不应该给它。 (伤寒论:15)
[1] 其气上行:指气上升顶胸的感觉,表示正气不虚。 还有人认为太阳能手表证书还在。
[2] 宜:含慎,即不可贸然用药。
[3] 方前法:指采用桂枝汤方后煎煮调理的方法。
太阳病误后,其气上行,说明正气未衰,表邪未陷,外治尚有机会。 可与桂枝汤合用,祛邪解表。 如果放错了,气不上冲,就是正气受损,正气不能胜邪,外邪内陷,桂枝汤不能治疗。
[原文]桂枝[1]原用于舒筋活络[2]。 若脉浮紧,发热汗出者,不宜同服。 永远知道[3]这一点,不要犯错误。 (伤寒论:16)
[1] 桂枝:即桂枝汤。
[2]解集:解集发汗,是指其方为缓汗剂。
[3] 识:记住的意思。
桂枝汤本是解肌发汗的温和剂。 若脉浮紧,无发热汗出,为太阳病伤寒证。 大汗宜用麻黄汤。 否则,病情严重会耽误治疗。 医者应时刻牢记,以免误用临床症状,故曰“常知此,勿误”。
【原文】酒病者不服桂枝汤。 如果你得到它,你会呕吐,因为酒鬼不喜欢甜食。 (《伤寒论》:17)平时饮酒的人,往往湿热内盛,而桂枝汤辛甘,辛温助热,甘味助湿。 引起呕吐。 以饮酒者为例,提醒湿热者忌服桂枝汤。
[原文]服桂枝汤呕吐者,服后吐脓血。 (《伤寒论》19) 桂枝汤性辛温,上火者不宜服; 误服则上火伤络,易生脓血。
【原文】太阴病,脉浮汗,宜加桂枝汤。 (伤寒论:276) 太阴病属虚寒内证,脉宜沉。 若今日太阴病脉逆,则为太阴病,阳表虚证。 桂枝汤宜治。 盖桂枝汤性温发汗剂。 可舒筋活络,散风散寒,调营养生。 可调和脾胃,助卫源。 外生者。 麻黄汤不用于此证,因其为强发汗剂,故仅适用于伤寒表证。
[原文] 呕吐止而身痛不已者,待闻[1] 和解,宜用桂枝汤治消何[2]。 (伤寒论:387)
[1] 新闻:有一种慎重感。
[2]小和:略和。
桂枝汤治疗霍乱内和外不和证。 霍乱既有外部的也有内部的。 经医治,呕吐已止,内气已趋恢复,但身痛不已,说明外症还在。 此时可酌情加桂枝汤微调营卫,疏解外感。 ,又能兼顾脾胃之气。
【 text】The often comes out of sweat, this is the of the honor qi, and the of the honor qi [1], the [2] is the qi does not share the glory qi . If the Rong is in the and Wei is , the will recur, and the of and Wei will heal, so is . ( on : 53) Notes:
[1] Rong Qi and: Rong Qi, that is, Ying Qi. Qi and , that is, the of Ying Qi is being by evil. [2] : to Wei Qi. to the of Wei Qi, which is not in with Ying Qi. and . The often , fever, to wind, , etc., which can rule out , which to due to . Erqi, Wei the , and it on the , and the power of and ; Ying in the , the five , and the six . The guard is the envoy of the camp , and the guard of the guard the camp. This is the state of , which is the of the camp and the guard. Now the Wei Qi flow , and loses its power of , , and , so that the are not dense, while the Ying Qi is , it is not by evil, but the Ying Yin is to guard , so it often . " the qi does not share the , the qi is and ", that is, the of the camp and the guard leads to . Fang uses to " his " to the of camp and , and heals from .
[ text] When the has no other [1], he has fever and and does not heal, this means that the Wei Qi is not . First of all, when [2] , it will heal, and is . ( on : 54) Notes:
[1] no other : to the .
[2] the time: to the fever and .
. There is no in the , and when the has fever and , it is due to the of camp and . Wei Qi is yang, Wei is by Gu Mi, now Wei Qi is not in , the and of Gu Mi is , Ying Yin be , so fever comes out , this is not by wind and cold, it is Wei Qi and Ying Qi are not For , can also be used to by . " at the right time will heal", that is, using fever and can not only exert the of the drug, but also " like water".
【】For those who have and body pain, warm the first, then the . Sini is for Wenli [1], and is for [2]. ( Xiali: 36) Three liang of (), three liang of peony and two liang of (), three or two big of , 12 of five , put in 7 of water, boil over low heat Three , the dregs, one liter of warm for cold, after it for a while, sip one liter of gruel to help the , warm and cover for a while, the whole body is , good, not like water . If you get ill after after it, take it after .
笔记:
[1] Sini : see the for the .
[2] : In " on ", there is the word "爆" for ; in , the the is . Li , , and body ache under the , it is and and cold, with solar , which to both and , it is to use Sini to warm the and cold first, and when the is cured, the qi After , use to to treat .
[ text] The said: A woman who has a flat pulse[1], a weak Yin pulse[2], is [3] and eat, has no cold or heat, and is . When there is this on the 60th day of the law [4], if there is a cure for the [5], but the who in [6], then he will not [7]. ( : 1) Notes:
[1] : to the calm and -free pulse.
[2] Yin pulse is small and weak: Yin pulse to Chi pulse;
[3] : "vomit" in " of the ", you can it.
[4] Yufa: Law, that is, the law; Yufa, to the law.
[5] : to wrong .
[6] But : to one month back.
[7] : , that is, cut off. There are about 3 : one is to stop the and use diet to ; the other is to treat to the root cause of the ; the third is to the to bad .
. A woman is and has for about 2 . Her pulse is calm and her Chi pulse is weak. She also has , can't eat, and has no or fever. This card is also an early . This is that after a woman is , Yin and blood are , and fetal gas is . In the first of a woman, 2 , the fetus is first , and the blood to the to the fetus, so that the 's Yin blood is , and the veins are not , so the Chi pulse is weak. If after 3 of , with the of fetal gas, the chi pulse may , such as "Su Wen·Ping Ren Qi Lun" says: "Women's hands have of , and they are also ." " for " said: "March pulse count." Li said: "Slip and loose, the fetus will be three ." This , to eat, is due to weak and , fetal gas down, loss and drop. the from the cell and to , the fetal qi will clamp the qi when the qi of the goes up and down. There is no cold or heat in the body, and are ruled out. The uses to the yin and yang of the and , build up the qi, qi and blood, and the fetus. If the does not know that it is , and the is , and and occur , it will cause the of qi, blood and body fluid, and the fetus. At this time, it is to take to treat the and the fetus, or to the . You can weigh the pros and cons Treat it.
[ ideas] ranks first in the , and is used in , both for and . Xu 's "Jin Kui Yao Lun Lun Zhu" said: "This soup, from the , is for and , and from the , is for Qi and yin and yang." took as his 's . There are the most and , such as plus , plus , , etc. can also be with other , such as Half and Half , soup etc. Those who use to add or have the basic of their , which may be by of and , or of the and , or of yin and yang. Some think that is a agent, so it is in the of , that is, it has the of camp and , yin and yang, and and .
is used in the to treat solar , , and ; it is used to treat colds, air- , , , skin , , , , ADHD and other in .
[ of ] (1) Li 's : Wu , a , from fever for six days, and , and , , and . It was that soup be given. his pulse as and large, of his said: "If you have fever and don't have a bowel for six or seven days, if you have a and fever, and your urine is clear, you don't know it's , it's still on the ." It is now mid-, and it is to drink with . was , that is the yang, and the of the twig will kill you. Li said: a lot, , so . there is no bowel , there is no pain in the , and it will heal with its camp and guard. So it is the to use it. At night, the and will stop, and the stool will pass by , so there are many and not be glued. If you use to make you , can you live?
(2) : Liu, male, 48 years old. from a cold in early , , fever and , when the fever is not , the more you the and to feel , but when the wind for a while, you will be , and the wind is very bad. So I have to wear and for self-, but the bad wind goes away, the fever and sweat come back again. The pulse is and slow, and the is white and moist, which is as . Throw in stick soup to warm and cover, sip to sweat and . [Liu , Nie , Fu . The of fever. : 's House, 1983.]
(3) Ban 's case: Li, , 25 years old. On 18, 1991, she went to see a of for 23 days. Self- after , which be by , and it will be worse when , times a day, by , less and dark , pale , pale with tooth marks on the side, pulse slow. The card to loss of blood and loss of . The of the body is sweet and warm to the Yang, the camp and the , the and sweat. : 6g twig, 10g white peony root, 10g , 10g , 10g , 10g , 6g . in water. After the for 3 doses, by 78, less , and light . Fang added 10g of fruit and 10g of root to and stop . 8 doses, self- , net. [Li Li. Ban 's in using . , 1992, (4): 15.]
Tang and Its and - " on and " Study Notes 9