《神农本草经》与经方应用之苦杏仁篇.pdf

圆园23 年 9 月第 47 卷第 5 期山东中医药大学学报音叶神农本草经曳与经方应用研究音叶神农本草经曳与经方应用之苦杏仁篇苗苗1袁孔洋洋1袁尤旭颖1袁张泽1袁袁红霞2渊1.天津中医药大学研究生院袁天津 301617曰 2.天津中医药大学管理学院袁天津 301617冤咱摘要暂 叶神农本草经曳载苦杏仁功效为野主咳逆上气袁雷鸣袁喉痹袁下气袁产乳袁金疮袁寒心袁奔豚冶遥 以叶神农本草经曳为纲尧叶伤寒杂病论曳之经方为目袁探讨苦杏仁的不同功效与配伍遥 苦杏仁主咳逆上气袁常配伍桂枝尧麻黄尧厚朴袁以桂枝加厚朴杏子汤尧麻黄汤为代表方曰主雷鸣袁常配伍干姜尧细辛尧五味子袁以厚朴麻黄汤为代表方曰主喉痹袁常配伍当归尧桂枝袁以续命汤为代表方曰主下气袁常配伍石膏尧甘草袁以麻黄杏仁甘草石膏汤为代表方曰主产乳袁乳汁不下袁苦杏仁能通之曰主金疮袁金伤成疮袁苦杏仁能敛之曰主寒心奔豚袁苦杏仁主通肺气袁水为金之子袁金母可训子逆遥 除叶神农本草经曳记载的功效外袁张仲景运用杏仁配伍不同药物亦有新的发挥袁如配伍白术尧薏苡仁尧赤小豆以祛湿行水袁代表方为麻黄加术汤尧麻黄杏仁薏苡甘草汤尧麻黄连翘赤小豆汤曰配伍火麻仁尧枳实以润肠通便袁代表方为麻子仁丸曰配伍大黄尧虫尧矾石以润燥养血袁代表方为大黄虫丸尧矾石丸遥咱关键词暂 叶神农本草经曳曰叶伤寒杂病论曳曰苦杏仁曰经方曰咳逆上气曰下气曰雷鸣曰喉痹曰产乳曰金疮咱中图分类号暂 R289.1咱文献标志码暂 A咱文章编号暂 1007-659X渊2023冤05-0554-06DOI院10.16294/ki.1007-659x.2023.05.003Kuxingren渊Armeniacae Semen Amarum冤 in Shennong爷s Classic of Materia Medica andClassical FormulasMIAO Miao1袁KONG Yangyang1袁YOU Xuying1袁ZHANG Ze1袁YUAN Hongxia2渊1.Graduate College袁Tianjin University of Traditional Chinese Medicine袁Tianjin 301617袁China曰2.College ofManagement袁Tianjin University of Traditional Chinese Medicine袁Tianjin 301617袁China冤AbstractThe efficacy of Kuxingren渊Armeniacae Semen Amarum冤 is recorded in the Shennong爷s Classic ofMateria Medica that 野it is mainly used to treat cough with dyspnea and upward counterflow of qi袁thunderoussound in the throat and throat impediment袁to descend qi and promote galactopoiesis袁to treat injury causedby metal袁pathogenic cold that damages the heart and Bentun冶.Based on the Shennong爷s Classic of MateriaMedica and the classical formulas in Treatise on Cold Pathogenic and Miscellaneous Diseases袁we analyzed thedifferent efficacies and combinations of Kuxingren.For treating cough with dyspnea and upward counterflowof qi袁Kuxingren is mainly combined with Guizhi渊Cinnamomi Ramulus冤袁Mahuang渊Ephedrae Herba冤and Houpo渊Magnoliae Officinalis Cortex冤袁representedby Guizhi Jia Houpo Xingzi Decoction渊桂枝加厚朴杏子汤冤 and Mahuang Decoction渊麻黄汤冤.Fortreating thunderous sound in the throat袁it is oftencombined with Ganjiang渊Zingibers Rhizoma冤袁Xixin咱收稿日期暂 2023-05-26咱基金项目暂 天津市教学成果奖重点培育项目渊编号院PGYJ-032冤咱作者简介暂 苗苗渊1997要冤袁女袁满族袁河北唐山人袁2020 年级硕士研究生袁研究方向院中医药防治脾胃病研究遥 电话院15930525381曰邮箱院遥咱通信作者暂 袁红霞渊1964要冤袁女袁山东邹平人袁医学博士袁教授袁博士研究生导师袁主要从事经方治疗消化系统疾病的研究遥 邮箱院遥第 47 卷 第 5 期山东中医药大学学报灾燥造援47袁晕燥援52023 年 9 月JOURNAL OF SHANDONG UNIVERSITY OF TRADITIONAL CHINESE MEDICINESep.2023554圆园23 年 9 月第 47 卷第 5 期渊Asari Radix Et Rhizoma冤 and Wuweizi渊Schisandrae Chinensis Fructus冤袁represented by Houpo MahuangDecoction渊厚朴麻黄汤冤.For treating throat impediment袁it is often combined with Danggui渊Angelicae SinensisRadix冤 and Guizhi袁represented by Xuming Decoction渊续命汤冤.To descend qi袁it is usually combined withShigao渊Gypsum Fibrosum冤 and Gancao渊Glycyrrhizae Radix et Rhizoma冤袁represented by Mahuang XingrenGancao Shigao Decoction渊麻黄杏仁甘草石膏汤冤.For treating galactostasis袁Kuxingren can promote galac鄄topoiesis.For treating injury caused by metal袁Kuxingren can heal up the sore.For treating pathogenic coldthat damages the heart and Bentun袁Kuxingren can ventilate lung qi.Water as the son of metal袁metal-mothercan treat water-son.In addition to the efficacies recorded in the Shennong爷s Classic of Materia Medica袁ZHANG Zhongjing had also made new use of Kuxingren.For example袁Kuxingren is combined with Baizhu渊Atractylodis Macrocephalae Rhizoma冤袁Yiyiren渊Coicis Semen冤 and Chixiaodou渊Vignae Semen冤 to expeldampness and promote diuresis袁represented by Mahuang Jiazhu Decoction渊麻黄加术汤冤袁Mahuang XingrenYiyi Gancao Decoction渊麻黄杏仁薏苡甘草汤冤 and Mahuang Lianqiao Chixiaodou Decoction渊麻黄连翘赤小豆汤冤曰Kuxingren is combined with Huomaren渊Cannabis Fructus冤 and Zhishi渊Aurantii Fructus Immaturus冤 tomoisten intestine and relax bowels袁represented by Maziren Pill渊麻子仁丸冤曰Kuxingren is combined withDahuang渊Rhei Radix et Rhizoma冤袁Zhechong渊Eupolyphaga Steleophaga冤 and Fanshi渊Alunite冤 to moisten drynessand nourish blood袁represented by Dahuang Zhechong Pill渊大黄虫丸冤 and Fanshi Pill渊矾石丸冤.KeywordsShennong爷s Classic of Materia Medica曰Treatise on Cold Pathogenic and Miscellaneous Diseases曰Kuxingren渊Armeniacae Semen Amarum冤曰classical formulas曰cough with dyspnea and upward counterflow ofqi曰descending qi曰thunderous sound in the throat曰throat impediment曰promoting galactopoiesis曰injury caused bymetal叶神农本草经曳渊叶本经曳冤尧叶伤寒杂病论曳为中医学经典著作袁被后世众多医家列为辨证用药之准则袁奉为圭臬遥 叶针灸甲乙经曳序院野伊尹以元圣之才袁撰用神农本草袁以为汤液冶袁叶伤寒论文献通考曳认为叶伤寒杂病论曳是以叶伊尹汤液曳为框架袁对其梳理及补充后完成袁而叶本经曳是伊尹著写叶伊尹汤液曳的参考和依据咱1暂袁故叶本经曳与叶伤寒杂病论曳可作为互文参考学习袁有非常重要的学术价值遥 现代医家秦高凤等咱2暂提出袁总结张仲景的用药思路袁还原经方的用药及配伍规律袁应以叶本经曳为蓝本和线索遥 因此袁本文以叶本经曳为纲袁叶伤寒杂病论曳之经方为目袁探讨叶本经曳中苦杏仁的功效在经方中不同的配伍及应用袁纲目并举袁从而指导临床遥1苦杏仁功效及经方配伍应用1.1主咳逆上气1.1.1方药常配伍桂枝尧麻黄尧厚朴遥 代表方为桂枝加厚朴杏子汤尧麻黄汤遥肺主宣发与肃降袁升降相宜袁以降为主遥 若肺卫不固袁正气虚弱曰或他脏先病缠绵难愈进而伤及肺脏或余邪长期留恋于肺袁亦可致肺脏虚损遥 此时袁六淫邪气可乘虚而入袁则肺气宣降失调袁气机紊乱袁发为咳逆上气遥 苦杏仁归肺经咱3暂袁当肺失宣降袁气机失常时袁可用苦杏仁治疗肺系疾病遥 张仲景多以苦杏仁配伍桂枝尧厚朴尧麻黄袁如桂枝加厚朴杏子汤尧麻黄汤袁其咳喘病机均为肺气卫外不固袁风邪或寒邪侵于内袁致肺窍不利袁肺失宣肃所致遥 其中桂枝甘尧温袁以解肌祛风见长袁配伍苦杏仁可治疗风邪伤及肺卫所致咳喘袁方为桂枝加厚朴杏子汤遥 叶伤寒论 窑辨太阳病脉证并治中第六曳言院野太阳病袁下之微喘者袁表未解故也袁桂枝加厚朴杏子汤主之遥冶麻黄辛尧温袁善解表散寒袁与苦杏仁相伍治疗寒邪闭表尧肺窍不利之咳喘袁方为麻黄汤遥 叶伤寒论 窑 辨太阳病脉证并治中第六曳载院野太阳病袁头痛发热袁身疼腰痛袁骨节疼痛袁恶风无汗而喘者袁麻黄汤主之遥冶叶本草便读 窑 果类 窑 杏仁曳亦言苦杏仁院野功专降气袁气降则痰消嗽止遥冶1.1.2医案某女袁65 岁袁2020 年 11 月 10 日初诊遥 主诉院咳嗽少痰 1 月余遥 患者既往慢性支气管炎病史 20 余年袁1 个月前外出感寒后