基于水郁理论探析甘姜苓术汤治疗寒湿腰痛

Exploring Application of Ganjianglingzhu Decoction for Lumbago with Cold-Damp Syndrome Based on Theory of Resolving Water Stagnation

摘要: 甘姜苓术汤，又名肾着汤，最早见于《金匮要略》，后亦见于《三因极一病证方论》卷之十七，主治妊娠腰脚肿痛。此方常见于骨科临床，对于腰痹之寒湿腰痛有较好的临床疗效。此症起于脾虚土衰不能制水，或因平素停饮聚集，清浊不分，以至于此。《黄帝内经》中基于“五行郁甚”提出了五种治法，其分别为：木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之，以此来恢复五行的正常生理状态，达到治疗疾病的效果。其中，水运所主之时出现异常则可引起水湿内停或引起肾病，水湿郁于腰部，气血瘀滞，故而为痹，此为水郁。甘姜苓术汤由干姜、茯苓、白术、甘草四味药构成，其意不在于补肾，而在于取其中药物辛热之性，温中燠土以散寒湿，加之利以渗湿而治水。正如张介宾所云：折，调制也。甘姜苓术汤以扶阳、实土之法以调制水郁，从而达到治疗临床寒湿腰痛的效果。文章将以此治法为基点，探析临床上以甘姜苓术汤治疗寒湿腰痛的治疗思想。

Abstract: Ganjianglingzhu decoction, also known as Shenzhuo decoction, was first seen in the “Synopsis of Golden Chamber”, and later also seen in the “Three Causes and One Disease Prescription”, Volume 17, treating pregnancy waist and foot pain. This prescription is commonly used in orthopedic clinics and has a good clinical effect on lumbago with cold-damp syndrome. This disease is caused by the deficiency of the spleen and the failure to make water, or because of the normal stop drinking and gathering, clear and turbidity so that this. In “Huangdi Neijing”, five treatment methods were put forward based on “five depression syndromes”, which were: stagnation of wood should be treated by smoothing, stagnation of fire by dispersing, stagnation of earth by attacking, stagnation of metal by dredging, and stagnation of water by inhibiting, in order to restore the normal physiological state of the five depression and achieve the effect of treating diseases. Among them, when the water transport is abnormal, it can cause water wetness or kidney disease, water wet stagnation in the waist, Qi, and blood stasis, which is pain, which is water stagnation. Ganjianglingzhu decoction is composed of dry ginger, poria, white atractylodes, and licorice. Its intention is not to tonify the kidney, but to take the nature of the drug to hot, warm soil to dispel cold dampness, plus the benefit to ooze dampness and control water. As Zhang Jiebin said: To restrain is to regulate. Ganjianglingzhu decoction is used to modulate water depression by supporting Yang and consolidating soil to achieve the treating effect of clinical cold dampness lumbago. Based on this treatment method, this article will explore the therapeutic idea of treating cold dampness lumbago with Ganjianglingzhu decoction in the clinic.