麻黄升麻汤条文方证浅析

Analysis of the Classical Text and Clinical Indications for Mahuang Shengma Decoction

摘要: 目的：解读宋本《伤寒论》第357条条文，明确麻黄升麻汤的适应症状、组方原理和基本病机，加深对条文方证的认识。方法：从条文出发，通过对症状的解读，以及结合中医典籍中药物功效的论述，分析麻黄升麻汤的基本病机，并通过对医案的解读，扩展了条文中具体症状的不同表现形式。结果：将条文中的具体症状划分为上焦的郁热和下焦的寒湿，以及二者分别对人体阴阳造成的损害，推演出麻黄升麻汤的基本病机为郁热在上伤阴、寒湿在下伤阳；将整首方剂划分为五个部分，即麻黄石膏组合、黄芩汤、白虎汤、升麻鳖甲汤及以相对应的药物加减变化，在一定程度上为其在临床上发挥应有的作用打下坚实的基础。结论：人体内的阳气不足、寒湿积聚等病理因素，阻碍了郁热的进一步内传，使其停留在上焦及体表。

Abstract: Objective: Interpret the provisions of Article 357 of the Song edition “Treatise on Cold Damage”, clarify the adaptation symptoms, composition principles and basic pathogenesis of ephedra and cohosh decoction, and deepen the understanding of the prescriptions of the articles. Methods: Starting from the provisions, through the interpretation of the symptoms and the discussion of the efficacy of the drugs in the classics of traditional Chinese medicine, the basic pathogenesis of ephedra and cohosh decoction was analyzed, and the different manifestations of specific symptoms in the articles were expanded through the interpretation of medical cases. Results: The specific symptoms in the article were divided into the heat of the upper coke and the cold and dampness of the lower coke, as well as the damage caused by the two to the yin and yang of the human body, respectively, and the basic pathogenesis of ephedra and cohosh decoction was that the heat of the ephedra decoction hurt the yin in the upper part and the cold and dampness hurt the yang in the lower part. The whole prescription is divided into five parts, namely ephedra gypsum combination, skullcap soup, white tiger soup, cimicifuga turtle jia decoction and the corresponding drug addition and subtraction changes, to a certain extent, to lay a solid foundation for it to play its due role in clinical practice.