《徐批叶天士晚年方案真本》建中汤应用探析

Analysis of the Application of Jianzhong Decoction in XU Critic YE Tian-Shi’s Medical Records in Old Age

摘要: 本文基于《徐批叶天士晚年方案真本》所载19则建中汤医案，系统分析叶天士晚年运用建中汤类方(含小建中汤、黄芪建中汤、归芪建中汤等)的辨证规律与学术思想。研究发现，叶氏以“劳伤阳气，中虚失运”为建中汤证的核心病机，以“形寒、纳减、脉虚”为关键辨证指征，强调“脾胃为本”的治疗观。叶氏应用建中汤不局限于传统虚劳范畴，更拓展至吐血、久嗽、汗证、冲气上逆等内伤杂病证治，并通过去姜防辛散，加人参、当归、黄芪补益体现其辨证与用药之精细。同时，建中汤营卫并治的特点也为阴虚证的治疗提供思路。

Abstract: Based on 19 medical cases of Jianzhong Decoction recorded in “XU Critic YE Tian-Shi’s Medical Records in Old Age”, this article systematically analyzes the diagnostic rules and academic thoughts of Ye Tianshi in his later years when applying Jianzhong Decoction and its variations (including Xiao Jianzhong Decoction, Huangqi Jianzhong Decoction, Guiqi Jianzhong Decoction, etc.). The research shows that Ye regarded “injury of yang qi due to overwork and deficiency of the Middle Jiao with impaired transportation” as the core pathogenesis of Jianzhong Decoction syndrome, and “chilliness, poor appetite, and weak pulse” as the key diagnostic indicators. He emphasized the therapeutic concept of “the spleen and stomach are the foundation”. His application of Jianzhong Decoction was not limited to the traditional category of deficiency syndrome but was also extended to the treatment of various diseases such as hemoptysis, chronic cough, sweating syndrome, and upward surging qi of the Chong meridian. The removal of ginger prevents pungent dispersion, while the addition of Ginseng, Angelica, and Astragalus for tonification reflects the meticulousness in syndrome differentiation and medication. Meanwhile, the characteristic of Jianzhong Decoction in treating both nutrient qi and defensive qi also provides an approach for the treatment of yin deficiency syndrome.