刍议肾气丸及其类方之源与变

Discussion on the Origin and Evolution of the Shenqi Pill and Its Analogues

摘要: 肾气丸及其类方构成了中医补肾法度的核心体系，然其源流繁复，古今同名异方、同方异名现象普遍，尤以今之“金匮肾气丸”与“桂附地黄丸”在名实对应上最易混淆。本文通过系统梳理《金匮要略》《小儿药证直诀》《严氏济生方》及《景岳全书》等关键中医古籍的文献记载，厘清肾气丸自东汉至明清时期在方药组成、剂量比例、主治证候及配伍理论等方面的动态演变过程，旨在为现代临床精准辨识与运用补肾类方提供文献基础与理论支撑。

Abstract: The Rehmannia Decoction and its related prescriptions form the core system of the TCM method of tonifying the kidney. However, its origin and development are complex, and the phenomenon of different prescriptions with the same name or the same prescription with different names is common in both ancient and modern times. Among them, the “Jinkui Rehmannia Decoction” and “Cinnamon and Aconite Rehmannia Decoction” of today are the most confusing in terms of name and reality correspondence. This article systematically reviews the literature records in key ancient TCM classics such as Essential Prescriptions from the Golden Cabinet, Direct Decisions on Pediatric Medication, Jisheng Fang, and Complete Works of Jingyue, and deeply clarifies the dynamic evolution process of the Rehmannia Decoction from the Eastern Han Dynasty to the Ming and Qing Dynasties in terms of its composition of herbs and ingredients, dosage ratios, main indications, and compatibility theories, aiming to provide a solid literature basis and theoretical support for the precise identification and application of tonifying kidney prescriptions in modern clinical practice.