基于“形气观”对《金匮要略》“惊悸吐衄下血病”诊治规律的研究

Research on the Diagnosis and Treatment Patterns for Palpitation and Bleeding Disorders in the Synopsis of the Golden Chamber Based on the Form-Qi Theory

摘要

《金匮要略》“惊悸吐衄下血病”为心与血脉的病变，心与血脉的关系为心所储藏的太阳、火气对血脉的化生与充养作用，即形与气的关系。故“惊悸吐衄下血病”产生的原因为心及心所储藏的太阳、火气出现了异常，心出现异常的原因为：①心之太阳、火气不足；②心被水扰；③心被寒伤。心所储藏的太阳、火气出现异常的原因为：①水湿盛损伤太阳、火气；②寒气盛损伤太阳、火气；③火热盛损伤太阳、火气。治疗当用桂枝、甘草等甘温或者黄芩、侧柏叶等苦味之品补心之太阳、火气，兼以黄连、大黄、浆水等清热泻火，茯苓、白术、半夏、蜀漆、赤小豆等祛痰浊水湿，附子、干姜、艾叶等温阳散寒之品祛太阳、火气损伤之因。

Abstract

In the Synopsis of the Golden Chamber, the section on "Trembling, vomiting, and bleeding" addresses pathologies of the heart and blood vessels. The relationship between the heart and blood vessels is the transformation and nourishment of the pulse by the sun and fire energy stored in the heart, that is, the relationship between form and qi. The reason for the occurrence of "palpitations, vomiting, and bleeding" is the abnormality of the heart and the stored sun and fire energy in the heart. The reason for the abnormality of the heart is: ① insufficient sun and fire energy in the heart; ② Heart disturbed by water; ③ My heart was hurt by the cold. The reason for the abnormality of the sun and fire stored in the heart is: ① Water dampness can damage the sun and fire; ② Excessive cold can damage the sun and fire; ③ Hot heat can damage the sun and fire energy. The treatment should use sweet and warm products such as cassia twig and licorice, or bitter products such as Scutellaria baicalensis and Platycodon grandiflorus leaves to nourish the sun and fire energy of the heart. It should also use products such as Huanglian, Dahuang, and Jiangshui to clear heat and eliminate fire, while products such as Poria cocos, Atractylodes macrocephala, Pinellia ternata, Sichuan lacquer, and adzuki beans can remove phlegm, turbid water, and dampness. Additionally, products such as Fuzi, dried ginger, and mugwort leaves can warm the yang and dispel cold to eliminate the damage.

关键词

心 / 脉 / 形气观 / 惊悸 / 吐衄 / 下血

Key words

heart / pulse / shape and qi observation / trembling / vomiting bleeding / bloodshed

参考文献

[1] 赵坤, 李成卫, 王庆国. 基于《黄帝内经》形气观分析心与血脉的关系[J]. 中医杂志, 2018, 59(5): 361-364.

[2] 赵坤. 秦汉时期气论视角下“心”与“脉”关系的历史考察[D]. 北京: 北京中医药大学, 2018.

[3] 田代华 整理. 黄帝内经素问[M]. 北京: 人民卫生出版社, 2005.

[4] 陈立 撰, 吴则虞 点校. 白虎通疏证[M]. 北京: 中华书局, 1994: 382-385.

[5] 李成卫, 王庆国. 脏象的含义与肝脏象理论的历史演变[J]. 世界中医药, 2015, 10(11): 1641—1644, 1649.

[6] 范永升, 姜德友. 金匮要略[M]. 北京: 中国中医药出版社, 2021: 188.

[7] 张仲景 述, 钱超尘 整理. 伤寒论[M]. 北京: 人民卫生出版社, 2005.

[8] 张仲景 述. 金匮要略方论[M]. 北京: 人民卫生出版社, 2012.

[9] 朱彬. 中药蜀漆的本草考证[J]. 浙江中医杂志, 2023, 58(3): 221-222.

[10] 阴倩雅, 杨鑫杰, 窦志芳, 等. 桂枝去芍药加蜀漆牡蛎龙骨救逆汤之方药探析[J]. 中华中医药杂志, 2020, 35(2): 959-961.

[11] 王丽杰, 刘梅. 浅谈《金匮要略》半夏麻黄丸法治疗心悸[J]. 中国中医急症, 2016, 25(7): 1452—1453, 1456.

[12] 钟赣生, 杨柏灿. 中药学[M]. 北京: 中国中医药出版社, 2021: 56.

[13] 詹徵羽, 顾思浩, 冯嘉铭, 等. 经典名方桂枝甘草汤的历史沿革与关键信息考证[J]. 上海中医药杂志, 2024, 58(10): 18-25.

[14] 张效科, 丁纪茹. 从经方中感悟仲景治疗心系病证用药智慧[J]. 陕西中医药大学学报, 2020, 43(1): 30-33.

[15] 王益斐, 侯春光, 赵娜, 等. 桂枝加桂汤方证认识和临床应用体会[J]. 浙江中医杂志, 2024, 59(2): 134-135.

[16] 韩学超, 孙坤坤, 徐琬梨. 苦味中药的归经及临床应用[J]. 山东中医药大学学报, 2022, 46(4): 463-466.

[17] 林昌松, 贾春华. 金匮要略讲义[M]. 北京: 人民卫生出版社, 2021: 169.

[18] 王玉兴. 金匮要略三家注[M]. 北京: 中国中医药出版社, 2013.

[19] 梁振钰, 刘茜, 陈桂敏. 侧柏叶在柏叶汤中的配伍意义探讨[J]. 中华中医药杂志, 2016, 31(8): 2971-2973.

[20] 陶弘景. 名医别录[M]. 北京: 人民卫生出版社, 1986: 227.

[21] 王浩婷, 李德杏, 李卫强, 等. 脾胃病经典名方黄土汤历史沿革与关键信息考证[J]. 河南中医, 2025, 45(1): 40-50.

[22] 李中梓. 雷公炮制药性解[M]. 北京: 人民军医出版社, 2013.

基金资助

河北省2020年度省属高校基本科研业务费项目(JYT2020015)