张玉琴教授经方治疗消渴病经验(1)
[摘要]消渴首见于《黄帝内经》，张仲景在《伤寒论》及《金匮要略》中对消渴病多有论述，记载了消渴病的病因病机及治疗消渴及其变证的方剂，对后世辨治消渴病及其变证奠定了理论基础，并提供了很多行之有效的方剂。张玉琴教授从事消渴病治疗多年，通读经典，并能灵活应用于临床，善用经方治疗消渴病及其变证，张教授常用白虎加人参汤、乌梅丸、五苓散、黄芪桂枝五物汤来治疗消渴病及其变证，临床上取得较好疗效，本文对以上方剂进行辨证分析。
[关键词]消渴病;消渴病变证;经方;经验总结
[中图分类号] R255 [文献标识码] A [文章编号] 1674-4721(2020)9(a)-0154-04
[Abstract] Xiaoke is first recorded in the Yellow Emperor′s Canon of Internal Medicine (Huangdi Neijing). Zhang Zhong-jing narrates a lot on Xiaoke in Treatise on Cold Damage (Shanghanlun) and Essentials from the Golden Cabinet (Jingui Yaolue)， which records the etiology and pathogenesis of Xiaoke， as well as formulas in treating Xiaoke and its transmuted patterns. He had laid a theoretical foundation for the treatment of Xiaoke and its transmuated patterns for later generations， and had provided many effective formulas. Professor Zhang Yu-qin has been engaged in the treatment of Xiaoke for many years， through reading the classics， she can flexibly apply it to clinical practice， and is good at using classical formulas to treat Xiaoke and its transmuted patterns. For these conditions， professor Zhang commonly uses White Tiger Plus Ginseng Decoction (Baihu and Renshen Decoction)， Wumei Pills， Five Substances Powder with Poria (Wuling Powder)， and Astragalus and Cinnamon Twig Five Substances Decoction (Huangqi Guizhi Wuwu Decoction)， which has achieved great clinical effect. In this paper， above-mentioned formulas in pattern differentiation were analyzed.
[Key words] Xiaoke; Transmuted patterns of Xiaoke; Classical formulas; Summary of experience
消渴首见于《黄帝内经》，《素问·奇病论》中有云“此人必数食甘美而多肥也，肥者令人内热，甘者令人中满，故其气上溢，转为消渴。”内经中多以“消瘅”之名论述消渴，然仲景学贯古今，临证辨治，于《伤寒论》及《金匮要略》中多次提及消渴之病症、脉象、治法及方药，提出“跌阳脉浮而数，浮即为气，数即消谷而大坚气盛则溲数，溲数即坚，坚数相搏，即为消渴。”“跌阳脉数，胃中有热，即消谷引食，大便必坚，小便即数。”为消渴病之主症，这与现代医学糖尿病之多饮、多尿、多食等症状不谋而合[1]。消渴病病机复杂多变，张仲景在《伤寒论》及《金匮要略》中多处论述了消渴病之病因病机及理法方药，张玉琴教授熟读经典，结合临床经验，应用经方治疗消渴病，多可取得较好疗效，现将张玉琴教授的经验总结如下。
1白虎加人参汤
张玉琴教授临证多应用白虎加人参汤治疗肺胃热盛型消渴，《金匮要略·消渴小便不利淋病脉证并治》中记载：“跌阳脉浮而数，浮即为气，数即消谷而大坚气盛则溲数，溲数即坚，坚数相搏，即为消渴。”“跌阳脉数，胃中有热，即消谷引食，大便必坚，小便即數。”张仲景认为夫胃中有热，故趺阳脉浮数，胃火炽盛，则见消谷善饥;热盛伤津，可见渴欲饮水;炽热上灼于肺，肺失输布，加之脾阳被遏，失于疏泄，水液直驱膀胱，故见小便频数，肺与大肠相表里，肺津失布，大肠失于以濡养，则见便坚。张教授根据临床大量观察，认为现代消渴病早期多以肺胃热盛为主，而白虎加人参汤为治疗消渴肺胃热盛型之首选方剂。白虎加人参汤记载于《金匮要略·消渴小便不利淋病脉证并治》篇：“渴欲饮水，口干舌燥者，白虎加人参汤主之。”“渴欲饮水，无表证者，白虎加人参汤主之。”胃热盛伤津而口渴不止，饮水虽能救津，但如若热不除，则仍气耗水不化津，仍有口干舌燥的症状，治宜清热益气、生津止渴。本方由白虎汤加人参组成，方中白虎汤清阳明邪热，人参益气补脾，生津止渴，《医学启源》[2]中提及人参可“治脾胃阳气不足及肺气促，短气、少气，补中缓中，泻肺脾胃中火邪。”也可根据实际情况，酌加补脾益气、生津、通便之剂，如：麦冬、天花粉、沙参、大黄、芒硝等。刘德城[3]通过临床观察证明应用白虎加人参汤治疗肺胃热盛型消渴有效。现代研究显示[4]，白虎加人参汤可有效减低高血糖对胰岛B细胞的损伤，保护大鼠胰岛素细胞(INS-1)，改善胰岛功能，从而达到治疗糖尿病的效果;也有研究表明[5]，白虎加人参汤可有效降低空腹血糖，有效缓解胰腺组织的氧化损伤，保护胰岛B细胞功能。, 百拇医药(王瑶 张玉琴)
[关键词]消渴病;消渴病变证;经方;经验总结
[中图分类号] R255 [文献标识码] A [文章编号] 1674-4721(2020)9(a)-0154-04
[Abstract] Xiaoke is first recorded in the Yellow Emperor′s Canon of Internal Medicine (Huangdi Neijing). Zhang Zhong-jing narrates a lot on Xiaoke in Treatise on Cold Damage (Shanghanlun) and Essentials from the Golden Cabinet (Jingui Yaolue)， which records the etiology and pathogenesis of Xiaoke， as well as formulas in treating Xiaoke and its transmuted patterns. He had laid a theoretical foundation for the treatment of Xiaoke and its transmuated patterns for later generations， and had provided many effective formulas. Professor Zhang Yu-qin has been engaged in the treatment of Xiaoke for many years， through reading the classics， she can flexibly apply it to clinical practice， and is good at using classical formulas to treat Xiaoke and its transmuted patterns. For these conditions， professor Zhang commonly uses White Tiger Plus Ginseng Decoction (Baihu and Renshen Decoction)， Wumei Pills， Five Substances Powder with Poria (Wuling Powder)， and Astragalus and Cinnamon Twig Five Substances Decoction (Huangqi Guizhi Wuwu Decoction)， which has achieved great clinical effect. In this paper， above-mentioned formulas in pattern differentiation were analyzed.
[Key words] Xiaoke; Transmuted patterns of Xiaoke; Classical formulas; Summary of experience
消渴首见于《黄帝内经》，《素问·奇病论》中有云“此人必数食甘美而多肥也，肥者令人内热，甘者令人中满，故其气上溢，转为消渴。”内经中多以“消瘅”之名论述消渴，然仲景学贯古今，临证辨治，于《伤寒论》及《金匮要略》中多次提及消渴之病症、脉象、治法及方药，提出“跌阳脉浮而数，浮即为气，数即消谷而大坚气盛则溲数，溲数即坚，坚数相搏，即为消渴。”“跌阳脉数，胃中有热，即消谷引食，大便必坚，小便即数。”为消渴病之主症，这与现代医学糖尿病之多饮、多尿、多食等症状不谋而合[1]。消渴病病机复杂多变，张仲景在《伤寒论》及《金匮要略》中多处论述了消渴病之病因病机及理法方药，张玉琴教授熟读经典，结合临床经验，应用经方治疗消渴病，多可取得较好疗效，现将张玉琴教授的经验总结如下。
1白虎加人参汤
张玉琴教授临证多应用白虎加人参汤治疗肺胃热盛型消渴，《金匮要略·消渴小便不利淋病脉证并治》中记载：“跌阳脉浮而数，浮即为气，数即消谷而大坚气盛则溲数，溲数即坚，坚数相搏，即为消渴。”“跌阳脉数，胃中有热，即消谷引食，大便必坚，小便即數。”张仲景认为夫胃中有热，故趺阳脉浮数，胃火炽盛，则见消谷善饥;热盛伤津，可见渴欲饮水;炽热上灼于肺，肺失输布，加之脾阳被遏，失于疏泄，水液直驱膀胱，故见小便频数，肺与大肠相表里，肺津失布，大肠失于以濡养，则见便坚。张教授根据临床大量观察，认为现代消渴病早期多以肺胃热盛为主，而白虎加人参汤为治疗消渴肺胃热盛型之首选方剂。白虎加人参汤记载于《金匮要略·消渴小便不利淋病脉证并治》篇：“渴欲饮水，口干舌燥者，白虎加人参汤主之。”“渴欲饮水，无表证者，白虎加人参汤主之。”胃热盛伤津而口渴不止，饮水虽能救津，但如若热不除，则仍气耗水不化津，仍有口干舌燥的症状，治宜清热益气、生津止渴。本方由白虎汤加人参组成，方中白虎汤清阳明邪热，人参益气补脾，生津止渴，《医学启源》[2]中提及人参可“治脾胃阳气不足及肺气促，短气、少气，补中缓中，泻肺脾胃中火邪。”也可根据实际情况，酌加补脾益气、生津、通便之剂，如：麦冬、天花粉、沙参、大黄、芒硝等。刘德城[3]通过临床观察证明应用白虎加人参汤治疗肺胃热盛型消渴有效。现代研究显示[4]，白虎加人参汤可有效减低高血糖对胰岛B细胞的损伤，保护大鼠胰岛素细胞(INS-1)，改善胰岛功能，从而达到治疗糖尿病的效果;也有研究表明[5]，白虎加人参汤可有效降低空腹血糖，有效缓解胰腺组织的氧化损伤，保护胰岛B细胞功能。, 百拇医药(王瑶 张玉琴)