论桂枝去桂加茯苓白术汤去桂之意.pdfVIP

• 1578 • ( ) 中华中医药杂志 原中国医药学报 2011年7月第26卷第7期 CJTCMP , July 2011, Vol . 26, No.7 ·研究报告· 论桂枝去桂加茯苓白术汤去桂之意 李宇铭（指导：姜良铎） （北京中医药大学第一临床医学院东直门医院，北京 100700） 摘要：对《伤寒论》所载桂枝去桂加茯苓白术汤，后世就去桂历来有所争议。一般认为去桂枝目的在表已解 或津液伤，但此说无论在理论或临床角度出发均有矛盾。从《伤寒论》中细考，在小柴胡汤与麻黄汤加减法中， 张仲景在利小便时习惯去除有碍利水的药物；再与真武汤、附子汤、当归芍药散等方比较，可发现“茯苓、白 术、芍药同用的“苓术芍配伍”，用以专利小便时，则不用桂枝。桂枝去桂加茯苓白术汤证情属阳气郁滞，水气 停滞表里，三焦不畅，因此以苓术芍配姜草枣而不用桂枝，目的是从方药配伍的角度考虑，使全方专利小便、通 阳气、达表里、畅三焦。 关键词：桂枝去桂加茯苓白术汤；伤寒论；水停阳郁；桂枝；苓芍术甘汤 Discussion on meaning of removing Cinnamomi in the Cinnamomi Decoction removing Cinnamomi and adding Poria and Atractylodis Macrocephalae LI Yu-ming ( Director: JIANG Liang-duo ) ( Dongzhimen Hospital, The First Clinical School Affi liated to Beijing University of Chinese Medicine, Beijing 100700, China ) Abstract: In history, there was a debate on the removal of Cinnamomi in the ‘Cinnamomi Decoction removing Cinnamomi and adding Poria and Atractylodis Macrocephalae’, which was record in Treatise on Cold Pathogenic Diseases. Generally, the objective of removal Cinnamomi was because of no exterior pattern or damage of body fluid, but there was contradiction in both theoretically and clinically. In the textual research of Treatise on Cold Pathogenic Diseases, in the modifi ed method of Bupleuri Decoction and Ephedrae Decoction, ZHANG Zhong-jing used to remove the herbal which would obstruct the water-draining; Moreover, by comparison of Zhenwu Decoction, Aconiti Praeparata Decoction, Angelica sinensis and Paeonia lactifl ora Powder, discovered that the combination of ‘Poria, Atractylodis