[中医方剂学第4讲泻下剂.ppt

第四节 泻下剂 大黄附子（细心）汤《金匮要略》 组成：大黄9g　附子9g　细辛3g　 功用：温阳散寒，通便止痛 主治：寒实腹痛。猝然心腹胀痛，痛如锥刺， 气急，大便不通。 方歌：大黄附子细辛汤，胁下寒凝疝痛方； ? 冷积内停成实证，温下寒实可复康。 趣味记忆：?三物备急丸。? 燥屎不行—热结胃肠津液被灼，肠失濡润 热 脘腹胀满—燥屎内结，腑气不通 热阴无 结便 下之不通—邪热渐盛，阴津渐竭，无水行舟 结津水 阴秘 口干唇燥，舌红 热盛津亏之体征 胃被行 亏证 苔黄，脉弦数 肠灼舟 使 甘草—补脾胃以助扶正，且能调和诸药 泻热通便益气养血 君 大黄、芒硝 枳实、厚朴 臣 人参、当归 佐 桔梗—宣肺通肠腑 生姜、大枣—养胃和中 攻下热结，荡涤胃肠实热积滞 —益气养血，扶正祛邪使攻不伤正 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 滋泄 君 玄参—滋阴泄热通便 滋阴清热，增液通便 阴热 臣 麦冬、生地—滋阴生津 增通 佐使 大黄、芒硝—软坚润燥，泄热通便 液便 增液承气汤《温病条辨》 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 一、定义：凡以泻下药为主组成，具有通导大便，泻下积 滞，攻逐水饮等作用，治疗里实证的方剂，统称泻下 剂。 属“八法”中的“下法”。 三、适用范围：便结不通与水饮内停所致的里实证。 如：热结、寒结、燥结、水结等。 二、立法依据：《素问·阴阳应象大论》：“其下者，引 而竭之” “其实者，散而泻之” 概 述 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 寒下—里热积滞实证。 温下—里寒积滞实证。 润下—肠燥便秘。 逐水—水饮壅盛于里的实证。 攻补兼施—里实积滞而正虚者。 四、分类： Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd