Discussion on the dose-effect relationship of ginger in “Treatise on Febrile Diseases”-生姜在《伤寒论》中的量效关系探讨

Many Chinese medicines are from the same source of medicine and food. For example, ginger is a typical plant with source of medicine and food. Some doctors may think that ginger is optional in clinical prescriptions, but it is not. Ginger was first published in the “Famous Doctors” in the late Han Dynasty: “Taste pungent, mild temperature. Indications for typhoid fever, headache, nasal congestion, coughing, and vomiting. Also, ginger, lukewarm, pungent, return to Wu Zang. Remove phlegm, lower the breath, Relieving vomiting, eliminating wind and cold and heat. Taking Xiaozhi for a long time will make you feel sad.” The medical sage Zhang Zhongjing attaches great importance to the use of ginger. In his book “Treatise on Febrile Diseases” 113 prescriptions, 39 prescriptions contain ginger, or it is a monarch medicine. Or as an envoy. If ginger can be used in clinical practice, it can not only improve the curative effect, but also eliminate the adverse gastrointestinal reactions of some drugs. Therefore, it is necessary to study the law of ginger application, especially the relationship between the dose of ginger and the curative effect.

1. Analysis on the efficacy of ginger

1. Jie Biao Yi Wei, such as Guizhi Decoction. Guizhi Decoction contains three groups of square roots: Guizhi with licorice to transform yang, peony with glycyrrhizin to transform yin, and jujube with licorice to benefit stomach qi and nourish stomach yin. Ginger plays two roles in Guizhi Decoction. One is to walk the surface, the medicine to help the monarch and ministers to harmonize the camp and health; the other is to walk the inside, and the stomach to warm the yang and nourish the vital energy. Although there are only five herbs in this prescription, it is rigorous in compatibility and has nourishment in the powder. Just as Ke Qin praised Guizhi Decoction in “Treatise on Febrile Diseases” as the leader of Zhongjing Group’s prescriptions, it nourishes yin and yang, harmonizes camp and health, and relieves muscles. The general formula for sweating is also.”

Relieve vomiting with the stomach, such as the size of Chaihu decoction. Ginger is the “sacred medicine for vomiting”, and has a strong anti-vomiting ability for the stomach. Xiao Chaihu Decoction Syndrome “upset and vomiting”, Dachai Hu Decoction Syndrome “Heart is anxious, vomiting will not stop”, etc. In clinical practice, no matter whether external evil or internal crime or miscellaneous disease internal injury, it is common to see stomach-qi discord and nausea and vomiting. Wait for the symptoms of stomach qi reversal, add ginger to the clinical medication, and use it for more testing.
Wenyang Liyin is like small pinellia soup. The syndrome of this prescription is caused by stopping the phlegm and drinking in the heart, and the stomach qi fails to heal. It is suitable for treating phlegm and dispersing drink, and reducing the adverse effects of the stomach. In the prescription, Pinellia sinensis is used for warming, slippery body and dry sex, which can remove dampness, resolve phlegm and clear drinks, and can also reduce adverse effects and stop vomiting. It is a noble medicine. Ginger is pungent and warm, which can not only reduce the adverse effects and relieve vomiting, but also warm the stomach and benefit the drink, and make the poison of Pinellia ternata. It is both a ministerial medicine and an adjuvant. The two medicines are matched together to make phlegm and drink to dissolve, regress the stomach and cause vomiting to stop. The prescription created by Zhong Jing has important guiding significance for the treatment of phlegm-drinking and vomiting or stomach-qi stagnation syndrome in later generations, and it has become a classic combination of expectorant and dissolving drink or stomach-reducing and anti-vomiting.
Article 157 of “Treatise on Febrile Diseases”: “Typhoid fever, after sweating, the stomach is not harmonious, the heart is hard, the dry food is stink, there is moisture under the flanks, the thunder in the abdomen will be beneficial, and the ginger will relieve the heart. Soup is the main one.” Ginger Xiexin Decoction is made up of Banxia Xiexin Decoction and ginger. Therefore, the clinical use of ginger Xiexin Decoction must see the “piness” of Banxia Xiexin Decoction. What is “ribs”? Zhong Jing made it very clear that stubbornness means “fullness without pain, press it.” “Hu Xishu’s Treatise on Febrile Diseases and Miscellaneous Diseases” states: “The clinical symptoms of dry food stinking, it is difficult to cure with Banxia Xiexin Decoction, and ginger must be added.” Get rid of the riffles.
Warming the stomach and replenishing qi: Take ginger Xin San to warm the yang qi, and mix with sweet medicine to treat the abdominal pain caused by asthenia, deficiency and cold. Such as Wenjianzhongqi Xiaojianzhong Decoction, Huangqi Jianzhong Decoction, etc.; compatible with warming and tonic products to treat abdominal pain caused by blood deficiency and cold. Such as warming blood and dispelling cold angelica ginger and mutton soup; Compatible with roasted licorice and jujube to warm the stomach, nourish the source of blood, and cure the lack of qi and blood, lack of energy, pulse generation, heart palpitations, Zhigancao soup, To replenish qi and nourish yin, clear yang and restore pulse.
6. Harmonizing the stomach and detoxifying ginger can make the toxicity of pinellia, such as Xiaobanxia soup, Xiaochaihu soup, etc.; it can make the mutton flavor, such as angelica ginger and mutton soup; in addition, ginger can also detoxify fish and crabs, and has been widely used For folk diet therapy.

Two, about the dose analysis of ginger

In “Treatise on Febrile Diseases”, there are a total of 35 prescriptions that use ginger in the main prescription. The most used amount is 8 taels, and the minimum is only 6 baht (one tael is 24 baht). It can be seen that Zhong Jing uses ginger for different prescriptions. The dosage is very particular and the verification is very accurate.

1. Three or two prescriptions for ginger, a total of 20 prescriptions.

Mainly Guizhi Decoction, such as Guizhi Decoction, Guizhi Plus Gegen Decoction, Guizhi Thicken Puxingzi Decoction, Guizhi Plus Yellow Decoction, Guizhi Plus Aconite Decoction, Guizhi Plus Peony Decoction, Guizhi Qushaoyao Decoction , Guizhi to Guizhi plus Fuling Baizhu Decoction, Xiaojianzhong Decoction and so on. For example, Guizhi decoction syndrome “headache, fever, sweating, bad wind, slow pulse”, use the pungent of ginger, add cinnamon twig to relieve the skin, help cassia twig licorice to benefit health, and help peony and licorice to smooth fluid, and alleviate the whole body. The prescriptions play a total of expelling wind and relieving form, reconciling the effects of Ying and Wei, and treating the deficiency of sun form. In addition, Xiaochaihu Decoction, Daqinglong Decoction, Guizhi Fuzi Quguijia Baizhu Decoction also use ginger in threes, such as “retching” in Guizhi Decoction syndrome, “like vomiting” in Xiao Chaihu Decoction, and Pueraria lobata plus Banxia Decoction The “but vomiting person” of the card, mainly plays the role of anti-vomiting with Weijiangni.

2. There are 2 prescriptions for ginger with four or two prescriptions.

There are Ginger Xiexin Decoction and Guizhi Xinjia Decoction. For example, Guizhi plus peony and ginger each have one or two ginseng Sanliang Xinjia Decoction (Guizhi Xinjia Decoction), the amount of ginger is one or two to four taels more than Guizhi Decoction, which is intended to strengthen the power of warming the stomach and benefiting health. Article 62 of “Treatise on Febrile Diseases”: “After sweating, body pain, pulse delay, one or two cassia twigs, peony ginger, and three or two new decoctions.” After sweating, body pain is unresolved. Fayi Guizhi Decoction sweats to relieve it. However, if the pulse is too late, it is due to the deficiency of stomach qi and body fluid. Only the plain product of “grass jujube” cannot revitalize the stomach qi. Therefore, add powerful ginseng and ginger for warming the stomach to restore the stomach qi, and even more peony to nourish the stomach. Body fluid, pray to warm and nourish muscles.

3. There are 3 prescriptions for ginger with five liang prescriptions.

There are Dachaihu soup, Xuanfu Daizhe soup and Angelica ginger mutton soup. For example, the Dachaihu Decoction syndrome “emergency, vomiting”, the Xuanfu Daizhe soup syndrome “typhoid fever and sweating, if vomiting, if the symptoms, and after relieving, the heart is hard, the suffocation does not get rid of”, Angelica ginger mutton soup For the “cold hernia, abdominal pain, and hypochondriac pain”, ginger is used up to 50 taels, which is mainly reflected in the strengthening and anti-vomiting effect of the stomach.

4. Ginger uses Liuliang’s prescription. There is 1 prescription in total.

There is evodia soup. For example, “Evodia, vomiting, belongs to Yangming, and it is the master of Evodia decoction”, “For those with retching, salivation, and headache, it is the master of Evodia decoction.” The vomiting of Evodia decoction is more severe, so ginger is used to 60 taels or less. Strengthen the effects of reducing adverse effects and relieving vomiting in the stomach, combined with Evodia, ginseng, jujube, etc., have the effects of warming and replenishing deficiency, reducing nibbiness and relieving vomiting. Indications of liver and stomach deficiency and cold, turbid yin on the contrary syndrome. Symptoms: General vomiting after eating, or vomiting of acid water, or retching, or vomiting of salivation and cold foam, chest fullness, abdominal pain, peak headache, chills, cold limbs, and even with cold hands and feet, stool diarrhea, irritability Restlessness, pale tongue, white slippery fur, heavy pulse or delayed pulse. It is often used clinically to treat chronic gastritis, vomiting during pregnancy, neuropathic vomiting, neuropathic headache, otogenic vertigo and other patients with liver and stomach deficiency and cold.

5. There are 3 prescriptions for ginger.

There are Houpu Ginger Banxia Licorice Ginseng Decoction, Xiao Banxia Decoction and Angelica Sini plus Evodia Ginger Decoction. Such as “after sweating, full of abdominal distension, Magnolia ginger Pinellia licorice ginseng soup is the main one.” Symptoms are full of abdominal distension, fullness of the heart, anorexia, vomiting, thin or white fur, weak pulse and other symptoms. This prescription focuses on eliminating but not replenishing, which can be described as “seven elimination and three replenishment”. Therefore, the dosage of ginseng and licorice should be small to avoid flatulence and stagnation.

6. Other dosages total 7 cubic meters.

There are half soup of Guizhi Mahuang, one or two ginger for Chaihu and Glauber salt soup, one or two ginger for Guizhi Eryue soup, one or two ginger for Guizhi Eryue soup, one or two ginger for Guizhi two ephedra soup, Chaihu, Guizhi soup and scutellaria Add one and two halves of ginger for Banxia Decoction, and ginger for Ephedra Lianqiao Chixiaodou Decoction. The amount of ginger is small. It is mainly used for epiphysis and mild syndrome. It is used with anti-epidermis such as Guizhi, Ephedra and Bupleurum. Use Yiwei to disperse evil spirits. The so-called serious illnesses are also serious medicines, and light illnesses are also light medicines.

Three, on the dose-effect relationship of ginger

Ginger is warm, Xinneng disperses and walks, and warm energy helps the sun warm the sun. Its active part can be on the surface or inside. When the amount of ginger is small (less than two to two), it is only used in the table to help Guizhi, ephedra and other antimony drugs to dispel evil and relieve the table, and to reconcile the Yingwei. It is mostly used for the table depression and mild syndrome, such as Gui Ma Ge Ban Tang. When the amount of ginger is medium (three to four taels), it can not only take the surface, relieve the appearance and dispel cold, reconcile the camp and health, but also walk the inside. It can be used with Pinellia jujube and stomach drink to reduce the adverse effect and relieve vomiting, such as Xiao Chai Hu Tang . When ginger is used in a larger amount (more than five or two), the main effect is in the inside, and it has the functions of warming the stomach and relieving vomiting, warming the middle and reducing the inverse, warming the yang benefit, and warming the yang tonic, such as Xiaobanxia soup, Xuanfudaizhe soup, thick Piaosheng ginger pinellia licorice ginseng soup and so on. Ginger is the “sacred medicine for vomiting”. Therefore, the more severe the stomach qi is not harmonious, the more severe the stomach qi, the more serious the symptoms of vomiting, the greater the dose of ginger used by Zhongjing. Mo Meishi said in the “Explanation of Classics and Prescriptions”: “It is easy to occur on the surface, but difficult to occur on the inside.” It is the most reasonable to use large doses of ginger to treat stomach qi and other internal syndromes, and it has also been clinically verified.

This article is excerpted from “Inquiry into the Origin and Development of Classical Prescriptions”

中药有不少是药食同源的,如生姜就是典型的药食同源植物。或有医者认为生姜在临床处方中可有可无,其实不然。生姜始载于汉末的《名医别录》:“味辛,微温。主治伤寒头痛、鼻塞、咳逆上气,止呕吐。又,生姜,微温,辛,归五藏。去痰,下气,止呕吐,除风邪寒热。久服小志少智,伤心气。”医圣张仲景非常重视生姜的运用,在其著作《伤寒论》113方中有39条方含有生姜,或为君药,或为佐使。在临床中若能运用生姜得法,不仅可提高疗效,亦可消除部分药物对胃肠不良反应,因此有必要研究生姜的应用规律,特别是生姜的剂量与疗效关系。

一、关于生姜的功效分析

1.解表益卫 如桂枝汤类方。桂枝汤含有三组方根:桂枝配甘草辛甘以化阳,芍药配甘草酸甘以化阴,大枣配甘草益胃气、养胃阴。生姜在桂枝汤中起两方面作用,一是走表,助君臣之药以调和营卫;二是走里,和胃以温阳益气畅津。本方虽只有五味药,但配伍严谨,散中有补,正如柯琴在《伤寒论附翼》中赞桂枝汤“为仲景群方之魁,乃滋阴和阳,调和营卫,解肌发汗之总方也。”

  1. 和胃止呕 如大小柴胡汤。生姜是“呕家圣药”,和胃止呕能力超强。小柴胡汤证“心烦喜呕”,大柴胡汤证“心下急,呕不止”等,临床中无论外邪内犯,还是杂病内伤,均常兼见胃气不和而见恶心、呕吐等胃气上逆的症状,临证用药多加配生姜,用之多验。
  2. 温阳利饮 如小半夏汤。本方证因痰饮停于心下,胃气失于和降所致。治宜化痰散饮,和胃降逆。方中用半夏辛温,体滑而性燥,可燥湿化痰涤饮,又能降逆和中止呕,是为君药。生姜辛温,既能降逆止呕,又可温胃利饮,且制半夏之毒,是臣药又兼佐药之用。二药相配,使痰祛饮化,逆降胃和而呕吐自止。仲景所创该方,对于后世痰饮呕吐或胃气上逆证的治疗具有重要的指导意义,已成为祛痰化饮或和胃降逆止呕的经典配伍组合。
  3. 散结消痞 《伤寒论》157条:“伤寒,汗出解之后,胃中不和,心下痞硬,干噫食臭,胁下有水气,腹中雷鸣下利者,生姜泻心汤主之。”生姜泻心汤即由半夏泻心汤加生姜四两而成,故临床使用生姜泻心汤必见半夏泻心汤的“痞”。何为“痞”?仲景讲得非常清楚,痞即是“满而不痛,按之濡”。《胡希恕讲伤寒杂病论》中说:“临床所见干噫食臭症状,用半夏泻心汤难以治愈,必加生姜”,确是经验之谈,可见生姜擅长和胃降逆,散结消痞。
  4. 温胃益气 取生姜辛散温通阳气,配甘药治虚劳虚寒里急的腹痛。如温建中气的小建中汤、黄芪建中汤之类;配伍温补之品,以治血虚寒结的腹痛。如温血散寒之当归生姜羊肉汤;配伍炙甘草、大枣以温养胃气,资营血之源,而治气血不足,心力不继,脉结代、心动悸之炙甘草汤,以益气滋阴,通阳复脉。

6.和胃解毒 生姜可制半夏毒性,如小半夏汤、小柴胡汤等;可制羊肉之膻味,如当归生姜羊肉汤;此外,生姜还可解鱼蟹之腥毒,已广泛用于民间食疗方。

二、关于生姜的剂量分析

在《伤寒论》中共有35条方在主方中用到生姜,用量最多者用至8两,最少仅用6铢(一两为24铢),可见仲景用生姜针对不同的方证,用量非常讲究,对证十分精准。

1.生姜用三两的方剂 共20方。

主要是桂枝汤类方,如桂枝汤、桂枝加葛根汤、桂枝加厚朴杏子汤、桂枝加大黄汤、桂枝加附子汤、桂枝加芍药汤、桂枝去芍药汤、桂枝去桂枝加茯苓白术汤、小建中汤等。如桂枝汤证“头痛,发热,汗出,恶风,脉缓”,用生姜之辛,佐桂枝以解肌表,助桂枝甘草以益卫,助芍药甘草以畅津,合全方共奏祛风解表,调和营卫之功效,治疗太阳表虚证。此外,小柴胡汤、大青龙汤、桂枝附子去桂加白术汤也是用生姜三两,如桂枝汤证的“干呕”,小柴胡汤证的“喜呕”,葛根加半夏汤证的“但呕者”,主要起和胃降逆止呕的作用。

2.生姜用四两的方剂 共2方。

有生姜泻心汤和桂枝新加汤。如桂枝加芍药生姜各一两人参三两新加汤(桂枝新加汤),生姜用量比桂枝汤多一两达四两,意加强温胃益卫之力。《伤寒论》第62条:“发汗后,身疼痛,脉沉迟者,桂枝加芍药生姜各一两人参三两新加汤主之。”发汗后,身复疼痛,为外未解,法宜桂枝汤发汗以解之。但如果见脉沉迟,为胃气津两虚,只凭“草枣”平淡之品己无力振兴胃气,故加补中有力的人参和温中健胃的生姜以复胃气,更加芍药以滋津液,祈能温养肌腠。

3.生姜用五两的方剂 共3方。

有大柴胡汤、旋覆代赭汤及当归生姜羊肉汤。如大柴胡汤证的“心下急,呕不止”,旋覆代赭汤证的“伤寒发汗,若吐、若下、解后,心下痞硬,噫气不除者”,当归生姜羊肉汤证的“寒疝,腹中痛,及胁痛里急者”,生姜均用至五两,主要体现在加强和胃降逆止呕的作用。

4.生姜用六两的方剂 共1方。

有吴茱萸汤。如“食谷欲呕,属阳明也,吴茱萸汤主之”,“干呕,吐涎沫,头痛者,吴茱萸汤主之。”吴茱萸汤证的呕吐比较厉害,因此生姜用至六两以加强降逆和胃止呕之功效,配合吴茱萸、人参、大枣等具有温中补虚,降逆止呕之功效。主治肝胃虚寒,浊阴上逆证。症见食后泛泛欲吐,或呕吐酸水,或干呕,或吐清涎冷沫,胸满脘痛,巅顶头痛,畏寒肢冷,甚则伴手足逆冷,大便泄泻,烦躁不宁,舌淡苔白滑,脉沉弦或迟等症。临床常用于治疗慢性胃炎、妊娠呕吐、神经性呕吐、神经性头痛、耳源性眩晕等属肝胃虚寒者。

5.生姜用八两的方剂 共3方。

有厚朴生姜半夏甘草人参汤、小半夏汤和当归四逆加吴茱萸生姜汤。如“发汗后,腹胀满者,厚朴生姜半夏甘草人参汤主之。”症见腹胀满,心下痞满,纳差,呕吐,苔薄白或白腻,脉无力等症。本方证重在消而不在补,可谓“七消三补”,因此人参和甘草用量宜小,以免胀气滞气。

6.其他用量 共7方。

有桂枝麻黄各半汤、柴胡加芒硝汤用生姜一两,桂枝二越婢一汤用生姜一两二铢,桂枝二麻黄一汤用生姜一两六铢,柴胡桂枝汤及黄芩加半夏汤用生姜一两半,麻黄连翘赤小豆汤用生姜二两等,生姜用量少,主要是用于表郁轻证,配合桂枝、麻黄、柴胡等解表药,轻佐以益卫散邪。即所谓病重药亦重,病轻药亦轻也。

三、关于生姜的量效关系

生姜辛温,辛能散能走,温能助阳温阳,其作用部位既可在表也可在里。生姜用量较少时(二两以下),仅在表助桂枝、麻黄等解表药祛邪解表,调和营卫,多用于表郁轻证,如桂麻各半汤。生姜用量中等时(三至四两),既可走表,解表散寒,调和营卫,又可走里,配合半夏大枣等和胃利饮,降逆止呕,如小柴胡汤。生姜用较大量时(五两以上),主要作用在里,起温胃止呕、温中降逆、温阳利饮、温阳补中的作用,如小半夏汤、旋覆代赭汤、厚朴生姜半夏甘草人参汤等。生姜为“呕家圣药”,因此,胃气不和、胃气上逆越厉害,呕逆症状越严重,仲景用生姜的剂量也越大。莫枚士在《经方例释》说:“在表易发,在里难发”,治胃气上逆等里证,生姜用大剂量是至理,在临床上也得到验证。

本文摘自《经方源流临证探微》

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