Analysis of Guizhi Zhimu Shaoyao Decoction in Synopsis of the Golden Chamber-《金匮要略》桂枝知母芍药汤解析

[Original] The limbs are painful, the body is strong, the feet are swollen like off, the head is dizzy, short of breath, warm and vomiting, Guizhi Peony Anemarrhena decoction is the main one.

[Explanation] Those who traverse the joints, the pain in the limbs refers to the pain in each joint, which is caused by rheumatic arthralgia. Due to wind dampness blocking the collaterals, poor circulation of qi and blood, and long-term physical consumption, the body is thin, weak in movement, thin limbs and swollen joints, similar to the knees of cranes, swollen feet seem to be separated from the body, numbness, and disturbance of wind evil. Yang leads to dizziness, dampness obstructs the middle focal point, chest tightness and shortness of breath, and stomach discomfort leads to nausea and vomiting. The main treatment is Guizhi Shaoyao Zhimu Decoction, which disperses wind and cold, dispels dampness and relieves pain.

[Therapeutic Law] Dispel wind and dampness, warm the meridians and dispel cold.

[Composition of prescriptions] Guizhi 4 taels, peony 3 taels, licorice 2 taels, Ephedra 2 taels, ginger 5 taels, Atractylodes 5 taels, Anemarrhena vulgaris 4 taels, Fangfeng 4 taels, and Aconite 2 taels (cannons).

[Administration and Taboos] Take seven liters of water for the top nine flavors, boil two liters, take Qihe warmly, and take three days a day.

[Theory of Classic Prescriptions] This prescription is composed of Guizhi Decoction Shaodazao, Mahuang Decoction Shao almonds plus Atractylodes, Aconite, Fangfeng and Zhimu. Take Ma and Gui in the prescription to dispel wind and cold, and relieve the cold and heat in the surface. It can be seen that when there is cold and heat in the prescription, use Atractylodes macrocephala to invigorate the spleen to dry the inner dampness, and aconite to warm the meridian to dispel cold and relieve pain. Because this syndrome is incomprehensible to heat, adding aconite but also fearing to help yang, it is used to reduce dryness, wind-proof and Guima are combined to dispel wind and cold, and the dosage of ginger is exclusively used to disperse water and dampness, and the spleen and stomach, to prevent nausea. If the prescription is to go to Zhimu, it is easy to prevent oneself, enhance the power of removing dampness and heat, and also supervise the dryness of aconite, plus astragalus for replenishing qi and removing dampness, its effect is better.

【New Use of Jing Fang】

(1) Guizhi Shaoyao Zhimu Decoction with 15 grams of Gentiana sylvestris, 30 grams of Salvia miltiorrhiza, 30 grams of Weilingxian, 8 grams of Fangji, it is effective in treating rheumatic arthralgia and joint swelling and pain.

(2) Guizhi Shaoyao Zhimu Decoction to remove ephedra, Zhimuyi ginseng 15 grams, and tangerine peel 15 grams, treat irritable bowel syndrome with strong liver and weak spleen.

[Hu Xishu’s medical records and clinical experience] Xu, male, 19 years old. The date of first visit was February 15, 1966. The left foot has been swollen and painful for five or six years, and it has worsened in the past two years. After taking X-ray film, it was confirmed to be calcaneal bone hyperplasia. Present symptoms: left foot swelling and pain, fear of cold, severe pain when walking, not thinking about drinking, thin white coating, sinking pulse. This rheumatism belongs to the syndrome of Sun Shaoyin, and it is the prescription of Guizhi Shaoyao Zhimu Decoction: Guizhi 12g, Ephedra 6g, White Peony 9g, Anemarrhena 12g, Ginger 12g, Sichuan Aconite 6g, Fangfeng 12g, Atractylodes 12g, Roasted Licorice 6g .

Result: After taking 7 doses of the medicine, the pain in the left heel was reduced, and the pain remained after walking, and the recovery was faster after rest than before treatment. Zengchuan Aconite was taken after 9g. After 1 month, the left heel swelled and the pain was not obvious.

[Interpretation and Appreciation] This prescription is mostly used for chronic rheumatism and rheumatoid arthritis with syndrome of Taiyang Shaoyin, especially those who see joint swelling and deformation accompanied by qi reversal. If rheumatic fever and joint swelling are obvious, plaster can be added.

Chen Ruichun’s medical case:

Liu ××, female, 27 years old, kindergarten teacher. First visit on April 8, 1979. When the patient saw a doctor, the joints of the two fingers were swollen, painful and deformed, and the pain was worse under cold water. The morning stiffness was obvious, the fingers could not bend, and the pain became worse in rainy days, and the local redness and swelling were obvious. Anti-“O”, normal erythrocyte sedimentation rate, positive rheumatoid factor

Positive). Others such as menstruation, diet, two stools, and sleep are the same, but the pain at night when the attack occurs, which affects sleep, the pulse is slow and stringy, the tongue is light and the blood pressure is normal.

Prescription: 10g of Guizhi, 15g of Radix Paeoniae Alba, 10g of Attached Tablets, 6g of Raw Ephedra, 15g of Anemarrhena, 10g of Atractylodes Macrocephalae 10g, 10g of Fangfeng, 10g of Qinguang, 6g of Sichuan and Caowu each, 5g of Roasted Licorice and 3 Pieces of Ginger. Take 1 dose a day and decoct for 1 hour. Decoction 2 times in divided doses.

Second visit, April 20. After taking the above 10 doses, I felt that the pain in the joints of the fingers was relieved, the morning stiffness disappeared, the pain and pain of washing with cold water were alleviated, and the others were still normal. Ask the original prescription to enter again.

Third visit, November 5. The patient took the medicine at the unit and took more than 40 doses successively. The redness and swelling of the finger joints basically subsided, the deformation did not increase, and the others were all normal. The pulse is slow and the tongue is soft. Guard the top before entering. Add another party and take the two alternately.

Recipe: 10g of Alone, 20g of Parasite, 10g of Gentiana, 3g of Asarum, 10g of Parsnip, 15g of Rehmanniae Rehmanniae, White

Peony root 10g, Chuanxiong 5g, Angelica 10g, Guizhi 10g, Poria 15g, Eucommia 10g, Achyranthes bidentata 15g, Codonopsis 15g, Raw Astragalus 15g, Mulberry Branch 15g. Decoction 1 dose a day, decocted 2 times in divided doses.

After that, the patient went to another place for medical treatment and was treated with insect medicine in a specialist hospital, but the symptoms were not improved. Sometimes I come to follow-up and use the first two alternately.

On October 15, 2001, he came back for a follow-up visit. The patient complained: After receiving the above treatment, the finger joints remained stable in their original appearance, the deformation did not aggravate, and he was able to take care of himself and insisted on going to work.㔾Menopausal for more than a year, full body, keep exercising, and retire at home. The above two prescriptions are still taken alternately.

Note: Rheumatoid arthritis is similar to Lijie wind pain in the “Golden Chamber”. Clinically, Guizhi Shaoyao Zhimu Decoction can be used to control symptoms. After treating many cases, the effect of relieving symptoms can be achieved. The author has the following experience:

(1) Rheumatoid arthritis should be detected, diagnosed and treated early. A worker who once treated a female seal engraving, when he found pain and swelling in his right index finger joint, came to see a doctor, and immediately gave Guizhi Shaoyao Zhimu Decoction. After taking 15 doses, he has not relapsed. Therefore, it should be controlled as soon as possible, because the disease is expensive in early treatment.

(2) For the treatment of rheumatoid arthritis, Guizhi Shaoyao Zhimu Decoction is the effective first choice. It should be added to this prescription to make Chuancaowu to enhance the curative effect of Wentong, and it should be taken for a long time, 40 doses, 50 doses or more. Until the symptoms are controlled, it is still necessary to consolidate from the upper side, but if the yin is weak, the medication will be very difficult. It will not work without warming, and it will hurt the yin with warming. There is no better way.

(3) The problem of using Duhuojijie Decoction. Originally, Duhuojijietang was a recipe for invigorating qi and blood, nourishing liver and kidney, but for patients with rheumatoid arthritis, after pain relief and symptom relief, it should be used in conjunction to make it nourishment, nourishment, and beneficial.

(4) The problem of using insect medicine. Many doctors use the method of searching wind to dry blood, which has no obvious effect on rheumatoid arthritis, and the reaction to dry blood is obvious after taking a lot of long-term use, so it is recommended to use less or not.

(5) The problem of using hormones to relieve pain. In the case of unbearable pain, use it for a period of time to relieve it. But just accept it when you see it. Long-term use is prone to cause osteoporosis, and at best, the gains and losses are mixed. In other words, the losses are greater than the gains. At present, there are tripterygium wilfordii drugs on the market. These drugs may be effective for some patients for a while, but long-term use of liver damage should not be ignored.

In short, both Chinese and Western medicines were not ideal for the treatment of this disease. The traditional Chinese medicine uses Guizhi Shaoyao Zhimu Decoction to add flavor, no toxic side effects are seen, and long-term use is also worry-free. Other hormone treatments, such as Tripterygium wilfordii and insect drugs, have found toxic side effects, which are worthy of further exploration and discussion.

Author: Wu Xiufei

【原文】诸肢节疼痛,身体魁赢,脚肿如脱,头眩短气,温温欲吐,桂枝芍药知母汤主之。

【诠释】历节者,遍历关节,诸肢节疼痛是指各关节都出现疼痛感,此乃风湿痹阻不通所致。由于风湿阻络,气血运行不畅,长期形体消耗,故身体廓瘦,活动无力,肢细而关节肿大,形同鹤膝一般,脚肿似与形体脱离,麻木不仁,风邪上扰清阳则头眩晕,湿阻中焦则胸闷短气,胃失和降则呕恶欲吐,治主桂枝芍药知母汤,发散风寒,祛湿止痛。

【治法】祛风除湿,温经散寒。

【方药组成】桂枝4两,芍药3两,甘草2两,麻黄2两,生姜5两,白术5两,知母4两,防风4两,附子2枚(炮)。

【服法与禁忌】上九味,以水七升,煮取二升,温服七合,日三服。

【经方方论】本方是桂枝汤少大枣,麻黄汤少杏仁另加白术、附子、防风、知母所组成。方中取麻、桂发散风寒,解在表之寒热,可见方证中当有寒热不解候,用白术健脾以燥里湿,附子温经散寒止痛。由于本证热不解,加附子又恐助阳,故佐知母以减其燥,防风与桂麻相合,表散风寒,生姜用量独重,散水湿,和脾胃,以止吐逆。本方若去知母易防己,增强祛湿热之力又可监制附子之燥,外加黄芪益气祛湿,其效更佳。

【经方新用】

(1)桂枝芍药知母汤加秦艽15克,丹参30克,威灵仙30克,防己8克,治疗风湿热痹,关节肿痛有佳效。

(2)桂枝芍药知母汤去麻黄、知母易人参15克,陈皮15克,治疗肝强脾弱之肠易激综合征。

【胡希恕医案与临证心得】徐某,男,19岁。初诊日期1966年2月15日。左足肿痛已五六年,近2年加重。经摄X线片,证实为跟骨骨质增生。现症:左足肿痛,怕冷,走路则痛甚,不思饮,苔薄白,脉沉弦。此风湿属太阳少阴合病,为桂枝芍药知母汤方证:桂枝12g,麻黄6g,白芍9g,知母12g,生姜12g,川附子6g,防风12g,苍术12g,炙甘草6g。

结果:上药服7剂,左足跟痛减,走路后仍痛,休息后较治疗前恢复快。增川附子为9g继服,1个月后左足跟肿消,疼痛已不明显。

【解读赏析】本方多用于慢性风湿、类风湿关节炎呈现太阳少阴合病,尤其是见关节肿大变形而伴见气冲呕逆者。若风湿热关节红肿热明显者,可加生石膏。

陈瑞春医案:

刘××,女,27岁,幼儿教师。1979年4月8日初诊。患者就诊时,两手指关节肿痛变形,下冷水则疼痛更甚,晨僵明显,手指已不能弯曲,遇阴雨天疼痛加剧,局部红肿明显。抗“O”、血沉正常,类风湿因子阳性(经多次检查均呈

阳性)。其他如月经、饮食、二便、睡眠皆无异,惟发作时夜间疼痛,影响睡眠,脉缓稍弦,舌淡润,血压正常。

处方:桂枝l0g,白芍15g·制附片10g,生麻黄6g,知母15g,白术10g,防风10g,秦光10g,制川、草乌各6g,炙甘草5g、生姜3片。每日1剂,久煎1小时.煎2次分服。

二诊,4月20日。服上方10剂,自觉手指关节胀痛感减轻,晨僵消失,洗冷水疼胀痛减轻,其他仍正常,嘱其原方再进。

三诊,11月5日。病者在单位取药,先后服40多剂,手指关节红肿基本消退,变形未见加重,其他均正常。脉缓,舌淡润。守上方再进。另加一方,两者交替服用。

处方;独活10g,寄生20g,秦艽10g,细辛3g,防风10g,熟地15g,白

芍10g,川芎5g,当归10g,桂枝10g、茯苓15g,杜仲10g,牛膝15g,党参15g,生黄芪15g,桑枝15g。水煎每日1剂,煎2次分服。

此后,患者还到外地就医,在专科医院用虫类药治疗,亦未能改善症状。有时也来复诊,用前两方交替使用。

2001年10月15日又来复诊,病者诉:自接受上述治疗后,手指关节仍稳定在原来的模样,变形未加重,生活能自理,坚持上班。㔾停经一年多,体态丰满,坚持锻炼,退休在家。仍以上两方交替服用。

按:类风湿性关节炎与《金匮》历节风痛相似,临床均以桂枝芍药知母汤加减能控制症状。经治多例,能取得缓解症状的效果。笔者有如下几点体会:

(1)类风湿性关节炎,应早发现、早确诊、早治疗。曾治一例女性刻印章的工人,当发现右食指关节疼痛红肿,前来就诊,当即予桂枝芍药知母汤,服15剂后,一直未复发。故应及早控制,此病贵在早治。

(2)治疗类风湿性关节炎,桂枝芍药知母汤是有效的首选方。应当在此方中加人制川草乌,增强温通的疗效,且应久服,40剂、50剂或更多。直至控制症状后,仍须以上方巩固,但若阴虚体质,用药则很为难,不用温通不行,用温通又伤阴,十分棘手,目前还没有更好的方法。

(3)用独活寄生汤的问题。本来独活寄生汤是补气活血、滋养肝肾之方,但对类风湿性关节炎患者,在止痛缓解症状后,应当配合用,使之滋养调补有益无损。

(4)用虫类药的问题。不少医者采用搜风燥血之法,对类风湿性关节炎并没有明显的疗效,且大量久服使之燥血的反应很明显,故主张少用或不用。

(5)用激素止痛的问题。在疼痛难忍的情况下,用一段时间,可以缓解一下。但应见好就收。长期使用易使骨质疏松、最多是得失参半.或者说失大于得。目前市场上还有雷公藤类药,这些药对有的患者可取效一时,但长期使用对肝脏损害不可忽视。

总之,本病日前的治疗状况,中西药均不理想。中药用桂枝芍药知母汤加味,未见有毒副作用,长期使用亦无虑。其他的激素治疗,如雷公藤、虫类药均发现毒副作用,值得进一步摸索和探讨。

作者:吴修飞

Leave a Reply

Your email address will not be published.