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甘温补虚的小建中汤-
甘温补虚的小建中汤

甘温补虚的小建中汤

【名词解释】

『建中』有建设中焦的意思。中焦在中医学中主要指脾胃,具有消化、吸收、转输水谷精微和化生气血的功能。

小建中汤是仲景名方,药物组成共六味。

药性甘温,能补虚

小建中汤是中医学中的一张名方,出自我国东汉医学家张仲景所著的《伤寒杂病论》中,用于治疗中焦脾胃虚寒,以致阴阳两虚,以阳虚为主的病症。其药物组成有饴糖一升(30克)、桂枝三两(9克)、白芍六两(18克)、炙甘草一两(6克)、生姜三两(9克)及大枣十二枚(30克)。

其中,桂枝、甘草温补阳气,白芍、甘草补益阴液,生姜、大枣鼓舞胃气。处方中,关键药物是饴糖,它专入脾胃,温中补虚缓急止痛的作用首屈一指。

中医理论认为,要想使阴阳虚损得以恢复,必须针对选用补充阴和阳的药物,但是这些药物要想被人体利用,还必须借助强健的脾胃运化才能实现。而一旦人体出现虚证,往往脾胃已经先虚,很难有效的行使其运化功能。饴糖正是为此而设,通过强壮脾胃,使阴阳得以恢复,所以,是本方的主药(君药)。

历代医家都公认,本方是甘温补虚的代表方剂,在中医方剂学中占有重要地位。它不仅治疗脾胃病,还能治疗内科杂病。

在《伤寒杂病论》详细列举了本方所治的病症,共有五条条文,分列如下:

“伤寒,阳脉涩,阴脉弦,法当腹中急痛,先予小建中汤。”

“虚劳,里急,悸衄腹中痛,梦失精,四肢酸疼,手足烦热,咽干口燥,小建中汤主之。”

“伤寒二三日,心中悸而烦者,小建中汤主之。”

“妇人腹中痛,小建中汤主之。”

“男子黄,小便自利,当与虚劳小建中汤。”

可以看出,本方主要治疗二种病症,即腹中急痛与虚劳。为了便于大家使用,现将本方的有关使用事项介绍如下。

1.腹中急痛

在宋代《苏沈良方》中有这样一段文字:“尝有人患心腹病不可忍,累用良医治之皆不效……士人陈承善医,投一剂遂定。问之,乃小建中汤。此药偏治腹中虚寒,补血,尤主腹痛。常人见其药性温平,未必信之。古人补虚只用此体面药,不须附子、硫磺。(陈)承用此药治腹痛如神,然腹痛按之便痛,重按却不甚痛,此止是气痛……气痛不可下,下之愈痛。此虚寒证也,此药尤相当。”

这段文字是对本方所能治疗腹痛特点的最佳解释。从中可以看出:小建中汤治疗腹痛效果神奇,一剂止痛。但是,本方并不是适用于所有的腹痛,只适用于“气痛”。这种腹痛的特点是“按之便痛,重按却不甚痛”,即所谓虚寒性腹痛。也就是说,实证、热证所引起的腹痛不能用本方治疗。

临床中,还有另外一种腹痛,特点是:上腹部疼痛,空腹时出现,进食后腹痛缓解,即所谓的“饥饿痛”。这种腹痛临床也很常见,用小建中汤也可缓解。这种腹痛常见于十二指肠球部溃疡或者高胃酸状态。有趣的是,服用本方后,不仅溃疡得以愈合,腹痛缓解,原有的反酸烧心也能很快得到缓解。

2.虚劳

虚劳,是中医学中特有的一类病证。病证的本质为人体的阴阳气血均有严重的虚损,而它的临床表现则多种多样。《伤寒杂病论》原书中即有“虚劳里急,悸,衄,腹中痛,梦失精,四肢酸疼,手足烦热,咽干口燥”“心中悸而烦者”“妇人腹中痛”“男子黄”等多种表现,但是总以极度的虚弱表现为其核心特征。

这类病人有一个共同的特征:胃口一般很差,进食量少,周身肌肉酸痛难忍,大便也不通畅,舌质胖大,舌苔少,脉象弦细。具备这样的特征,是应用小建中汤的适应症。现代临床报道,小建中汤常用于治疗胃十二指肠球部溃疡、慢性肝炎、神经衰弱、再生障碍性贫血、功能性发热、各种大病后出现的精神体力衰惫等病症。

哪些人不适合用小建中汤?

《伤寒杂病论》原书在小建中汤方后注明:“呕家不可与建中汤,以甜故也。”意思是,经常呕吐的病人不适宜服用小建中汤。此外,有痰湿瘀滞,或气血瘀滞,或阴虚火旺之人也不能使用。这些人多有明显的痰湿和瘀滞征象,表现为舌苔腻厚、脉象滑数,进食不慎很容易上火。此外,由于方中有含糖药物,糖尿病人、感冒患者不宜服用。

中成药和汤药的效果一样吗?

小建中汤中的主药是饴糖,它在本方中有至关重要的“建中”作用;如果去掉饴糖,就不能称为小建中汤,也不具有温中补虚而“建中”的作用,更不能治疗虚劳,所治的腹痛也不是脾胃虚寒证的腹痛。

而目前市售的中成药制剂“小建中颗粒”和“小建中胶囊”,虽然冠名“小建中”,但是仔细阅读这两种中成药的药物说明书,其中的“主要成分”中并无饴糖,但在“功能主治”仍提及“温中补虚,缓急止痛”,从医理分析,显然不妥。此外,在“适用疾病”中都提及治疗“胃炎”“功能性消化不良”,但在小建中胶囊说明书“适用疾病”中竟有“虚寒泄泻”,显然从“主要成分”判断,小建中胶囊不具备此治疗功效。因此,单从药物说明书看,这两种中成药在文字内涵方面有明显的缺陷。

所以,笔者认为,目前市售的中成药不能代替小建中汤,请大家在选用时予以注意。

“小建中汤”的姊妹方

在《伤寒杂病论》中还有黄芪建中汤、《备急千金要方》内补当归建中汤和大建中汤,可以说都和“小建中汤”有联系。

黄芪建中汤是在小建中汤基础上加“黄芪一两半”(4.5克),治疗“虚劳里急,诸不足”。与小建中汤比较,治疗虚劳和腹痛更适宜,所以在临床上黄芪建中汤更为多用。

当归建中汤是在黄芪建中汤基础上加入“当归四两”(12克),与小建中汤相比,补气养血作用更强,用以治疗“妇人产后虚羸不足,腹中刺痛不止,吸吸少气”“产后一月日,得服四五剂为善,令人强壮”等病证。可见本方更适宜用于治疗女性产后的腹痛虚弱。

大建中汤也以饴糖为主药,加了川椒、干姜和人参,与小建中汤相比,温中散寒止痛作用更加突出,治疗“心胸中大寒痛,呕不能饮食,腹中寒,上冲皮起,出见有头足,上下痛而不可触近”。对于脾胃寒邪盛而脾胃虚引起的腹痛呕吐更为适宜。

点击下方图片,足不出户,即可与神黄名医在线交流! 

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