四逆汤类方每服汤量变化对“保胃气”思想的体现

四逆汤类方所对应的疾病病机均为阴盛阳虚、脾肾阳衰,由于人身整体的阳气虚衰,脾胃阳气也会相应的减弱,因此四逆汤类方所治疗的疾病,在临床上也会出现诸多脾胃方面的证候表现。面对阳气的衰弱,临床治疗重在扶阳,而汤剂的服用,以水为媒介,水为阴,多饮则伤阳气。因此,治疗阳气虚衰这类疾病,就要考虑到患者每次服用汤药的量,不可猛喝而损伤脾胃阳气,反致病重。所以,在考虑到"保胃气"这个层面时,四逆汤类方的每服汤量相对于其他汤方服用时要小很多。《伤寒论》四逆汤类方的服用汤量变化,是兼顾了胃气衰微,受纳、运化等能力减弱而作出的调整,以避免不适量的汤药入胃而阻碍气机升降出入的正常运动,从而妨碍方药的疗效,这正是体现了"保胃气"思想。

"Protecting Stomach Qi" Reflected by Quantity Change per Serving of Type of Frigid Extremities Decoction in Treatise on Cold Damage Diseases

The pathogenesis of all the corresponding diseases treated by type of Frigid Extremities Decoction is due to excessive yin and deficient yang,yang deficiency of spleen and kidney.Because the whole body's yang qi is deficient,spleen-stomach yang qi will be weakened accordingly.Therefore,diseases treated by type of Frigid Extremities Decoction are marked by many aspects of the spleen and stomach syndrome in clinical practice.For deficient yang,strengthening yang is necessary.While in terms of decoction,water is the medium.Water belongs to yin,too much water will hurt yang qi,so the patient's dosage quantity per serving should be considered and too much usage at one time should be avoided,otherwise,spleen-stomach yang qi will be hurt,and the disease will be worsened.When considering "protecting stomach qi",quantity per serving of type of Frigid Extremities Decoction should be relatively smaller.This kind of change considers both weakened receiving,transport capacity due to deficient stomach qi and responding adjustment in order to avoid hindering the normal movement of Qi of ascending and descending due to improper amount of decoction,exertion of efficiency of drugs.This is just a manifestation of "protecting stomach qi".