【方剂学】逐水剂--十枣汤 Ten Jujubes Decoction

逐水剂

适用于水饮壅盛于里之实证

代表方：

十枣汤👈👈

禹功散

1. 十枣汤--攻逐水饮

甘遂、大戟、芫花、大枣

1a. 组成

君：

a. 甘遂 (Kansui)

苦寒有毒，善行经隧之水湿

b. 大戟 (Euphorbia)

苦寒，善泻脏腑之水邪

c. 芫花 (Dahlia)

辛温，善消胸胁伏饮痰癖

佐使：大枣 (Jujube)

益脾缓中，防止逐水伤及脾胃
缓和诸药毒性，使邪去而不伤正
培土制水

【主以峻下逐水，佐以甘缓补中】

1b. 主治

1. 悬饮：水饮壅盛，停聚于里，内外泛滥

咳唾胸胁引痛，或胸背掣痛不得息：饮停胸胁，上迫于肺，气机阻滞

甚则胸背掣痛不得息

心下痞硬，干呕短气：水饮停于心下

心下痞硬：胃脘部堵塞满闷不适，按之硬满的症候

多因胃气虚弱，邪气逆结所致

干呕：无物有声

实：因邪气犯胃，致气机失调
虚：因久病耗伤胃气，使胃通降功能失常

短气：呼吸短促，不能接续，似喘而无喘症

虚证：与少气同属肺气不足
实证：与喘相似

实喘：病邪壅塞于肺，气道不畅
虚喘：肺肾气虚，肾不纳气

头痛目眩：上扰清阳

舌苔白滑：外感寒湿，水湿内停

脉沉弦：肝郁气滞、或水饮内停

沉：轻取不应,重按始得。（沉脉显现的部位较正常脉深）

病症：里证，为阴脉

里实：沉而有力

气血内困于里。多因水、寒、积滞所致（寒主收引，水性沉潜，积滞则阳气伏郁）。

弦：脉力较强、脉道较硬、两端绷紧，触手点长

主肝胆病、疼痛、痰饮、虐疾—— 弦为肝脉，为气机不畅之象。
胃气衰败——脉弦劲如循刀刃

2. 水肿：壅盛之实证

一身悉肿，尤以身半以下为重：水饮泛溢肢体

腹胀喘满：阻滞胸腹，气机壅塞

二便不利：与肝肾相关

肝主疏泄
肾主水，司二便

脉沉实：实证

沉：轻取不应,重按始得。（沉脉显现的部位较正常脉深）

病症：里证，为阴脉

里实：沉而有力

气血内困于里。多因水、寒、积滞所致（寒主收引，水性沉潜，积滞则阳气伏郁）。

实：三部脉举按均充实有力，其势来去皆盛，应指愊愊。是一切有力脉的总称

病症：见于实证。

邪气亢盛而正气不虚，邪正相搏，气血涌盛，脉管内充盈度较高，脉管呈紧张状态,故脉来充实有力。

为什么佐使为大枣，不是甘草？

因为甘草反甘遂 & 大戟 & 芫花

本方服法

“三药”为末，枣汤送服
“平旦”空腹服之
从小剂量始，据证递加
“得快下利后”，停后服，“糜粥自养”。因其逐水之力峻猛，只宜暂用，不可久服。
孕妇忌服。

十枣汤、舟车丸、控涎丹、甘遂半夏汤

同：逐水之剂

异：

十枣汤：攻逐水饮之通用剂，尤善治悬饮

舟车丸：

十枣汤去大枣，加诸多破气之品，尤重加黑丑、轻粉
其逐水之力峻猛，适用于水肿实证而病情急重者
此乃逐水与行气相配，前后二阴水陆并行，故称“舟车”

控涎丹：

十枣汤去芫花、大枣，加白芥子，改为丸剂
其逐水之力较十枣汤略缓，又增祛痰之力，尤能祛皮里膜外之痰
故主治多种伏痰之证

甘遂半夏汤：

甘遂加半夏、芍药、甘草
其逐水之力尤缓
加半夏和胃化痰，且方中甘遂与甘草为伍，相反相成，激发药力，独具匠心
主治留饮心下坚满

Comments

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