張仲景對《湯液經》的借鑑與變革

在醫學那浩渺如煙的歷史長河中，每一部經典醫書都似一座巍峨的燈塔，爲後世醫者照亮前行的道路。張仲景的《傷寒雜病論》與那神祕的《湯液經》，便如同兩顆交相輝映卻又各具特色的星辰，在醫道的天空中留下了獨特的軌跡。

張仲景，這位被後世尊稱爲“醫聖”的傳奇人物，在其《傷寒雜病論》的序中，謙遜地提及自己引用了諸多古籍。然而，對於《湯液經》這部在醫書領域本應有着濃墨重彩地位的典籍，他卻未着重言說。這一看似不經意的“忽略”，恰似平靜湖面下湧動的暗流，引發了後世無數醫者與學者的思索與探尋。

當我們深入剖析《傷寒雜病論》與《湯液經》的方劑體系時，便能發現二者之間既有着千絲萬縷的聯繫，又存在着顯著的差異。《湯液經》的方劑體系，宛如一部嚴謹有序的樂章，方子在前，病症居中，藥物隨後，最後詳細闡述熬製方法與主治病症。這種排列方式，猶如將一件精美的藝術品，從各個角度清晰地展示在人們面前，讓人一目瞭然地瞭解方劑的全貌。據相關研究統計，在現存的一些古代醫書殘卷中，《湯液經》的這種體系完整度高達百分之八十以上，爲後世研究古代方劑提供了極爲珍貴的模板。

而張仲景的《傷寒雜病論》則另闢蹊徑，以病爲先導，先詳細闡述病症的病理病機，如同一位高明的偵探，抽絲剝繭地剖析疾病的根源，然後再娓娓道來如何進行治療，最後纔給出具體的方藥。這種“病—症—方”的排列方式，就像是一場精心策劃的戰役，先明確作戰目標，再製定戰略戰術，最後調配兵力武器。例如，在書中常見的“麻黃湯主之”“桂枝湯主之”，將湯劑置於後方，且還有諸多加減法，爲臨牀應用提供了極大的靈活性。據臨牀實踐統計，運用《傷寒雜病論》中的方劑加減法進行治療，患者的治癒率相較於固定方劑使用提高了近百分之二十。

再看方劑的命名與歸屬，更是能體現出張仲景的獨特匠心。《輔行訣·湯液經》中的方劑有着一套整齊劃一的“六合體系”，而張仲景卻將青龍湯安排在太陽篇，白虎湯置於陽明篇，真武湯、玄武湯歸入少陰篇，朱鳥則化身爲黃連阿膠雞子黃湯。這種重新編排，並非簡單的隨意爲之，而是基於他對疾病分類與方劑功效的深刻理解。就像一位技藝高超的畫家，將不同的色彩重新組合，創造出了一幅獨具風格的畫卷。

以小青龍湯爲例，在《輔行訣·湯液經》裏它被稱爲大青龍湯，而張仲景所講的麻黃湯在《輔行訣·湯液經》中則是小青龍湯。這種名稱的變換，看似令人困惑，實則是張仲景在深入研究方劑功效後，根據臨牀實際需求進行的精準調整。他就像一位智慧的工匠，對原有的材料進行精心打磨與改造，使其更加符合治療疾病的要求。

還有那陰旦陽旦湯，在張仲景的筆下也有了新的名字與內涵。桂枝湯本爲陽旦湯，小陽旦湯即桂枝湯，正陽陽旦爲小建中湯，黃芪建中湯則是大陽旦湯。這種改名換姓，並非是爲了故弄玄虛，而是張仲景在傳承的基礎上進行的創新與發展。他以病爲核心，圍繞疾病的病理病機重新構建方劑體系，使方劑與疾病之間的對應關係更加緊密，爲臨牀治療提供了更加科學、有效的指導。

有人或許會說，張仲景不過是給《湯液經》的方藥改個名，換個藥，再包裝一番罷了。然而，這種觀點實在是過於片面與膚淺。醫學的發展猶如一條奔騰不息的河流，每一代醫者都是在前人的基礎上不斷前行。張仲景對《湯液經》的借鑑與變革，並非簡單的抄襲與模仿，而是在深入理解其精髓的基礎上，結合自己的臨牀實踐與對疾病的認識，進行的一次大膽而成功的創新。

他的《傷寒雜病論》不僅繼承了《湯液經》等古籍的優秀成果，更以其獨特的理論體系與臨牀應用價值，成爲了中醫發展史上的一座里程碑。據不完全統計，自《傷寒雜病論》問世以來，對其研究與應用的文獻資料數以萬計，其影響不僅遍及中國大地，還傳播到了日本、韓國、越南等國家，爲世界醫學的發展做出了重要貢獻。

在醫道的傳承與發展中，我們應尊重每一位醫者的智慧與貢獻，以客觀、嚴謹的態度去研究與分析經典醫書。張仲景與《湯液經》的故事告訴我們，傳承並非一成不變的因循守舊，而是在繼承中創新，在變革中發展。只有這樣，我們才能在醫道的漫漫長路上不斷前行，爲人類的健康事業創造更加美好的未來。讓我們銘記這些醫學經典，汲取其中的智慧與力量，在新時代的醫道征程中書寫屬於我們的輝煌篇章。

作者簡介：梁世傑 中醫高年資主治醫師，本科學歷，從事中醫臨牀工作24年，積累了較豐富的臨牀經驗。師從首都醫科大學附屬北京中醫院肝病科主任醫師、著名老中醫陳勇，侍診多載，深得器重，盡得真傳！擅用“商湯經方分類療法”、專病專方結合“焦樹德學術思想”“關幼波十綱辨證”學術思想治療疑難雜症爲特色。現任北京樹德堂中醫研究院研究員，北京中醫藥薪火傳承新3+3工程—焦樹德門人（陳勇）傳承工作站研究員，國際易聯易學與養生專委會常務理事，中國中醫藥研究促進會焦樹德學術傳承專業委員會委員，中國藥文化研究會中醫藥慢病防治分會首批癌症領域入庫專家。榮獲2020年中國中醫藥研究促進會仲景醫學分會舉辦的第八屆醫聖仲景南陽論壇“經方名醫”榮譽稱號。2023年首屆京津冀“扁鵲杯”燕趙醫學研究主題徵文優秀獎獲得者。事蹟入選《當代科學家》雜誌、《中華英才》雜誌。

Winter remedies: "cleanse," "clarify" and "contaminate," we''ll have to work on it.

Ladies and gentlemen, let''s talk about winter maintenance today. Look at this day. It''s a very high bloom of sesame seeds. Most people have enough nutrition, even surplus. Like the water in that reservoir, it''s about to overflow. Then someone asked, ''All this is going to happen. What else can winter weather do?'' Hey, don''t jump to conclusions first, listen to me tell you this slowly.

Let me start by saying why modern people''s overnutrition is not incompatible with winter remedies. You think, in the past, the days were hard and materially abundant, and people didn''t have much oil or water in their stomachs. In winter, that had to be properly replenished, like charging a battery-drained cell phone, and the energy had to be replenished. But nowadays it''s different. We eat lots of fish and meat every day, and the nutrition is very good. But that means there''s nothing wrong with our health? No, no, no! It''s like a beautiful big house. The outside looks gorgeous, but inside, the sewers are blocked and the electrical circuitry is a little faulty. The same is true of our body. With excess nutrients, it is easy to accumulate some metabolic products in the body, like garbage and dust in the house, which must be cleaned in time.

Now we need a new understanding of "fixing." It is no longer the kind of stuffing of nutrients into the body that used to be like stuffing ducks. Instead, emphasis is placed on conditioning the body and removing what is not supposed to be in the body. It is like a river. If a river is blocked, you just fill it with water, the water must not flood out. You must clear the silt and clear the river so that the water can flow properly. The same is true of our body, which must clean out all the metabolic products, phlegm, etc. so that the blood and air can operate smoothly.

Traditional tonifying and modern tonifying are both for the sake of harmonizing qi and blood, harmonizing yin and yang. Think about how comfortable it would be if the blood in your body were like a pot of stale weed? There must be something wrong. So, winter remedies are still necessary, but they are not for you to make a fool of them.

For people who are overnourished, I''ll give you a few tricks. The first thing is "clear." What''s the point? It is to clear the heat and reduce the fire, and balance the excess heat evil in the body. Think about it. Nowadays, many people catch fire at all times, have bubbles on their mouths, and have pimples on their faces. This is the problem of internal heat. It''s like the temperature in the house is too high, and you have to open the windows to breathe and cool down. According to incomplete statistics, more than 60% of people have different degrees of fire symptoms in winter, so this cold fever cannot be ignored.

The second method is "chemation," which is to chemical the phlegm to remove the damp. Do you know that many people nowadays have phlegm in their bodies. This phlegm is like moisture in a house. Over time, the furniture must become moldy. When phlegm accumulates in the body, it makes people feel tired and their head slumped. I have a friend who is sluggish and tired all day. After a few days of conditioning under the guidance of a professional doctor, he is now mentally adequate. So uh, it''s important to hydrate the phlegm.

The third trick is "through," which is to relieve bruising and clear the meridians. The connections in our body are like the traffic arteries in a city. If there is a traffic jam, the whole city will be paralyzed. If the meridians in the body are not connected, the blood and blood circulation is not smooth, and it is easy to suffer pain here and there. It is like a water pipe. If there is dirt in it, the water will not flow smoothly. So, we need to clear the meridians so that the blood and blood can flow smoothly.

But, officers, this winter maintenance is not something you can do at home alone. You need to make reasonable repairs under the guidance of a professional doctor, just like you need to have a driver''s license. Without professional guidance, you can''t go into a ditch. A professional physician is like a navigational navigator, able to give you a plan of supplements that is best for you based on your medical condition.

So, although modern people are overnourished, winter supplements are still necessary. We must use a new concept to understand remedies, start with cleansing, healing and healing, and treat the body well under the guidance of a professional physician. Let us also get strong in winter and welcome the new year in good health. Are you saying that''s the point?

Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine with an undergraduate degree. He has been engaged in traditional medicine clinical work for 24 years and has accumulated a wealth of clinical experience. Following Chen Yong, chief physician of liver disease at Beijing Traditional Medicine Hospital, affiliated with Capital Medical University, and renowned old Chinese medicine, he has been treated for many years and received great attention. He specializes in the treatment of difficult diseases using "conversational traditional therapy" and special treatments combined with the academic ideas of Jiao Shude and Guan Yubo''s ten-level diagnosis.He is currently a researcher at the Shude Tang TCM Research Institute in Beijing, a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance workstation of Jiao Shude''s protégés (Chen Yong),He is a standing committee member of the International Expert Committee on E-learning and Health Care, a member of the Jiao Shude Academic Heritage Special Committee of the Chinese Association for the Advancement of Chinese Medicine Research, and the first cancer specialist to be included in the chapter of the Chinese Pharmaceutical Culture Research Association. Won the 2020 China Association for the Promotion of Traditional Chinese Medicine Zhongjing Medical Branch held the eighth session of the Medical Saint Zhongjing Nanyang Forum "Classic Prescription Famous Doctor" honorary title. The winner of the first Beijing-Tianjin-Hebei "Pingui Cup" Yanzhao Medical Research Essay Award in 2023. His work was featured in the journal Current Scientist and the journal Chinese Talent.