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腎虚を基礎病態とする少陰病の主薬方は,炙甘草を含む四逆湯類炙甘草を含まない方剤(白通湯・真武湯・附子湯)の二群に分けられる。また幾多の文献に見られる腎虚の治療薬方の多くにも炙甘草は含まれていない。炙甘草の役割を理解するために,危機存亡の病態にある四逆湯,白通湯の各證の相異を,先人の諸説と筆者の治験を礎に考察した。構成生薬は,四逆湯が炙甘草,乾薑,生附子であり,白通湯が葱白,乾薑,生附子である。両湯倶に補脾胃,補腎の作用があるが,いずれの作用が主となるかは炙甘草の有無により異なる。四逆湯は補腎より補脾胃に優れ,白通湯は補脾胃よりも補腎に優れている。この規(のり)は急性症のみならず,慢性症の腎虚の治療においても適つている。炙甘草は少陰病期の治療において重要な役割を担っていると考えられる。
Patients suffering through a period of shoinbyo (shao yin bing) must essentially be treated for impaired renal function. Formulations commonly prescribed during this period can be divided into two categories: the Shigyakuto (si ni tang) group which includes Glycyrrhizae Radix, and the Hakutsuto (bai tong tang), Hakutsukachotanjuto, Shimbuto (zhen wu tang) and Bushito (fu zi tang) groups, which do not include roasted Glycyrrhizae Radix. In order to understand the significance of Glycyrrhizae Radix, we have examined symptomatic differences in life-threatening situations, by comparing Shigyakuto and Hakutsuto formulations, based on both previous cases, and our own clinical studies. Shigyakuto is composed of roasted Glycyrrhizae Radix, Zingiberis Siccatum Rhizoma, and crude Aconiti Tuber, while Hakutsuto is composed of Allii Fistulosi Bullbus, Zingiberis Siccatum Rhizoma, and crude Aconiti Tuber. These formulations activate renal function, as well as gastroenterological function (bu pi wei). Which function is affected dominantly, however, appears to be dependent on whether roasted Glycyrrhizae Radix is included. In the Shigyakuto group of formulations which include Glycyrrhizae Radix, the activation of gastroenterological function is greater than that of renal function, whereas in the other formulation groups which do not include Glycyrrhizae Radix, activation of renal function is greater. This treatment principle can be applied not only in the acute phase of shoinbyo, but in the chronic phase as well. Therefore we believe that roasted Glycyrrhizae Radix has an important role in the effective Kampo treatment of patients suffering through periods of shoinbyo.
