杜怀棠应用柴胡陷胸汤临证经验撷萃

Clinical Experience of DU Huaitang’s Application of Chaihu Xianxiong Decoction(柴胡陷胸汤)

杜怀棠师承秦伯未先生、董建华院士,在诊治外感热病方面倡导寒温统一思想,内伤杂病方面则宗孟河学派和缓醇正之用药特点,临证善用经方化裁治疗外感内伤诸病。柴胡陷胸汤为其临床常用方剂,此方系将《伤寒论》之小柴胡汤与小陷胸汤合方加减而成之和解通降方,兼取小柴胡汤和解表里之长及小陷胸汤清热涤痰之功,又佐以枳实、桔梗调理气机。现代医家多用此方治疗心系、脾胃系及气血津液系病证,杜老则常将其作为基础方辨证加减应用于发热、咳嗽、眩晕等属少阳病而见痰气交结蕴热之证者,可发挥和解少阳平寒热、理气化痰定眩晕、升降相因止咳嗽等作用,体现了中医学“异病同治”的特色,并常在此方取效基础上配伍滋阴养血之品,以防清热化痰理气之品过用伤及津血,体现“时时顾护津血”之意,临床收效良好,为现代中医临床重扩大此方的适用范围、指明此方的应用特点等提供一定的参考与启发。

Under the guidance of Mr.QIN Bowei and academician DONG Jianhua,Professor DU Huaitang advocates the idea of unifying cold and heat in the diagnosis and treatment of exogenous fever diseases,while in the treatment of internal injuries and miscellaneous diseases,he adheres to the medication characteristics of Menghe school and moderating and makes good use of classical prescriptions in the treatment of exogenous and internal injuries.Chaihu Xianxiong Decoction(柴胡陷胸汤)is a commonly-used clinical prescription.This prescription is a reconciliation dredging and descending formula made by adding and subtracting Xiaochaihu Decoction(小柴胡汤)and Xiaoxianxiong Decoction(小陷胸汤)in Treatise on Febrile Diseases.It also takes the advantages of Xiaochaihu Decoction in reconciling the exterior and interior and the function of Xiaoxianxiong Decoction in clearing heat and eliminating phlegm,supplemented by Zhishi(Fructus Aurantii Immaturus)and Jiegeng(Radix Platycodonis)to regulate Qi.Modern doctors often use this prescription to treat the diseases and syndromes of heart system,spleen and stomach system and Qi,blood and body fluid system.Professor DU often uses it as the basic prescription and apply it to treat fever,cough,vertigo and other Shaoyang diseases,which syndrome was phlegm Qi intersection and heat accumulation.It can play the role of reconciliation of Shaoyang and calming cold and heat,regulating Qi and resolving phlegm,calming vertigo,ascending and descending and stopping cough,reflecting the characteristics of“simultaneous treatment of different diseases”in traditional Chinese medicine.On the basis of the effect of this prescription,it is often combined with the drugs of nourishing Yin and nourishing blood,so as to prevent the excessive use of the drugs of clearing heat,resolving phlegm and regulating Qi from damaging the body fluid and blood,reflecting the meaning of“always taking care of the body fluid and blood”,and the clinical effect is good,which provides some reference and inspiration for the clinical application of modern traditional Chinese medicine to expand the scope of application of this prescription and point out the application characteristics of this prescription.