对于小柴胡汤治疗淋证的思考

Thoughts on Xiaochaihu Decoction(小柴胡汤)Treating Strangury

淋证是以小便频数短涩,淋沥涩痛,小腹拘急,痛引腰腹为基本特征的临床常见疾病,其起病或急或缓,其病程或长或短。按病因和症状特点不同,可分为热淋、气淋、血淋、膏淋、石淋、劳淋六证,病理因素为湿热,病位在肾与膀胱,本病相当于西医学的急、慢性尿路感染,泌尿道结核,尿路结石,急、慢性前列腺炎,化学性膀胱炎,乳糜尿以及尿道综合征等。临床上淋证常常会伴有寒热往来、恶心呕吐、口苦等少阳证的表现,此为湿热阻滞少阳,少阳枢机不利,影响膀胱气化,治疗时单纯清热利湿则效果不佳,难以治愈,致使病情反复。此时论治若以少阳病机为主,以小柴胡汤为主方和解少阳,结合清热利湿之法,配合清热凉血、利湿通淋、补益肝肾之方,治疗效果更为明显,在临床上值得借鉴。

As a common clinical disease,strangury is a disease characterized by short and frequent urination,astringent pain,and abdominal pain.Its onset is either acute or slow,and its course can be longer or shorter.According to different causes and symptoms,it can be divided into six syndromes:heat strangury,Qi strangury,blood strangury,unctuous strangury,stone strangury,and strangury caused by overstrain.The pathological factor is damp-heat and it is located in the kidney and bladder.This disease is equivalent to acute and chronic urinary tract infections,urinary tract tuberculosis,urinary tract stones,acute and chronic prosta⁃titis,chemical cystitis,chyluria and urethral syndrome in western medicine.Clinically,the strangury is often accompanied by cold and heat exchanges,nausea and vomiting,and bitter mouth.The symptoms of Shaoyang are blocked by damp-heat and the cardio⁃version of Shaoyang is unfavorable,which affects bladder gasification.Therefore,it is difficult to treat strangury by only using clear⁃ing the damp-heat,which leads to disease relapse.So at this time,if the treatment is mainly based on the pathogenesis of Shaoy⁃ang,and taking Xiaochaihu Decoction(小柴胡汤)as the main method to reconcile Shaoyang,combined with the method of elimi⁃nating damp-heat and promoting urinary dis-charge,and nourishing liver and kidney,the therapeutic effect will be more obvious⁃ly,which is worthy of learning from the clinic.