小柴胡汤“一方多证”现象辨析

Differentiatin of "One Prescription wih Different Syndromes" of Xiaochaihu Decoction

不少经方都存在着主治多样和一方多证的问题,不过在小柴胡汤的运用中表现更为突出。言小柴胡证,当分广狭之义、当有主次兼变之别。如从狭义的主要证型而论,当属少阳无疑,但从广义的可用证型而论,则诸证之中,属少阳有之,兼少阳有之,非少阳者也有之。言用和解法,当分正治权变之义、当有隔一隔二之别。如从狭义的和解少阳而论,当以疏气转枢为先,但从广义的和解矛盾而论,则诸法之中,分消表里者属之,调和寒热者属之,兼顾虚实者也属之。故对待经方"一方多证"的问题,若分证有主次之别、论病有常变之议、言方有主方与变方之用、论法有正治与权变之分,议药亦有加减与化裁之例。诚如是,则在运用经方时,达到广而不滥、活而不乱,并与时方各知其长、互补其短,使临床选方加减真正能够圆机活法,以应万变。

There exist various indications and ＂one prescnption with different syndromes＂ in many classical prescription, which was prominent in the application of Xiaochaihu Decoction. Xiaochaihu Decoction syndromes have the difference of the broad sense and the narrow sense, the primary and the secondary. As to the the narrow sense, Xiaochaihu Decoction syndromes belong to Shaoyang syndrome; as to the broad sense, some belong to Shaoyang syndrome, some to other syndrornes. As to harmonizing method, the change of routine treatment should be considered. For the narrow sense of harmonizing Shaoyang syndrome, regulating-qi should be the primary, while for the broad sense of harmonizing contradictions, harmonizing the interior and the exterior respectively, regulating the cold and the heat, compromising astbenia and sthenia should be included. Therefore, the issue of ＂one prescription with different syndromes＂ has the the primary syndrome and the secondary one, the routine disease and the changed one, the main prescription and the modified one, the routine treatment and paradoxical treatment, and so on.