“百合病”与“小柴胡汤证”异同辨析

Lily Disease and Xiao Chai Hu Decoction syndrome Similarities and Differences of The Analysis

"百合病"与"小柴胡汤证"同出《伤寒杂病论》,症候及用药思路均有相似之处,不易分辨;病机均涉情志不抒、化热伤阴,百合病由阴虚内热引起,不涉及外邪;小柴胡汤证虚实夹杂,半表半里,为外感热病;两者均有饮食失和、口苦之症,因气机枢机不利心烦、站立不安、不得眠等,症状百出,不好辨别;仲景常以"呕"与"不呕"来判断是否邪入少阳;呕吐及因实邪壅于少阳所循之两胁造成胸胁苦满等症均是小柴胡汤证;百合病并无实邪,整体乃百脉空虚引起心肺阴虚,此与小柴胡汤证虚实夹杂不难辨别;百合病百脉当空,小柴胡汤证虚实夹杂。小柴胡汤证治疗不当,误用汗吐下三法,终会造成百脉阴虚,转变为百合病;百合病"变成渴"、"渴不差"、"变发热",病机发展趋势阴伤热甚,重在养阴清热,早期注意保护阴液,防其传变、加重;百合病临床表现在时间先后上没有一定规律、症状多变,极易误诊误治,"随证治之"是整体治疗原则,仲景除给出以百合地黄汤正治,根据不同病情给予不同治疗方案;小柴胡汤组方思想来自古代"和"的哲学,调理阴阳、表里、气血、经络、脏腑,和解少阳,明辨一通。临床应抓住二者病机差异要点,表证慎用补益,整体阴虚忌用攻邪,辨证论治,减少误诊,提高临床诊治疗效。

The Lily disease and the Xiao Chaihu decoction syndrome both come out of Treatise on Febrile and Miscellaneous Diseases. The symptoms and medication ideas have many similarities and it＇s difficult to distinguish. The pathogenesis of this two diseases are involved that the emotions can＇t get expressed, and turning the heat to injuring Yin. The lily disease was caused by yin deficiency asthenia and internal heat and don＇t involve external affections. Xiao Chaihu Decoction syndrome intermingle deficiency and excess. It＇s semi-exterior and semi-interior and it is a kind of exogenous febrile diseases. Both the two diseases have the symptom of eating disorder and bitter taste. It＇s difficult to distinguish them because there are a lot of symptoms which are heart restless, fidget and somnipathy which caused by the depression of Qi＇s concentration. Zhongjing always judge the invasion of Shaoyang with evil by if vomiting. The symptom such as vomiting and the fullness and discomfort in chest and hypochondrium caused by excessive pathogen which retaining at Shaoyang Meridian circulating on both sides of the ribs is Xiao Chaihu Decoction syndrome. There is no excessive pathogen in Lily disease and the entirely is that because all the channels are void, so the heart and lung get into deficiency of yin. So it＇s easy to distinguish from the Xiao Chaihu Decoction syndrome. In Lily disease, all the channels are void and Xiao Chaihu Decoction syndrome intermingle deficiency and excess. In the treating of the Xiao Chaihu Decoction syndrome, if you misuse the three therapeutic methods , in the end all the channels will be in deficiency of yin and turn the disease into lily disease. Development trend of pathogenesis is Yin deficiency induces internal heat. The treating emphasis is nourishing Yin and cleaning heat. In the early phase, you should pay attention on protecting Yin fluid and preventing it from transmission and making sure it don＇t get worse.There is no definite pattern in the clinical manifestations of lily disease in time domain. And the symptom is changeable. It＇s easy to get the diagnosis and treatment into wrong way. The overall therapeutic principle is to treat the disease on the basis of the symptom. Zhongjing uses the Baihe Dihuang Decoction as the main treatment. Also according to different conditions he uses different treatment protocols. The theory of the Xiao Chaihu Decoction comes from the ancient philosophy called ＂＇He＂ . It regulates Yin and Yang, the exterior and interior, Qi and blood, meridians and viscera. Then it makes Shaoyang harmonizing and you can distinguish the diseases clearly. In the clinic treatment, we should catch the different key points of pathogenesis of the two diseases. Be careful in using of tonic medicines according to the exterior syndromes. And we should prohibit elimination when the whole body in deficiency of Yin. Also we should plan treatment according to diagnosis. Reducing misdiaguose and improving curative effect.