历代医家运用辛温解表方药治疗咽喉疼痛的经验研究

Empirical Research on Previous Medical Treatment of Sore Throat with Xin Wen Relieving Drugs

目的归纳总结古籍文献中运用辛温解表方药治疗咽喉疼痛的辨识及用药经验。方法以《中华医典(光盘版)》为工具,检索与辛温解表方药治疗咽喉疼痛有关的古籍文献原文,根据纳排标准筛选出符合要求者并从中提取相关信息,经过规范化处理后录入WPS2013建立数据库,采用内容分析法与描述性统计加以分类与归纳。结果辨识方面:采用辛温解表方药所治咽痛常具有以下特点。望诊:咽喉局部色白或紫且不甚肿大,或咽喉局部色白且扁桃体明显肿大,舌润。闻诊:暴喑(急性声音嘶哑)。问诊:有感受寒邪或服冷剂(对苦寒泻下药的统称)会加重病情的病史,常兼见恶寒(伴或不伴发热)、下利、咽喉异物感、咳嗽或口不渴等症状。切诊:脉沉、迟/缓、弱/微、细,或脉浮、弦/紧、数/疾。用药方面:常用于治疗阴证咽痛的辛温解表方药有桔梗汤、半夏散及汤、六味汤、荆防败毒散及麻黄细辛附子汤等方剂,以及细辛、荆芥、葱白、桂枝、生姜等药物。结论咽痛辨证时应关注患者发病的诱因、治疗经过、四诊特点,"恶寒、舌润、脉沉/细/弱"对辛温解表方药的使用有较强提示作用;桔梗汤、半夏散及汤等经方为各家所喜用,细辛、葱白等亦为利咽要药。

Objective： To conclude the identification and treatment experiences of sore throat with Xin Wen relieving drugs in ancient Chinese literature. Methods： The relevant data from original about Xin Wen relieving drugs on sore throat retrieved in the Chinese Medical Classics was collected and normalized to set up database by WPS2013. Content analysis method and descriptive statistics were used to analyze the data. Results： 1）Characteristics of sore throat treated with Xin Wen relieving drugs in identification included ： Inspection： less-than-swelling throat with white or purple color,or white throat with enlarged tonsils,humid tongue coating;Inquiry：history of infecting wind-cold or aggravation after taking the bitter-cold purgatives,with common concurrently syndromes such as aversion to cold（accompanied by fever or not）,diarrhea,foreign body sensation of throat,cough,a mouth to work not thirsty,etc.;Pulse-taking： deep pulse,retarded/moderate pulse,weak/faint pulse,thready pulse or floating pulse,string-like/tight pulse,rapid/swift pulse. 2）In the inspection of drug usage,Jiegeng decoction,Banxia powder and decoction,Liuwei decoction,Jingfang Baidu powder and Mahuang Xixin Fuzi decoction were most commonly used for the treatment of Yin-syndrome sore throat,as well as some herbal medicine like Asarum,Schizonepeta,Congbai,Cassia Twig,Ginger,etc. Conclusion： Predisposing factors,the process of the treatment and the four diagnostic information should be emphasized in the identification of sore throat. For those who are accompanied by aversion to cold,moistened tongue and deep/thready/weak pulse might consider Xin Wen relieving drugs. Decoctions like Jiegeng decoction and Banxia powder and decoction are popular prescriptions for Yin-syndrome sore throat,while herbs like Asarum and Congbai are important medicine relieving sore throat.