何庆勇运用泽泻汤的经验

He Qingyong’s experiences in the application of zexie decoction

泽泻汤出自《金匮要略》,为水饮上犯证而设。泽泻汤的临床运用有以下三个关键点:一是抓住主要方证与方证鉴别,泽泻汤的方证是:头晕,前额如有贴物,呈持续性,头晕与体位无关,大便溏稀,舌体肥大异常,苔水滑或白腻,脉弦沉。其主要方证是:头晕,前额如有贴物,头晕与体位无关,舌淡胖,凡是符合上述方证者,用之皆效,且应当与苓桂术甘汤方证相鉴别。二是依照原方比例使用,泽泻与白术的比例应为5∶2,且应用重剂,常按照经方绝对剂量,用泽泻50~70g,白术用20~28g,量少则无效。三是依照类方加减以及经方叠用,依五苓类方加减,可在泽泻汤基础上加猪苓、茯苓、桂枝,取五苓散之意,可叠用茯苓杏仁甘草汤、桂枝甘草汤、枳术汤等方剂。文章还列举了何师运用泽泻汤的两个典型医案。

Zexie decoction came from Synopsis Golden Chamber,which is designed for the syndrome of water flooding up.There are three key points in the uses of zexie decoction.1.To recognize the major prescription and syndrome differentiation.The syndrome of zexie decoction is persistent dizzinessn with heavy feeling on the forehead,unrelated to postural change,loose stools,with pale swollen tongue,white slippery coating,and string-taut and deep pulse.The main syndrome is dizziness with heavy feeling on the forehead,unrelated to postural change,with pale swollen tongue.It should be differentiated from linggui zhugan decoction.2.Using the origin dosage.The dose ratio of Alisma orientale and Atractylodes should be 5:2.The large dosage of herb should be specially considered.Alisma orientale,50 to 70g and Atractylodes,20 to 28g ensure the effective results.3.Modifying the formula according to similar formulas and combining with other formulas.It can be modified with wuling decoction,and be combined with fuling xingren gancao decoction,guizhi gancao decoction and zhizhu decoction.In the paper,two typical cases were reported to explain the application of zexie decoction.