六味地黄丸在《未刻本叶氏医案》中的应用探析

Clinical Application Analysis on Liuwei Dihuang Pills in the “Unprinted YE’s Medical Records”

[目的]总结清代新安医学代表人物叶天士在《未刻本叶氏医案》中运用六味地黄丸的临证经验及其药味加减规律。[方法]采用医史文献学研究方法,通过研读《未刻本叶氏医案》,采撷其中使用六味地黄丸的39则验案,对其进行收集分类整理和数据统计分析,归纳六味地黄丸的应用门类、药味加减规律,并从中总结叶氏临证经验。[结果]在临证诊疗中,叶天士多将六味地黄丸应用于咳嗽、咳血、眩晕、哮喘、下利、心悸、浮肿、腹胀等疾患,其基本病机多为肾阴不足,厥阳上扰,而杂病丛生,故治法以填补真阴为主,并依据辨证夹以纳气、散寒、潜阳、利水之法。临证中常加入五味子、肉桂、生牡蛎、牛膝、附子、车前子、川石斛等药物。[结论]叶天士临证用药常不避滋腻,治病求本,以存体为要,并贯彻异病同治思想,重视水火共济,善于运用六味地黄丸调和阴阳。其用药特色及临床经验,对当今用药有极大的启发。

[Objective]To summarize clinical experience and the law of addition and decrease of herbs of YE Tianshi, who was a representative of Xin ’an Medical School in the Qing Dynasty, using Liuwei Dihuang Pills in the Unprinted YE’s Medical Records.[Methods]By adopting the research method of medical history documentation, through the study of the Unprinted YE’s Medical Records, 39 cases of YE Tianshi applying Liuwei Dihuang Pills were selected so as to sort out and analyze the categories and the law of addition and decrease of herbs medicine. These help to summarize the clinical experience of YE Tianshi. [Results]YE Tianshi applied Liuwei Dihuang Pills mostly for treating cough, hemoptysis, vertigo, asthma, diarrhea, palpitation,edema, abdominal distention and other diseases. These basic pathogenesis are of deficiency of kidney-Yin,which causes excess of Yang,and miscellaneous diseases appear. YE Tianshi mainly chose herbs to nourish kidney-Yin, adding the treatment of receiving Qi, expelling coldness, suppressing Yang and draining water. In clinical practice, YE Tianshi usually added Schisandrae chinensis fructus, cinnamomi cortex, ostreae concha,achyranthis bidentatae radix, aconite lateralis radix praeparata, plantaginis semen, dendrobii caulis.[Conclusion]With the aim of finding out the origin of a disease and preserving essence, YE Tianshi used Chinese herbs of nourishing kidney-Yin correctly when applying Liuwei Dihuang Pills without reducing intestinal motility.Implementing the idea of treating different diseases with the same treatment and attaching importance to the balance of water and fire, YE Tianshi was good at using Liuwei Dihuang Pills to coordinate Yin and Yang of human body. The characteristics and clinical experience of his medication have great enlightenment to medication nowadays.