读“柴胡证,但见一证便是”的思考

Thinking about Syndromes with One Typical Symptom Treated by Xiaochaihu Decoction

小柴胡汤源自《伤寒论》,是临床和解剂中的经典方,也是历代医家临床上喜欢用的经验方,主治伤寒少阳病证。邪在半表半里,症见往来寒热,胸胁苦满,默默不欲饮食,心烦喜呕,口苦,咽干,目眩,舌苔薄白,脉弦者;妇人伤寒,热入血室,经水适断,寒热发作有时;疟疾,黄疸等内伤杂病而见以上少阳病证者。小柴胡汤所主治的病证即为柴胡证,张仲景在《伤寒论》中提到"伤寒中风,有柴胡证,但见一证便是",指出运用小柴胡汤的原则性,又指出了运用小柴胡汤的灵活性,但因其条文短小精悍,可从多角度多方面进行解读,并且《伤寒论》中述及运用小柴胡汤的条文较多,涉及不同疾病。以致后世从医的学者无法准确得出柴胡证指的是具体哪一症或哪几症,以及运用小柴胡汤的时机各自持有不同观点,临床对于小柴胡汤证的辨证施治也有一定分歧。随着现代医学的不断发展,小柴胡汤的主治功效得到越来越多的补充丰富及证实,现代临床常用于治疗感冒、流行性感冒、疟疾、慢性肝炎、肝硬化、急慢性胆囊炎、胆结石、急性胰腺炎、胸膜炎、中耳炎等属胆胃不和者。通过阅读学习《伤寒论》及相关文献,总结思考历代医家的学术思维,以期为小柴胡汤的应用以及临床如何更好地论治提供帮助。

Xiaochaihu decoction is not only a classic harmonizing prescription in Treatise on Febrile Diseases,but also the empirical prescription of past dynasties doctors used to treat Shaoyang disease.The evil is in the space between the exterior and the interior,and the symptoms include alternating episodes of chills and fever,feeling of fullness and oppression in the chest and hypochondria,loss of appetite,dysphoria and nausea,bitter taste and dry throat and vertigo,thin white fur of tongue and stringy pulse.For women who have hypomenorrhea,malaria,jaundice and other miscellaneous diseases,the disease should be treated by Xiaochaihu decoction.ZHANG Zhongjing in Treatise on febrile Diseases pointed out the principle and flexibility of using Xiaochaihu decoction.It can be interpreted from many angles and aspects,and with the development of modern medicine,the effect of Xiaochaihu Decoction is more and more abundant and confirmed.Chronic hepatitis,liver cirrhosis,acute and chronic cholecystitis,gallstones,acute pancreatitis,pleurisy,otitis media and so on can be treated with this formula.Through reading and learning Treatise on Febrile Diseases and related literature,this paper summarized and thought about the academic thinking of doctors in previous dynasties,in order to provide help for the application of Xiaochaihu Decoction and better clinical treatment.