夏永良运用柴胡温胆汤验案四则

Four Medical Cases of Professor XIA Yongliang’s Clinical Experience in Using Chaihu Wendan Decoction

[目的]总结夏永良老师临床应用柴胡温胆汤的经验。[方法]通过跟师随诊及仔细研读夏师临证病案,选取诊断为不寐、郁证、眩晕、乳癖的四则验案,从病机、症候、不同药物的加减等角度论述夏师临证应用柴胡温胆汤的经验。[结果]夏师临床运用柴胡温胆汤时,抓住气机郁滞、痰热内扰这一病机,重视石菖蒲、制远志等祛痰药和龙骨、牡蛎等安神药的使用,灵活加减,治疗不寐、郁证、眩晕、乳癖等疾病。所选4则医案,不寐案中随症加用安神药;郁证案中伍用理气解郁、泻火除烦之药;眩晕案中合用半夏白术天麻汤加减;乳癖案除理气药外更投用丹参、川芎等活血药。诸案辨证施治,获效俱佳。[结论]夏师抓住气机郁滞、痰浊内扰这一病机,灵活运用柴胡温胆汤加减治疗不寐、郁证、眩晕、乳癖等疾病,取得了可观的临床疗效,值得同道借鉴。

[Objective]To summarize the experience of Teacher XIA Yongliang in clinical application of Chaihu Wendan Decoction.[Methods]Through following Teacher XIA in clinical work,studying Teacher XIA’s medical cases,selecting medical records on insomnia,depression syndrome,vertigo and cystic hyperplasia of breast,this paper summarized Teacher XIA’s thoughts and experience on using Chaihu Wendan Decoction from the aspects of pathogenesis,symptom,addition and subtraction of drugs.[Results]In clinical application of Chaihu Wendan Decoction,Teacher XIA grasps the pathogenesis of stagnation of Qi and internal disturbance of phlegm heat,attaches importance to the use of expectorant drugs such as Acorus tatarinowii,Polygala tenuifolia Willd.and sedative drugs such as Osdraconis,Ostreagigas Thunberg,flexibly adds and subtracts to treat insomnia,depression,vertigo,cystic hyperplasia of breast and other diseases.Take the four selected cases as example,sedative drugs were added along with the illness in the case of insomnia;while treating the case of depression,the drugs of regulating Qi to relieve depression and drugs of purging fire to relieve annoyance were used;Banxia Baizhu Tianma Decoction was combined in the case of vertigo;while treating cystic hyperplasia of breast,blood-activating drugs such as Salvia miltiorrhiza and Ligusticum chuanxiong were used besides drugs of regulating Qi.The above cases got proper syndrome differentiation with good results.[Conclusion]Teacher XIA grasps the pathogenesis of stagnation of Qi and internal disturbance of phlegm heat,flexibly uses Chaihu Wendan Decoction to treat insomnia,depression syndrome,vertigo,cystic hyperplasia of breast and other diseases.His experience has achieved considerable clinical effect,which is worthy of reference.