庄礼兴基于“痰热”病机运用温胆汤经验举隅

Experience of ZHUANG Li-Xing for Clinical Application of Wendan Decoction Based on the Pathogenesis of Phlegm-heat

对庄礼兴教授基于"痰热"病机临床应用温胆汤的经验进行总结。庄礼兴教授在临床运用温胆汤治疗疾病时,围绕病证的"痰热互结"核心病机,治标与治本相兼顾,灵活加减温胆汤,治疗各种病证。治疗痰热郁滞于胆腑之少阳经证,可用温胆汤合柴胡、黄芩、菊花、春砂仁等。治疗痰热蒙蔽清窍之阳闭证,可用温胆汤加天竹黄、胆南星、鲜竹沥水以增强清热化痰之作用,加入麝香、冰片等芳香开窍的药物以加强促醒的疗效。治疗中风患者痰热阻滞于肠腑之便秘,急性期之便秘可用温胆汤合承气汤,同时可加入胆南星、鲜竹沥水、瓜蒌仁、桃仁以助清热化痰、润肠通便;中风后期之便秘,采用温胆汤为主以化痰泻热,加杏仁、全瓜蒌、川厚朴、冬瓜仁以宣肺通腑。治疗痰热扰心之郁证,可用温胆汤加郁金、合欢皮、生龙骨、生牡蛎、柴胡、白芍,而对痰热扰心之癫狂证,可用温胆汤辅以龙齿、珍珠母、灯心草、竹叶心以清心镇惊。治疗痰热郁滞于肝胆经之蛇串疮,可用温胆汤加柴胡、龙胆、栀子、黄芩、薏苡仁、通草。

The experience of Professor ZHUANG Li-Xing for the clinical application of Wendan Decoction based on the pathogenesis of phlegm-heat was summarized. During the clinical application of Wendan Decoction in treating various diseases,Professor ZHUANG Li-Xing grasps the key pathogenesis of phlegm blended with heat of the indications for Wendan Decoction, and adopts the therapies of treating symptoms and primary cause simultaneously for the treatment of various clinical diseases by modifying Wendan Decoction flexibly. For the treatment of the Shaoyang meridian syndrome caused by phlegm-heat stagnation in the gallbladder, Wendan Decoction combined with Radix Bupleuri, Radix Scutellariae, Flos Chrysanthemi and Fructus Amomi is recommended. For the treatment of yang blockage syndrome caused by phlegm-heat blocking the upper orifices,Wendan Decoction combined with Concretio Silicea Bambusae,Arisaema cum Bile and fresh Succus Bambusae can be used for enhancing the actions of clearing heat and resolving phlegm,and the application of aromatic herbs of inducing resuscitation such as Moschus and Borneolum Syntheticum can promote the awakening action. For the treatment of constipation in the stroke patients caused by phlegm-heat stagnation in the intestines,constipation at the acute stage of stroke can be used by Wendan Decoction plus Chengqi Decoction, and the herbs of Arisaema cum Bile, fresh Succus Bambusae, Semen Trichosanthis and Semen Juglandis can be added for assisting the actions of clearing heat and resolving phlegm,and moistening intestines to relieve constipation. For the treatment of constipation at the late stage of stroke,Wendan Decoction can be used for resolving phlegm and purging heat,and the herbs of Semen Armeniacae Amarum,Fructus Trichosanthis,Cortex Magnoliae Officinalis,and Semen Benincasae can be added for dispersing lung to unblock the intestines. For the treatment of depressive syndrome induced by phlegm-heat disturbing the heart,Wendan Decoction plus Radix Curcumae,Cortex Albiziae,Os Draconis, Concha Ostreae, Radix Bupleuri, and Radix Paeoniae Alba is recommended. For the treatment of manic-depressive syndrome induced by phlegm-heat disturbing the heart, Wendan Decoction with Dens Draconis,Concha Margaritifera,Medulla Junci and Folium Bambusae(young leaves of the bamboo)added can be used for clearing heart and relieving convulsion. For the treatment of herpes zoster caused by phlegm-heat stagnation in the liver-gallbladder meridian,Wendan Decoction plus Radix Bupleuri,Radix Gentianae,Fructus Gardeniae,Radix Scutellariae,Semen Coicis,and Medulla Tetrapanacis is recommended.