崔云教授运用桂枝加龙骨牡蛎汤治疗男科疾病经验

Professor CUI Yun's Experience in Treating Male Diseases with Guizhi Jia Longgu Muli Decoction

[目的]介绍崔云教授运用桂枝加龙骨牡蛎汤治疗男科疾病的经验。[方法]通过收集和分析崔师运用桂枝加龙骨牡蛎汤治疗的男科临床病例,结合历代医家对此方方证的认识以及崔师临证所谈所述,在充分阐述方证病机、用方心得和化裁用药的基础上,全面总结其运用此方的经验,并举典型医案加以论证。[结果]历代医家对桂枝加龙骨牡蛎汤方证具有不同认识,从不同角度阐发了方证病机。崔师认为,桂枝加龙骨牡蛎汤的临床应用当综合各家所言,发挥各家学说之特点,根据不同的疾病类型和病机角度,以阴阳两虚为前提,灵活运用于心肾不交证、肝肾阳虚证和中焦脾虚证的治疗。崔师运用桂枝加龙骨牡蛎汤遵循药味不改、舍剂量而取配比,以及兼顾男科疾病特点的原则,尽量守经方之原貌,又适度化裁,以适应男科病特点,同时根据气血阴阳虚损的轻重及不同疾病的特点,灵活配伍。所举两则医案,医案一中患者辨为心肾不交证,用桂枝加龙骨牡蛎汤合三才封髓丹潜阳入阴、交通心肾;医案二中患者辨为脾肾两虚证,用桂枝加龙骨牡蛎汤配合补肾药物,以温补中焦、固摄肾气。治疗月余,二者症状皆得到显著改善,即是理法有效之体现。[结论]崔师承经方之旨意,结合男科疾病特点,拓展经方之病机内涵,用于指导治疗,并重视经方配伍、用量和化裁,收获了显著效果。其丰富经验值得进一步研究,并作为临床借鉴。

[Objective]To introduce Professor CUI Yun's experience in treating male diseases with Guizhi Jia Longgu Muli Decoction.[Methods]Based on the collection and analysis of Professor CUI's clinical cases of male diseases,combined with medical experts in past dynasties and CUI Yun's talks and narrates in clinical treatment of male diseases with Guizhi Jia Longgu Muli Decoction,on the basis of full expounding of the pathogenesis,experience with drug use and modification,the experiences of use of the prescription was comprehensively summarized,and typical medical cases were cited to demonstrate.[Results]There were different understandings of Guizhi Jia Longgu Muli Decoction,including the theory of heart and kidney,liver and kidney,spleen and stomach,etc.,explaining the prescription syndrome and pathogenesis from different perspectives,and guiding the treatment.Professor CUI believes that the clinical application of Guizhi Jia Longgu Muli Decoction should be flexibly applied to the treatment of the syndrome of non-intersection of the heart and kidney,Yang deficiency of the liver and kidney and spleen deficiency in middle-Jiao.Its applicant should put all views together,give play to the characteristics of each theory,according to the different syndromes and pathogenesis and take deficiency of Yin and Yang as the premise.Professor CUI applies Guizhi Jia Longgu Muli Decoction in accordance with the principles of keeping the number unchanged,choosing the proportion instead of the dosage and taking into account the characteristics of male diseases,keeping the original appearance of the prescription as far as possible,and modifying it appropriately to adapt to the characteristics of male diseases.At the same time,according to the severity of deficiency of Qi,blood,Yin and Yang and the characteristics of different diseases,modifies flexibly.In the two medical cases cited,the first patient was identified as the syndrome of non-intersection of the heart and kidney,and treated by both Guizhi Jia Longgu Muli Decoction and Sancai Fengsui Dan to submerge Yang into Yin and coordinate the heart and kidney.The second patient was identified as the syndrome of deficiency of the spleen and kidney,Guizhi Jia Longgu Muli Decoction combined with tonifying kidney's drugs was used to warm and tonify middle-Jiao and consolidate the kidney Qi.After a month of treatment,both symptoms were significantly relieved,which is the embodiment of the effective method.[Conclusion]According to the meaning of classical prescription and combined with the characteristics of male diseases,Professor CUI expands the pathogenesis connotation of classical prescription for guiding treatment,and pays attention to the compatibility,dosage and chemical reduction of classical prescription.His rich experience is worthy of further study and clinical reference.