夏永良运用小陷胸加枳实汤验案四则

Four Medical Cases of XIA Yongliang’s Clinical Experience in Using Xiaoxianxiong plus Zhishi Decoction

[目的]总结夏永良老师临床应用小陷胸加枳实汤的经验。[方法]通过跟师随诊并查阅夏师医案,选取胃痛、咳嗽、胃痞、吐酸验案4则,从病因病机、辨证论治、用药特点等方面,论述夏师临证运用小陷胸加枳实汤的经验。[结果]夏师认为,运用小陷胸加枳实汤时,需抓住痰热郁阻、胃气上逆这一病机,常以嗳气泛酸、胃痛脘胀、大便干结等为主症。临床多合用左金丸、乌贝散、旋覆代赭汤、半夏厚朴汤等,常用于治疗胃食管反流病、慢性胃炎、胆汁反流性胃炎、慢性咳嗽、慢性咽炎等疾病,尤其在胃食管反流病的治疗中应用较多。[结论]夏师从痰热郁阻、胃气上逆出发,灵活运用小陷胸加枳实汤治疗胃痛、咳嗽、胃痞、吐酸等疾病,临床疗效确切,值得学习与推广应用。

[Objective]To summarize the experience of Teacher XIA Yongliang in clinical application of Xiaoxianxiong plus Zhishi Decoction.[Methods]Through following Teacher XIA in clinical work,checking Teacher XIA’s medical cases,selecting medical records of stomachache,cough,epigastric fullness and acid regurgitation,this paper summarized Teacher XIA’s thoughts and experience on using Xiaoxianxiong plus Zhishi Decoction from the aspects of pathogenesis,symptom,addition and subtraction of drugs.[Results]Teacher XIA believes that in the clinical application of Xiaoxianxiong plus Zhishi Decoction,it is necessary to grasp the pathogenesis of phlegm-heat stagnation and stomach Qi inversion.And the main symptoms of this syndrome are belching,pantothenic acid,stomachache,abdominal distention,dry stool and so on.Teacher XIA often combines Xiaoxianxiong plus Zhishi Decoction with Zuojin Pill,Wubei Powder,Xuanfu Daizhe Decoction and Banxia Houpu Decoction,etc.He often uses this prescription to treat gastroesophageal reflux disease,chronic gastritis,bile reflux gastritis,chronic cough,chronic pharyngitis and so on,especially gastroesophageal reflux disease.[Conclusion]Teacher XIA grasps the pathogenesis of phlegm-heat stagnation and stomach Qi inversion,flexibly uses Xiaoxianxiong plus Zhishi Decoction to treat stomachache,cough,epigastric fullness and acid regurgitation,and achieved considerable clinical effect,his experience is worthy of reference.