基于重症病例及现代病理生理机制的小柴胡汤合麻杏石甘汤方证条文内涵解读及其治疗肺部感染、慢性阻塞性肺疾病急性加重等急危重症体会

Connotation of Xiao Chaihu Decoction combined with Maxing Shigan Decoction based on severe cases and modern pathophysiological mechanism and application for severe pulmonary infection and acute exacerbation of chronic obstructive pulmonary disease in critical care medicine

小柴胡汤合麻杏石甘汤为经方合方,均出自张仲景的《伤寒论》。该方具有和解少阳,辛凉宣泄,清肺平喘功效,主治三阳合病,邪热壅肺证。小柴胡汤合麻杏石甘汤为治疗外感病三阳合病的经典组合,在北方外感诸疾中尤为常用。小柴胡汤合麻杏石甘汤也是新型冠状病毒感染伴见发热、咳嗽的治疗主方。麻杏石甘汤是历代临床治疗肺热咳喘的经典名方。“汗出而喘”,揭示邪热壅肺,轻者可见于咳喘的同时伴见额头、发际汗出溱溱,重症多见于全身汗出,前胸“挂满”豆大汗珠,成排成串,现代医学认为与肺部感染有关。“无大热”,这里的“大热”言症状而不言病机,并非热证不重,恰恰相反,提示火热与炎症很重。小柴胡汤合麻杏石甘汤证指征:(1)疾病方面,可用于病毒性肺炎、支气管肺炎、大叶性肺炎、支原体肺炎、新型冠状病毒感染、麻疹合并肺炎、重症急性呼吸综合征(SARS)、禽流感、甲型H1N1流感、慢性阻塞性肺疾病合并急性加重、百日咳等;(2)症状方面,其指征包括口苦、咽干、目眩、默默不欲饮食、心烦喜呕、胸胁苦满,往来寒热、恶寒与发热交替、低热、中等发热、或高热均可见,胸闷咳喘、咳嗽咳痰、黄痰难咳,口干渴、欲冷饮、烦躁、汗出,小便黄、大便干,舌红、苔薄白或黄、质干,脉浮滑数有力、右寸为主。

Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic herbal formula.All of them are derived from Treatise on Cold Damage(Shang Han Lun)by ZHANG Zhong-jing.This combination has the effects of harmonizing lesser yang,relieving exterior syndrome,clearing lung heat,and relieving panting.It is mainly used for treating the disease involving the triple-Yang combination of diseases and accumulation of pathogenic heat in the lung.Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic combination for the treatment of exogenous diseases involving the triple-Yang combination.They are commonly used in exogenous diseases,especially in the north of China.This combination is also the main treatment strategy for coronavirus disease 2019(COVID-19)accompanied by fever and cough.Maxing Shigan Decoction is a classical herbal formula for treating the syndrome of phlegm-heat obstructing the lung."Dyspnea after sweating"suggests the accumulation of pathogenic heat in the lung.Patients with mild symptoms may develop cough and asthma along with forehead sweating,and those in critical severe may develop whole-body sweating,especially the front chest.Modern medicine believes that the above situation is related to lung infection."Mild fever"refers to syndromes rather than pathogenesis.It does not mean that the heat syndrome is not heavy,instead,it suggests that severe heat and inflammation have occurred.The indications of Xiao Chaihu Decoction combined with Maxing Shigan Decoction are as fllows.In terms of diseases,it is suitable for the treatment of viral pneumonia,bronchopneumonia,lobar pneumonia,mycoplasma pneumonia,COVID-19 infection,measles with pneumonia,severe acute respiratory syndrome(SARS),avian influenza,HIN1 influenza,chronic obstructive pulmonary disease with acute exacerbation,pertussis,and other influenza and pneumonia.@In terms of syndromes,it can be used for the syndromes of bitter mouth,dry pharynx,vertigo,loss of appetite,vexation,vomiting,and fullness and discomfort in the chest and hypochondrium.It can also be used to treat alternate attacks of chill and fever and different degrees of fever,as well as chest tightness,cough,asthma,expectoration,dry mouth,wanting cold drinks,feeling agitated,sweating,yellow urine,dry stool,red tongue,yellow or white fur,and floating,smooth,and powerful pulse,especially the right wrist pulse.