基于现代病理生理机制的柴胡加龙骨牡蛎汤方证解读及临床运用体会

Clinical application of Chaihu Jia Longgu Muli Decoction based on modern pathophysiology mechanism

柴胡加龙骨牡蛎汤出自东汉医家张仲景的《伤寒论》,原文将该方用于治疗伤寒太阳表证误用下法,导致邪气内陷而成表里俱病,虚实互见之变证。现多将该方用于少阳阳明合病。基于现代病理生理机制,对柴胡加龙骨牡蛎汤的经典条文内涵进行解读,其“胸满”“烦”“惊”“小便不利”“谵语”“一身尽重,不可转侧”均具有深刻的病理生理学基础,涉及心血管、呼吸、神经系统、精神神经等多个系统病变。该方临床应用范围极其广泛,可用于治疗癫痫、脑动脉硬化、脑梗死等脑血管疾病,高血压病、心律失常等心血管疾病,以及失眠、便秘、焦虑、抑郁状态、心脏神经官能症等急慢性疾病以及心身医学疾病。其临床运用指征包括胸胁苦满,口苦,咽干,目眩的柴胡证;失眠,焦虑,抑郁,易惊,烦躁,多梦等精神神经症状;舌质红,舌苔厚黄腻,脉弦硬有力。除了单方应用之外,该方在合方运用上也有规律可循,笔者发现,该方临床常与瓜蒌薤白类方、温胆汤、枳术丸、橘枳姜汤、酸枣仁汤、半夏白术天麻汤等经典名方合用。

Chaihu Jia Longgu Muli Decoction was firstly recorded in Treatise on Cold Damage(ZHANG Zhong-jing,Eastern Han Dynasty).According to this medical classic,it is originally used in the treatment of the Shaoyang and Yangming sy ndrome.Based on the modern pathophysiological mechanism,this study interpreted the classic provisions of Chaihu Jia Longgu Muli Decoction.Original records of"chest fullness""annoyance""shock""difficult urination""delirium""heavy body and failing to turn over"all have profound pathophysiological basis,involving disorders in cardiovascular,respiratory,nervous,and menta l systems.This formula is widely used,which can be applied to treat epilepsy,cerebral arteriosclerosis,cerebral infarction,and other cerebrovascular diseases,hypertension,arrhythmia,and other cardiovascular diseases,insomnia,constipation,anxiety,depression,cardiac neurosis and other acute and chronic diseases as well as diseases in psychosomatic medicine.The clinical indications include Bupleuri Radix-targeted syndrome such as fullness and discomfort in chest and hypochondrium,bitter taste mouth,dry throat,and dizziness,the insomnia,anxiety,depression,susceptibility to fright,upset,dreamfulness and other psychiatric symptoms,red tongue,thick and yellow tongue coating,and wiry hard and powerful pulse.This formula was found to be used in combination with other formulas,such as Gualou Xiebai Decoction,Wendan Decoction,Zhizhu Pills,Juzhijiang Decoction,Suanzaoren Decoction,and Banxia Baizhu Tianma Decoction.