茵陈蒿汤临床应用经验

Clinical Application Experience of Yinchenhao Decoction

茵陈蒿汤出自《伤寒论》《金匮要略》。茵陈蒿汤作为治疗黄疸的第一方,临床运用此方应把握其六个关键点:一为阳黄专方,其核心病机是湿、热、瘀互结,枢机不利,致使脾胃肝胆功能异常,郁结于肌肤而发黄;二为亦谷疸专方,因饮食水谷不节,肆食肥甘厚腻、辛辣之品,致脾寒胃热,脾胃运化失权,出现腹满,大便干,小便难,饱食则烦躁且头晕的谷疸表现;三为遵循原方相对剂量,重用茵陈,剂量应高于大黄、栀子用量,至少30 g以上,大黄常用6~28 g,栀子常用12~16 g;四为方证辨证抓主证,茵陈蒿汤的主要方证为但头汗出,身黄,巩膜黄染,大便干;五为经方叠用,结合患者临床症状,将茵陈蒿汤与栀子豉汤、栀子干姜汤、调胃承气汤等合用;六为病后调护与转归方运用,病后恢复期可辨证选用三仁汤、茵陈四苓汤、归芍六君子汤等方剂。本文通过论治茵陈蒿汤临床运用经验,以期为临床治疗提供一定参考。

Yinchenhao Decoction started to show from the book Treatise on Febrile Diseases and Synopsis of Golden Chamber.As the first formula for the treatment of jaundice,the clinical application of Yinchenhao Decoction should grasp its six key points.First,it is a special prescription for yang jaundice,and its core pathogenesis is that dampness,heat and blood stasis are intertwined,and the axis is unfavorable,which leads to spleen,stomach,liver and gallbladder dysfunction,stagnation in the skin and yellowing.Second,it is also a special prescription for treating dietary jaundice.Because of improper diet and eating fatty,sweet,greasy and spicy products,the spleen is cold and the stomach is hot,and the spleen and stomach lose their power,resulting in full abdomen,dry stool,difficulty in urinating,and irritability and dizziness when eating to fullness.Third,follow the relative dose of the classical prescription,and heavy dose of Artemisia capillaris should be higher than the dosage of rhubarb and gardenia jasminoides,at least 30 g;the weight of rhubarb is 6~28 g and the weight of gardenia jasminoides is 12~16 g.Fourth,grasping its main syndrome by syndrome differentiation.The main syndrome of Yinchenhao Decoction is that the head is sweating,the body is yellow,the sclera is yellow,and the stool is dry.Fifth,combination with classic prescriptions was needed.With the acutual symptoms of the patient,Yinchenhao Decoction was combined with Zhizichi Decoction,Zhizi Ganjiang Decoction and Tiaowei Chengqi Decoction.Sixth,attaching importance to postdisease nursing care and prescription prognostic application.Prescriptions such as Sanren Decoction,Yinchen Siling Decoction and Guishao Liujunzi Decoction can be selected in the recovery period after illness.This article discusses the clinical application experience of Yinchenhao Decoction in order to provide some reference for clinical treatment.