当归六黄汤加减治疗汗证医案一则

Treating one case of hidrosis syndrome with the Danggui Liuhuang decoction

汗出为临床常见症状,而汗出过多则为人体异常状态,西医称之为多汗症,根据起病原因分为原发性多汗和继发性多汗,临床上多采用手术和非手术治疗。中医则认为汗证是由于阴阳失调、营卫不和、腠理不固而致汗液外泄失常的一类病证,包括盗汗、自汗、绝汗(或脱汗)、黄汗、战汗,其中盗汗与自汗较为多见。文章从病因病机、治则及中西医的治疗进展认识汗证,并介绍了治疗主方当归六黄汤的病机与功用。当归六黄汤首载于李杲(号东垣)的《兰室秘藏》,由当归、生地黄、熟地黄、黄芩、黄柏、黄连、黄芪七味药组成,可滋阴泻火、固表止汗,常用于治疗盗汗。虽然当归六黄汤历来为治疗盗汗的名方,临床上主要用来治疗阴虚火旺型盗汗,但其同样可以用来治疗自汗,如张介宾(号景岳)所言:“阳证自汗或盗汗者,但察其脉证有火,或夜热烦渴,或便热喜冷之类,皆阳盛阴虚也,宜当归六黄汤为第一。”即不论自汗或盗汗,只要病机为火热内盛所致,皆可用当归六黄汤治疗。文章介绍当归六黄汤治疗自汗与盗汗并现医案一则,更好地认识到当归六黄汤的功效,以期今后能更好地运用当归六黄汤治疗汗出症状。

Sweating is a common clinical symptom,and excessive sweating is an abnormal state of the human body,which is called hyperhidrosis in Western medicine,which is divided into primary hyperhidrosis and secondary hyperhidrosis according to the cause of onset,and surgery or non-surgical treatment is mostly used in clinical practice.TCM believes that hidrosis syndrome is a type of disease syndrome that causes abnormal sweat leakage due to Yin(阴)and Yang(阳)imbalance,disharmony between Ying(营)and Wei(卫),and insecurity of the interstices,including night sweating,self-sweating,apogee sweating(or sweating in shock),yellow sweat,and transpiration nerveuse,among which night sweating and self-sweating are more common.This article understands hidrosis syndrome from the perspectives of the etiology,pathogenesis,treatment principles and treatment progress of TCM and Western medicine,and introduces the pathogenesis and function of the Danggui Liuhuang decoction(当归六黄汤).The Danggui Liuhuang decoction was first published Lanshi Micang(《兰室秘藏》),which is composed of Danggui(Radix Angelicae Sinensis),Shengdihuang(Radix Rehmanniae),Shudihuang(Radix Rehmanniae Preparata),Huangqin(Radix Scutellariae),Huangbo(Cortex Phellodendri Chinsis),Huanglian(Rhizoma Coptidis),and Huangqi(Radix Astragali),can nourish Yin and relieve fire,fix the surface and stop perspiration,and is often used to treat night sweating.Although the Danggui Liuhuang decoction has always been a famous prescription for treating night sweating,it is mainly used to treat deficiency of Yin and fire hyperactivity type of night sweating in clinical practice,also can be used to treat self-sweating,as ZHANG Jiebin said,regardless of self-sweating or night sweating,as long as the pathogenesis is caused by dryness-heat being excessive in the interior,it can be treated with the Danggui Liuhuang decoction.In this paper,we can understand the efficacy of the Danggui Liuhuang decoction on self-sweating and night sweating, in order to more use the Danggui Liuhuang decoction in the treatment of diaphoretic symptoms in the future.