龙胆泻肝汤源流探析与经脉解读

Longdan Xiegan Decoction and its interpretation from the perspective of meridians

系统梳理历代医书中的龙胆泻肝汤发现, 最初《兰室秘藏》所载龙胆泻肝汤主要针对男子前阴臊臭之疾, 经过薛己的加减变化使主治范围逐渐泛化扩展, 并出现方剂名称、组成和源流混乱的问题, 《景岳全书》和《医方集解》在这一问题上表现得较为突出。过往医家多从脏腑角度对该方进行解读, 转换视角从经脉角度重新解读, 或可更好理解龙胆泻肝汤的主治规律。将前阴的病症归于足厥阴肝经, 而将胁痛、耳聋等病症归于足少阳胆经, 并根据病情加减用药, 既有利于对该方全面与深入的理解以实现临床辨证与用药精准, 也可促使现代研究者重新思考经络学说在整个中医理论体系的形成与发展过程中起到的重要作用。

By systematically examing through Longdan Xiegan Decoction in medical books of the past dynasties,it was found that the Longdan Xiegan Decoction recorded in Lan Shi Mi Cang mainly targeted men's genital odor at frist.After Xue Ji's addition and subtraction,the scope of the prescription was gradually generalized and expanded,and confusion its name,composition and source of the prescription appeared,which was particularly prominent in Jingyue Quanshu and Yifang Jijie.Doctors used to interpret this prescription from the perspective of viscera.In order to better understand the main treatment rules of Longdan Xiegan Decoction,it is necessary to change the perspective and reinterpreted it from the perspective of meridians.Attributing the symptoms of the perineum to Liver Meridian of Foot-Jueyin,hypochondriac pain,deafness and other symptoms to the Gallbladder Meridian of Foot-Shaoyang,and adding or subtracting herbs according to the specific conditions,is not only conducive to a comprehensive and in-depth understanding of the prescription to achieve accurate clinical syndrome differentiation and medication,but also prompts modern researchers to rethink the important role of meridian theory in the formation and development of the theoretical system of traditional Chinese medicine.