李庭凯教授应用柴胡加龙骨牡蛎汤异病同治经验

Professor LI Tingkai's experience in treating different diseases with the Chaihu plus Longgu Muli decoction

柴胡加龙骨牡蛎汤出自张机(字仲景)的《伤寒论》,原方用于治疗太阳病误用下法后表邪内陷而致邪郁少阳,邪气弥漫三焦,表里俱病而出现的胸满、心烦、小便不利等病证。此方具有和解少阳、通阳泄热、重镇安神之效,可使少阳枢机运转,三焦畅达。文章介绍以柴胡加龙骨牡蛎汤为基础方治疗不寐、胃痞、汗证、郁证的病案四则。所举不寐案乃肝郁气滞、气机不利之证,以疏肝解郁、调畅气机为基本治法;所举胃痞案为肝胃不和之证,治以疏肝和胃之法;所举汗证验案为肝肺气郁之证,治以疏肝理肺之法;所举郁证案乃气机不利、肝气扰神之证,以调畅气机、镇静安神为治疗大法。此四则病案虽临床表现不一,但追溯其疾病起因均与情志改变相关,肝失疏泄而累及他脏,阴阳不和,均宜宣畅气机,调和阴阳,故方选柴胡加龙骨牡蛎汤加减化裁治疗,均获得较好疗效。柴胡加龙骨牡蛎汤临床应用广泛,通过搜集临床应用柴胡加龙骨牡蛎汤四则医案,展现山西省中医院李庭凯教授卓越的诊疗思路,为临床活用经方提供参考。

The Chaihu plus Longgu Muli decoction(柴胡加龙骨牡蛎汤) is from Shanghan Lun(《伤寒论》). The original prescription was used for chest fullness, upset, inhibited urination and other diseases caused by Taiyang(太阳) disease. This prescription has the effect on reconciling Shaoyang(少阳), clearing the Yang(阳) and relieving heat, and calming the nerves. It can make the pivot of Shaoyang work, and the triple energizer clear. The paper introduces four cases of insomnia, stomach stuffiness, hyperhidrosis and depression treated with the Chaihu plus Longgu Muli decoction. The insomnia is believed the syndrome of liver Qi(气) stagnation and Qi disturbance, and the basic treatment is to soothe the liver, relieve depression and regulate Qi. The stomach stuffiness is believed the syndrome of liver and stomach disharmony, and the treatment is to soothe the liver and regulate the stomach. The hyperhidrosis is believed the syndrome of liver lung Qi depression, and the treatment is to soothe the liver and regulate the lung. The depression is believed the syndrome of Qi disturbance, and the treatment is to regulate Qi and calm the mind. Although the clinical manifestations of these four cases are different, the causes are related to emotional changes. The liver is not regulated and the other organs are involved. Yin(阴) and Yang are not harmonious. It is appropriate to smooth Qi and adjust Yin and Yang. Therefore, the Chaihu plus Longgu Muli decoction is selected for treatment. After the application of the Chaihu plus Longgu Muli decoction, all cases get better curative effects. The author collected four medical cases of clinical application of the Chaihu plus Longgu Muli decoction, showed Professor LI Tingkai's superb diagnosis and treatment ideas, and provided references for clinical flexible use of classical prescriptions.