刍议小青龙汤治喘去麻黄加杏仁的临床意义

Clinical value of removing ephedra and adding almond for the Small Qinglong Decoction in treating dyspnea

“若喘,去麻黄,加杏仁”是小青龙汤加减法之一。依据《伤寒杂病论》原文及后世医家注解,总结了对于去麻加杏法的4种观点,即“水饮说”“气逆说”“血虚说”和“下焦阳虚说”。系统分析叶天士、吴鞠通和张锡纯三家临证验案,该加减法在三者临床实践中常用且有较好的疗效。原文、后世注解、医案皆提示血虚和下焦阳虚等麻黄的使用禁忌是去麻黄的根本原因,加用杏仁则可宣肺祛痰利水,更适合慢性、虚性、反复发作性的咳喘。

‘Removing ephedra and adding almond when the patient has dyspnea’was one of modifications of the Small Qinglong Decoction.Based on the original text of Treatise on Febrile and Miscellaneous Diseases and the annotations of later generations of doctors,four views on the modification of removing ephedra and adding almond are summarized,namely‘water retention theory’‘adverse rising of qi theory’‘blood deficiency theory’and‘lower jiao yang-deficiency theory’.Systematically analyzing the clinical cases of YE Tianshi,WU Jutong and ZHANG Xichun,the modification of removing ephedra and adding almonds was commonly used and has remarkable therapeutic effect in their clinical practice.The original text,annotations,and clinical cases all suggest that the drug contraindications of ephedra such as blood deficiency and lower jiao yang-deficiency are the root causes for removing ephedra.The addition of almond can help ventilate lung qi,eliminate phlegm,and remove dampness,making it more suitable for treating chronic,deficiency syndrome,recurrent cough and dyspnea.