清中化湿类方的临床运用与证机辨析

Clinical application and syndrome and pathogenesis differentiation of recipes of clearing dampnessheat in middle jiao

结合病案,辨析半夏泻心汤与黄连温胆汤、小陷胸汤与清中汤,连朴饮与加味连苏饮、凉膈散与甘露消毒丹、蒿芩清胆汤与大柴胡汤的证机异同。认为:半夏泻心汤与黄连温胆汤皆辛开苦降,前者攻补兼施,后者重在化痰;小陷胸汤与清中汤均可治疗胃痛,前者涤痰理气,后者主胃中实热;连朴饮与加味连苏饮均可治疗胃气上逆,前者芳香化湿,后者寒热同调;使用凉膈散或甘露消毒丹时需辨清病位;蒿芩清胆汤、大柴胡汤都能清泄肝胆,但适用的病情程度不同。临床运用清中化湿类方,当掌握各方的证机特点,使选方精准有效。

Syndrome of dampness-heat in middle jiao is a common pattern in gastroenterology,and therapy of clearing dampness-heat in middle jiao is the commonly used treatment for this syndrome. Combined with the medical cases,this paper differentiates and analyzes the similarities and differences on syndrome and pathogenesis between Banxia Xiexin Decoction and Huanglian Wendan Decoction,Xiaoxianxiong Decoction and Qingzhong Decoction,Lianpu Decoction and Modified Liansu Decoction,Liangge Powder and Ganlu Xiaodu Pellet,Haoqin Qingdan Decoction and Dachaihui Decoction. It is considered that,both Banxia Xiexin Decoction and Huanglian Wendan Decoction show the effects of opening with pungent and descending with bitter natured drug,the former makes reinforcement and elimination in combination,the latter emphasizes removing phlegm. Both Xiaoxianxiong Decoction and Qingzhong Decoction can treat stomachache,the former focuses on clearing phlegm and regulating qi-flowing,the latter aims at excessive heat in stomach. Both Lianpu Decoction and Modified Liansu Decoction can treat syndrome of adverse rising of stomach qi,the former resolves dampness with aromatics,the latter co-regulates cold and heat. For Liangge Powder and Ganlu Xiaodu Pellet,it should make clear differentiation on disease location. Both Haoqin Qingdan Decoction and Dachaihui Decoction can clear stagnant heat in liver and gallbladder,but the degree of illness is different. In clinical practice,only when the syndrome and pathogenesis characteristics of each recipe are held,the accurate and effective prescriptions could be selected.