中医药研究论丛

222.5 苓桂术甘汤治疗痰饮病的文献回顾与临床验案解析
TJ TCM.22(2) : 45-54, 2019
苓桂术甘汤治疗痰饮病的文献回顾与临床验案解析
The Review of Linggui Zhugan Decoction Treating Phlegm-Related Diseases and Clinical Applications
许尧钦1* 李佳蓉1 李俞生1 王瑜婷1
1 奇美医学中心中医部,台南,台湾
【摘要】
苓桂术甘汤,出自後汉张仲景《伤寒杂病论》,典籍中揭示苓桂术甘汤适用於心下逆满、头眩、气短等痰饮病之时机。本方重用茯苓甘淡为君,健脾运湿,渗湿化饮,通调水道;桂枝为臣,温阳化气,通经行水,加强化饮利水之力;佐以白术健脾燥湿,助脾运化以杜绝生痰之源;炙甘草则甘温补脾益气,兼调和诸药为使。四药共奏健脾利湿,温阳化饮之功。
吾等认为:临床使用本方时,只要掌握「痰饮为患」的主要病机,临证能够分清主诉病位(在脏腑或经络),辨明与次要病机之联结关系(风、寒、湿、热、虚、瘀),审慎分析辨证,灵活处方加减,其实可以广泛应用於冠心病、关节风湿痹痛、高血压、摄护腺肥大频尿、肠胃病、鼻病等痰饮病的治疗。本文举出五个验案为例,此五案疾病不同,临床表现各异,但其中阳不振,痰饮为患之病机则相同。五案皆以苓桂术甘汤为主方加减治疗,均获良效,体现了中医「治病求本,异病同治」之理。
【关键词】苓桂术甘汤、伤寒杂病论、痰饮病、异病同治
Hsu Yao Chin1* Lee Chia Jung1 Lee Yu Sheng1 Wang Yu Ting1
1Department of Chinese medicine, Chi Mei medical center, Tainan, Taiwan
【Summary】
Linggui Zhugan Decoction is a Chinese herbal formula from an ancient traditional Chinese Medicine book titled Shang Han Zabing Lun in which noted that this decoction is mainly applied to phlegm-related diseases such as epigastric distention, dizziness and shortness of breath. The formula comprises four Chinese herbs: Poria, Ramulus Cinnamomi, Rhizoma Atractylodis Macrocephalae and Radix Glycyrrhizae. Poria strengthens the spleen, drains dampness, and transforms phlegm; Ramulus Cinnamomi warms the Yang, facilitates the flow of Qi through channels, and helps to resolve congested fluids; Rhizoma Atractylodis Macrocephalae strengthens the spleen and dries dampness. Radix Glycyrrhizae supplements spleen Qi and harmonizes other herbs. These four herbs work together to strengthen spleen, resolve dampness, warm and transform the phlegm.
Only when we identify the phlegm pattern, distinguish the key mechanism, the position of illness (in organs or channels), the influence of other causes (wind, cold, damp, heat, vacuity, stasis), we could flexibly apply Linggui Zhugan Decoction in treating other clinical diseases including coronary diseases, impediment or muscle pain, hypertension, frequent urination, gastrointestinal diseases, nasal diseases and so on. In this article, we presented five effective cases using Linggui Zhugan Decoction to show that despite of different signs and symptoms, they all suffered from phlegm and dampness due to a common mechanism of devitalized middle Yang, reflecting the principles of Traditional Chinese Medicine: to treat the root; to treat different diseases with same method.
【Keywords】Linggui Zhugan Decoction, Shan Han Zabing Lun, Phlegm-Related Disease, same treatment for different diseases