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222.6 从中医典籍看龙胆泻肝汤的方源追溯与临床应用纪录

TJ TCM.22(2) : 55-62, 2019

DOI : 10.6516/TJTCM.201909_22(2).0006

从中医典籍看龙胆泻肝汤的方源追溯与临床应用纪录

Clinical Review and Origin Tracing of the Long-Dan-Xie-Gan-Tang Decoctions in Ancient Traditional Chinese Medicine Works

吴重廷1　许尧钦1*

1 奇美医学中心中医部，台南，台湾

【摘要】

龙胆泻肝汤为中医治疗肝火上炎与肝经湿热的经典方剂，《医方集解》记载共三首龙胆泻肝汤，第一首为目前中医临床所习用「原方」，据《医方集解》记载本方来自《局方》，但经考证《太平惠民和剂局方》并无龙胆泻肝汤记载。第二首为东垣龙胆泻肝汤，方源来自《兰室秘藏》，主治因风湿热合於下焦所致的前阴热痒臊臭，第三首龙胆泻肝汤，据考证可能源自元罗天益《卫生宝鉴》，主要治疗治疗口苦胆瘅。

透过整理蒐集归纳明清重要典籍中有关龙胆泻肝汤的使用记录，结果显示：「原方」与「宝鉴方」在明清中医典籍纪录中受到比较多医家采用，「东垣方」组成较简单，可视为「原方」的基础。但在临床使用上，以上三首方剂清利肝胆湿热的目标并无太大分别。举凡肝经湿热下注的囊痈便毒，下疳悬痈，淋症阴疮，或肝火上炎的口苦耳聋，舌肿牙痈，带状疱疹等，均是本方之适用范围。

【关键词】龙胆泻肝汤、医方集解、兰室秘藏、卫生宝鉴、肝火上炎、肝经湿热

Wu Chung-Ting1　Hsu Yao-Chin1*

1Department of Chinese medicine, Chi Mei medical center, Tainan, Taiwan

【Summary】

Long-Dan-Xie-Gan-Tang (LDXGT) decoction is the typical formula in Traditional Chinese Medicine (TCM) to treat dampness-heat syndrome of liver meridian and upflaming of liver fire. There are three LDXGT decoctions in the work of Yi-Fang-Ji-Jie. The first formula origin was stated that it’s from the book Ju-Fang. But we searched the whole book of Tai-Ping-Hui-Min-He-Ji-Ju-Fang, LDXGT decoction is not found. The second formula LDXGT decoction is derived from Lan-Shi-Mi-Cang, which is the works of Li Dong-Yuan. It is used to treat itching of external genitalia. The third LDXGT decoction dictated in the book Yi-Fang-Ji-Jie maybe derived from the book Wei-Sheng-Bao-Jian after our research and is originally used to treat bitter taste of the mouth.

We searched the many ancient works of Traditional Chinese Medicine about the use record of LDXGT decoction and found: The first and the third LDXGT decoction are used more frequently. The second LDXGT decoction can be seen as the basis of the first LDXGT decoction. But all the three LDXGT decoctions have the same purpose to clear damp-heat of the liver. So there is no clear distinction in clinical use between three decoctions. We can use it to treat carbuncle of the genital region, urethritis, month bitterness, tongue swelling, herpes zoster.

【Keywords】Long-Dan-Xie-Gan-Tang decoction, Yi-Fang-Ji-Jie, Lan-Shi-Mi-Cang, Wei-Sheng-Bao-Jian, dampness-heat syndrome of liver meridian, liver upflaming of liver fire

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