三部《名医类案》中历代医家误用小柴胡汤医案探析
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摘要
小柴胡汤误治案是指在错误的病机下运用小柴胡汤,不惟旧病不除,反致祸患频出。研究文献中的小柴胡汤误治医案有助于今人警惕小柴胡汤适应证中的疑似病症,文章通过举例分析3部《名医类案》中的12例小柴胡汤误治医案,根据辨证施治过程中的关键环节,分类总结其失误原因,以期为临证运用小柴胡汤提供借鉴:(1)发热性疾病,除首辨外感与内伤外,外感患者尚需辨别其属阴证或阳证,内伤患者需判断其属实证或虚证;(2)当少阳与阳明症状相兼时,需全面运用四诊合参以减少失误;(3)"但见一症"思路必须在把握少阳枢机不利这一病机的前提下进行应用;(4)施治阶段,医者需耐心交代服药宜忌,以防治疗事倍功半。
The mistreatment of Xiaochaihu Decoction refers to the use of Xiaochaihu Decoction under the wrong pathogenesis. In this case, not only does the old disease not be removed, but the disaster often occurs. The mistreatment of Xiaochaihu Decoction in the research literature helps people to be alert to the suspected symptoms in Xiaochaihu Decoction indications. This topic intends to analyze 12 cases of Xiaochaihu Decoction misdiagnosed in three series of Mingyi Leian. According to the key links in the process of syndrome differentiation, the reasons for the mistakes are summarized in order to provide reference for the use of Xiaochaihu Decoction in clinical trials. The experience includes:(1)In febrile diseases, except for exogenous disease and internal damage, patients with exogenous disease need to distinguish yin syndrome or yang syndrome; patients with internal damage need to judge excess syndrome or deficiency syndrome.(2)When the symptoms of Shaoyang disease and Yangming disease are combined, it is necessary to fully use the comprehensive analysis of data gained by four diagnostic methods to reduce errors.(3)‘Just see a symptom' must be applied under the premise of grasping the adverse mechanism of Shaoyang disharmony;(4)In the treatment stage, the doctors should be patient and accountable for telling patients compatibility and incompatibility of drugs, so as to prevent treatment from getting half the result with twice the effort.
The mistreatment of Xiaochaihu Decoction refers to the use of Xiaochaihu Decoction under the wrong pathogenesis. In this case, not only does the old disease not be removed, but the disaster often occurs. The mistreatment of Xiaochaihu Decoction in the research literature helps people to be alert to the suspected symptoms in Xiaochaihu Decoction indications. This topic intends to analyze 12 cases of Xiaochaihu Decoction misdiagnosed in three series of Mingyi Leian. According to the key links in the process of syndrome differentiation, the reasons for the mistakes are summarized in order to provide reference for the use of Xiaochaihu Decoction in clinical trials. The experience includes:(1)In febrile diseases, except for exogenous disease and internal damage, patients with exogenous disease need to distinguish yin syndrome or yang syndrome; patients with internal damage need to judge excess syndrome or deficiency syndrome.(2)When the symptoms of Shaoyang disease and Yangming disease are combined, it is necessary to fully use the comprehensive analysis of data gained by four diagnostic methods to reduce errors.(3)‘Just see a symptom' must be applied under the premise of grasping the adverse mechanism of Shaoyang disharmony;(4)In the treatment stage, the doctors should be patient and accountable for telling patients compatibility and incompatibility of drugs, so as to prevent treatment from getting half the result with twice the effort.
引文
[1]明·江瓘.名医类案.北京:人民卫生出版社,2014:11
[2]清·魏之琇.续名医类案.北京:人民卫生出版社,2015:11
[3]鲁兆麟.二续名医类案.沈阳:辽宁科学技术出版社,1996:9
[4]郝云,赵一敏.从小柴胡汤效用探究少阳枢机原理临床意义.中华中医药杂志,2017,32(1):4870-4872
[2]清·魏之琇.续名医类案.北京:人民卫生出版社,2015:11
[3]鲁兆麟.二续名医类案.沈阳:辽宁科学技术出版社,1996:9
[4]郝云,赵一敏.从小柴胡汤效用探究少阳枢机原理临床意义.中华中医药杂志,2017,32(1):4870-4872