【作者】 刘西强；

【导师】 黄煌；

【作者基本信息】 南京中医药大学 ， 中医临床基础， 2010， 博士

【摘要】 目的：本文主要目的是研究温胆汤方证,以指导临床更加安全有效地运用本方。方法：广泛搜集相关资料,按照文献性质不同,研究主体分为类方文献研究、医论类文献研究、古代医案类文献研究、临床观察类文献研究、现代医案类文献研究、黄煌教授温胆汤经验研究六部分,根据研究需要及文献特点,采取有差异的研究方法,分别统计与分析温胆汤方证相关内容,如温胆汤主治疾病、温胆汤主治症状、温胆汤体质等；最后,对如上各部分研究结果进行对比与分析,归纳温胆汤方证。结果：1.探讨了“方证”和“方的体质”的内涵和定义；2.通过文献统计与分析,揭示了各部分文献所蕴含的温胆汤方证内容,最后归纳出较为完善的温胆汤方证；3.探讨了温胆汤临床使用的相关问题,如温胆汤证出现的时机与病因、温胆汤加减运用、疗程、疗效情况、剂型剂量、煎服法、临床注意事项；4.探讨了温胆汤相关的理论问题,如温胆汤来源与原始方义、温胆汤病机与功效、温胆汤与痰饮的关系、半夏药性与炮制、温胆汤作用机制等。结论：1.温胆汤功效：调胆和胃,理气化痰,健脾安神。2.温胆汤证病机：胆胃不和,气郁痰搏,脾不健运。3.温胆汤原方温凉兼进、补泻兼施,不温不燥,调和为主,原义为治疗胆虚寒证,主要涉及足少阳阳明经和三焦经。4.温胆汤方证三大类原因：(1)体虚或大病后；(2)痰湿内盛或痰热内扰；(3)可以引起精神神经损害的各种因素。5.现代药理和实验研究表明,温胆汤可以调节精神神经系统功能,如抗失眠、抗抑郁、抗精神分裂、防治老年痴呆、改善记忆力、镇痛、镇惊、抗惊厥等,调节血脂,改善血流变,防治冠心病,抗衰老,治疗炎症和组织损伤,改善肾功能。6.从主治症状、主治疾病和体质方面对温胆汤方证进行如下表述：(1)温胆汤最典型的主治症状：失眠、惊恐、烦躁、恶心呕吐、食欲不振、眩晕。其他比较重要的主治症状：脉弦、疲倦、心悸怔忡、胸满闷、发热、脉数、自汗、多梦、喘息、全身浮肿、苔腻、脉滑、苔黄、舌红、口渴、苔白、腹胀满、咯痰、便秘、头昏头重、舌淡、苔厚、苔薄、腹痛等。(2)温胆汤可治疗病种非常多,最多分布于精神神经系统,其次为消化系统,再次为呼吸系统和循环系统,耳和乳突疾病比例也不小。温胆汤最典型的主治疾病为：失眠症、梅尼埃病、精神分裂症、高血压病、抑郁症,其次为癫痫、冠心病、神经官能症、慢性浅表性胃炎、神经性呕吐、中风、焦虑症等。因病种分散,在参考主治疾病的同时,处方多需辨证论治。(3)温胆汤体质：1)从小儿到老人均可出现,中青年最多,而3-10岁也较为集中；2)患者女性稍多；3)体型中等者最多,多体格健壮,也有久病,或产后虚弱,或体素虚,患者胖瘦均有,而胖者较瘦者多；4)面部滋润或油腻,或色白,或色黄暗,或色红,或浮肿貌,常缺乏正常光泽；5)患病前思维敏捷、聪明,对外界刺激敏感,感情丰富,多思虑,做事追求完美,容易心慌,处理事情容易犹豫不决；6)主诉甚多而怪异,却无明显阳性体征；7)经常饮酒,或喜食肥甘厚味；8)患者经常出现的异常症状,多属神经系统和消化系统,其次为呼吸系统和循环系统,如失眠、惊恐、恶心呕吐、烦躁、易怒、眩晕、疲倦、心悸怔忡、焦虑、抑郁、胸满闷、自汗、多梦、喘息、嗳气、全身浮肿、腹胀满、头晕头昏头重、咯痰、便秘、腹痛、吐酸、咽喉异物感等；9)口腔经常感觉异常,如口渴、口干、口粘、口苦、口麻、口臭、淡而无味等；10)舌苔多腻,可表现为厚苔、白腻苔、黄腻苔、燥苔、滑苔,也可为正常苔；11)舌质多为正常,亦可表现为舌红、舌淡或舌黯；12)舌体多为正常,亦可表现为舌胖；13)脉象或滑,或弦,或数,亦有很大比例为正常,少数有偏细或偏小者；14)曾经患有或现患有某些疾病,如梅尼埃病、神经性呕吐、精神分裂症、高血压病、癫痫、冠心病、神经官能症、焦虑症、慢性浅表性胃炎、妊娠呕吐、睡行症、咽异感症、癔病、恐惧症、慢性胆囊炎、抑郁症、中风、嗜睡症、多汗症、偏头痛、创伤后应激障碍、儿童恐怖症、白大衣性高血压等。更多还原

【Abstract】 Object:The main object is to study formula symptoms and signs of Wendan Tang, therefore we could use Wendan Tang safely and effectively.Methods:Based on the related data collected widely, and according to different natures of the literature, the research could be divided into the formula research, medical experience summary of Wendan Tang in history, medical cases of Wendan Tang in history, modern medical cases of Wendan Tang, elite part of professor HuangHuang’s experience, etc. Different methods are applied to different parts according to the need of study and features of each part. Finally we conclude and analyse ancient and modern literature in retrospect in order to sum up formula symptoms and signs, such as main disease spectrum, main symptoms, bodytype, etc of Wendan Tang.Results:1.connotation and definition of bodytype of formula as well as formula Symptoms and Signs are discussed.2.Throught analyse the literature, principles related to formula symptoms and signs of different parts are be researched, Finally we conclude impeccable Symptoms and Signs of Wendan Tang.3.We discuss clinical problems related, such as chance and cause of disease, pattern and dosage, modification, course of treatment, curative effects, method of simmering, and announcements the do’s and don’ts. As well as We explore the methods for the study on formula and syndromes and constitution, etc. By the main principle of being practical and realistic and useful to clinical, and provide some important literature, when studying the formula Symptoms and Signs of Wendan Tang.4. We discuss theory related to Wendan Tang, such as the source and its original purpose, pathogenesi and efficacy, relation to phlegm and fluid retention, functiong mechanism, medicinal nature and processing method of Banxia.Conclution:1.Effecacy of Wendan Tang:Regulating Gallbladder and harmonizing stomach, regulating qi and resolving phlegm, invigorating spleen and tranquilizing mind.2. Pathological mechanism of Wendan Tang:Disequilibrium between gallbladder and stomach, qi stagnation and phlegm accumulation, dysfunction of spleen.3. The original composition of Wendan Tang uses warm and cool drugs concurrently, invigorating and purging simultaneously, neither warm nor dry, and makes coordination as the main effect. The original meaning of "wen" means to treat the syndrome of gallbladder asthenia-coldness, and mainly involves Gallbladder Meridian of Foot-Shaoyang and Sanjiao Meridian.4.Three main mechanisms that cause formula-syndrome of Wendan Tang. l)debility or after serious or chronic disease.2)Inner redundance of phlegm-dampness or inner disturbance by phlegm-heat. 3)Various of factors that cause psychological or neural defect.5. According to modern pharmaceutical experiment, Wendan Tang can regulate the function of psychological and neural system, i. e., counteracting insomnia, depression, schizophrenia, preventing and curing senile dementia, improving the faculty of memory, relieving pain, convulsion, adjusting blood fat, ameliorating blood rheological indices, preventing and curing coronary heart disease, anti-aging, treating inflammatory and histological injuries, and improving renal function.6. Formula Symptoms and Signs of Wendan Tang:(1)When used Wendan Tang, the symptoms of psychiatric system and digestive system should be paid attention, such as insomnia, fright, restlessness, nausea and vomiting, vertigo. (2)The patients number of Psychiatric system is the most, that of digestive system is the second, and that of circulatory system and respiratory system are thethird, that of ear and mastoid system is much too. Wendan Tang is mainly applicable to insomnia, meniere’s syndrome, schizophrenia, hypertension, depression. Secondly, it is also applicable to epilepsy, coronary heart disease, neurosis, tinnitus, palpitation, chronic superficial gastritis, neurotic vomiting, stroke, acid reflex, anxiety syndrome, etc. The application of Wendan Tang nowadays mainly relies on traditional syndrome differentiation, more diseases could be seen in the dissertation, they are only for reference. (3)Bodytype:l)It is fit to people of all ages, from the old to the young, the middle-aged, youth and the children the most; 2)among the patients the female are more; 3)medium-sized figure the most, muscular physique are more, and also prolonged illness, or postpartum weakness, or kidney yin deficiency; patients might be fat or thin, while fat ones are more; 4)the complexion could be moistening or greasy, or white, or dark yellow, or red, or puffiness appearances lack of luster; 5)before the patients suffered from the diseases, they should be quick-minded, clever, sensitive to external stimuli, abundant feelings, overthinking, they tend to be perfect, easily palpitate, be hesitant when dealing with something; 6)chief complaints are more and strange but they have no obvious positive body signs; 7)they often drink wine and take in greasy and rich food.8)They usually manifest the symptoms of psychiatric system and digestive system, secondly of respiratory system. such as insomnia, fright, nausea and vomiting, restlessness, anxiety, irritable, vertigo, lassitude, palpitation, depression, fullness and distress in the chest, spontaneous sweating, dreamy, panting, belching, edema all around, distending feeling and fullness in the lower abdomen, dizzy, heaviness of head, expectoration, constipation, abdominal pain, acid reflex, globus hystericus; 9)the patients could also show thirsty, or dry mouth, or sticky mouth, or bitter taste in the mouth, or numbness of the mouth, or oral malodor, or light and tasteless; 10)tongue coating is greasy, or thick, or whitish and greasy, or yellow and greasy, or dry, or smooth, or normal tongue fur; 11)most of the patients show normal tongue texture, manifesting reddish tongue, light-colored tongue, or grayish tongue; 12)tongue body could be normal, or showing swollen tongue; 13)the pulse should be slippery, or taut, or rapid, and also proportionally normal, a few of patients show thin and small pulse; 14)had suffered or are suffering from schizophrenia, hypertension, epilepsy, coronary heart disease, neurosis, tinnitus, neurotic vomiting, chronic superficial gastritis, vomiting of pregnancy, sleepwalking, globus hystericus, hysteria, phobia, chronic cholecystitis, depression, meniere’s syndrome, mania, stroke, lethargy, hyperhidrosis, migraine, post-traumatic stress disorder, children phobia, white coat hypertension, etc.更多还原