【作者】 何永明；

【导师】 黄煌；

【作者基本信息】 南京中医药大学 ， 临床中药学， 2009， 博士

【摘要】 中医学在数千年的发展中,积累了大量宝贵的经验。方药作为中医治疗病证的主要方法之一,不断地发展和完善。其中,历代医家所常用的经典方剂,配伍合理、组方精纯、疗效卓著。这些经典方剂及其适应证,应当成为中医学研究的重点内容。方证,是方药和病证的对立统一。把经典方剂和其适应证作为相对应的整体来研究,即方证研究。柴苓汤,是小柴胡汤与五苓散的合方。在古代一般用来治疗,伤寒泄泻身热、伤风伤暑阳明疟、麻疹痘疮疝气等病证,症见身热、口渴、腹泻、小便不利者。20世纪80年代后,中外学者对柴苓汤的药理作用进行了深入研究,在临床广泛运用于内、外、妇、儿、皮肤、骨伤、肿瘤等各科多种病证的治疗。柴苓汤方证研究,以柴苓汤方剂和其适应证为研究重点,从药物方剂和临床运用两个方面进行了论证总结。柴苓汤的组方药物有:柴胡、黄芩、半夏、党参、甘草、生姜、大枣、茯苓、猪苓、泽泻、白术、肉桂。关于古人参,经考证认为《伤寒杂病论》记载的“人参”当为桔梗科党参而非五加科人参。以桂林古本《伤寒杂病论》为研究内容,归纳整理了:柴苓汤组方药物在经方中的剂量范围、小柴胡汤在经方中的运用规律、五苓散在经方中的运用规律、人参在经方中的运用规律。同时,综述了柴苓汤的历史沿革、组方药物和柴苓汤方剂的现代药理研究。柴苓汤剂型,在国内以汤剂为主,在日本以颗粒剂为主。以“辨证论治”或“辨病施治”为原则,运用柴苓汤未发现明显不良反应。临床运用方面,整理了柴苓汤的现代临床运用状况、黄煌教授运用柴苓汤的经验。此外,笔者本着“方证相应”的精神,运用柴苓汤治疗多例肿瘤病人,取得了较好地疗效。柴苓汤治疗的病证,以水液代谢障碍性疾病、自身免疫性疾病为多,临床表现以水肿、蛋白尿、腹泻为常见,疗效作用有治疗疾病、缓解症状、增效减毒、改善生活质量等方面。黄煌教授在治疗肿瘤病人时,柴苓汤也有着较多地运用,强调“方—病—人”方证三角的有机联系。柴苓汤证的典型表现有:病人情绪低落或焦虑,食欲不振或呕吐,胸胁苦满,口渴,便溏,小便不利,面目肢体浮肿,舌暗淡苔薄白,脉浮数或沉弦。在临床运用柴苓汤时,有治疗疾病、改善症候、调理体质三种情况。疗效评价,从病人的自我感受、症状体征、理化检查、生活质量、生存时间等多方面观察。更多还原

【Abstract】 Chailing decoction,Xiaochaihu decoction combining with Wuling powder,was used to alleviated disease and syndrome in ancient time like fever,thirst,diarrhea, dysuria,etc.From 80s of 20th Century,the pharmacology of the decoction has been studied deeply.It is used extensively in various diseases and syndromes.The study of formula syndrome of Chailing decoction put emphasis on components and indications.Chailing decoction consists of chaihu,huangqin,banxia,dangshen, gancao,shengjiang,dazao,fuling,zhuling,zexie,baizhu and rougui.The form of the formula is mainly decoction in China and granule in Japan.When used according to the principles of Syndrome Differentiation or Disease Differentiation,there have no obvious adverse reactions with the decoction.We clean up the clinical usage and experiences of Dr Huang huang about the decoction.The decoction also shows satisfied effects in patients with cancer based on the principle of formula related syndrome.The representative symptoms and signs of the syndrome include depressed or anxious of mood,inappetence,vomiting,thirst,diarrhea,disuria,edema in face or lower limbs.The tongue is often dim and plump and tongue coat is thin and white. The clinical usage of the decoction includes treating diseases,alleviating symptoms and adjusting constitution.The efficacy of decoction can be judged by evaluating the feeling of patients,symptoms and signs,physical and chemical examination,quality of life and Survival Time,ect.更多还原