【作者】 黄芳；

【导师】 赵映前；

【作者基本信息】 湖北中医药大学 ， 中医临床基础， 2010， 博士

【摘要】 目的：本课题旨在通过归纳张仲景对神志病证的辨证论治规律,并搜集临床案例及医论,从历代医家对仲景治疗神志病证的方药运用和理论扩展,总结经方在治疗神志疾病方面的运用规律,以期对临证用方提供有益的借鉴。方法：本文以文献研究的方式,对古代和现代文献中有关经方治疗神志病的医案、医论进行整理,采用归纳总结、类症研究的方法,将《伤寒杂病论》中治疗烦躁、不寐、癫狂、脏躁、百合病等神志疾病的方剂列出,以类证鉴别的形式,阐述仲景对每一方证的因机证治、方药配伍、用量用法,以及后世对仲景方的理解和运用,包括加减法、扩大应用之法、独到的用量用法等。尤其是对其扩展运用,阐明其扩大运用的理论和用方规律,包括古代医家的扩大运用及现代医家用治现代医学中的精神疾病的辨证论治规律。结果：经方中用于治疗神志病证的方剂有五苓散、栀子豉汤、白虎汤、三承气汤、桃核承气汤、小柴胡汤、柴胡桂枝汤等,其治疗的神志病证有烦躁、不寐、癫狂、痫证、奔豚病、脏躁、百合病等。根据文献整理,可以看到经方在古今治疗精神疾病方面运用广泛,且疗效显著。经方不仅用治仲景方中所涉神志疾病,而且广泛用于治疗现代医学中的精神分裂症、抑郁焦虑症、各种神经官能症等。由于辨证论治及方证相应的用方原则,及神志疾病病机的复杂多样性,经方治疗神志病也表现出了中医的异病同治和同病异治的特点,即一个经方常可治疗数种神志疾病,又某种神志疾病根据其具体的病机,又可能由多个经方来治疗。结论：经方治疗精神疾病不仅应用广泛,且疗效较为显著。临证运用经方治疗神志疾病的规律可归纳如下几点：1、惊狂和癫痫类神志病多从痰、火、瘀论治,主要方剂有桂枝去芍药加龙骨牡蛎汤、柴胡加龙骨牡蛎汤、生铁落饮、栀子豉汤、白虎汤、大承气汤、桃核承气汤等。2、心悸、脏躁、不寐等属气血亏虚证型的神志病多从补脾胃、调营卫论治,主要方剂有小建中汤、桂枝汤、甘麦大枣汤、炙甘草汤等。3、郁证及现代医学中的抑郁症、各种神经官能症多从气郁、痰滞及疏肝郁、和枢机论治,主要方剂有小柴胡汤、柴胡桂枝汤、半夏厚朴汤等。4、更年期综合症及各种神经症等阴属血亏虚及阴阳两虚证型者,多从补阴血、滋阴和阳论治,主要方剂有小建中汤、甘麦大枣汤、百合地黄汤、乌梅丸等。临床医者运用经方的用方规律有：1、以辨证为主,辨证与辨病相结合是运用经方的基本(?)思路。2、方证相应是临证选用经方的基本原则。2、师其法而不泥其方,针对具体病情,化裁运用是临床运用经方的主要形式。3、针对复杂病机,合方运用,是临床提高疗效的重要方法。4、融汇新知,发皇古义,是拓展经方运用的重要途径。更多还原

【Abstract】 Objective:To summarize the using rules of classical prescriptions to mental sickness,we include zhang zhongjing’ s prescriptions to mental sickness according to syndrome differentiationl, and collect the clinical cases and theories of medicine, thus from those applying classical prescriptions to mental sickness and extending on theories, we can get some salutary lessons on clinical treatment. Method:by using document study and analogue methods, this article list the prescriptions on mental sickness, elucidate those prescriptions’Pathogenesis, indications, attending syndromes, usage, reconstitution and later generations’applying, especially the extensive applying, adding and subtracting, distinctive usages. Then summarize the regularity of applying.Results:there are more than twenty classical prescriptions on mental sickness, such as wulingsan, zhizichitang, baihutang, chengqitang, taohe chengqitang, xiaochaihutang, chaihu-guizhi tang, etc. the mental sickness include dysthesia, insomnia, mania, mania, bentunbing, zangzao, baihebing, etc. Those prescriptions are applied to not only mental sickness in antiquity medical books, but also mental sickness such as Schizophrenia, melancholia, neurosis etc. in modern medical books. Furthermore, the classical prescriptions show remarkable curative effects. Those classical prescriptions are applied to multiple mental sickness; or different mental sickness can be treated by one classical prescriptions due to the rules of applying according to syndrome differentiation and the complexity of mental sickness.Conclusion:The classical prescriptions are applied to mental sickness widely and effectively. The rules and of clinical applying are revealed as follows:1. The base of applying classical prescriptions is corresponding between syndromes and prescriptions. To apply those classical prescriptions to mental sickness precisely, the classical prescriptions’pathogenesis and indications are pivotal.2、applying the classical prescriptions shoud not stick to those classical prescriptions, to the contrary, the flexibility is deeply important.3、The classical prescriptions are always applied with other classical prescriptions or non- classical prescriptions, in order to accord with multiple pathogenesis and make it good.更多还原