小柴胡汤和柴胡加龙骨牡蛎汤方证比较研究

【作者】 卫向龙；

【导师】 瞿融；

【作者基本信息】 南京中医药大学 ， 方剂学， 2005， 硕士

【摘要】 柴胡加龙骨牡蛎汤由小柴胡汤加减而成。本文收集整理了183例小柴胡汤和130例柴胡加龙骨牡蛎汤的现代临床验案，在中医理论的指导下，运用统计学方法对两方证进行了系统的比较研究。 结果显示，小柴胡汤证和柴胡加龙骨牡蛎汤证有相似之处，在主要症状方面皆有胸胁苦满、心烦和不欲饮食等，同时又有明显区别。小柴胡汤证以外感邪气为主要病因，外感发热疾病为主要病种，不欲饮食、恶心呕吐、胸胁苦满、往来寒热等为主要症状，少阳枢机不利为基本病机，与《伤寒论》原文比较变化不甚明显；柴胡加龙骨牡蛎汤证以精神刺激为主要病因，神志疾病为主要病种，胸满、烦躁、口苦、神情呆滞、惊恐、精神抑郁、失眠、便秘等为主要症状，肝气郁滞或兼痰热内扰心神为基本病机，与原文相比应用范围扩大，由原书的误治变证，转以神志疾病为主。 在方药运用方面，两方君药柴胡的平均用量之比仍接近于原方比例，即2：1。小柴胡汤中柴胡平均用量在10～20克左右，波动较大，其余药物变化不大，加味药物以清热药、解表药为主；柴胡加龙骨牡蛎汤中柴胡用量为10克左右，且波动不大，龙骨和牡蛎常用15克和30克两种剂量，其他药物用量变化不大，加味药物以平肝息风药、安神药为主。提示小柴胡汤和柴胡加龙骨牡蛎汤方证的差异，与药味和药量的加减变化密切相关。更多还原

【Abstract】 Chaihujialugumulitang decoction derives from Xiaochaihutang decoction. The essay collects 183 clinical cases of Xiaochaihutang decoction and 130 cases of Chaihujialugumulitang decoction. It makes a comparative study about Xiaochaihutang decoction and chaihujialugumulitang decoction with statistics under the guidance of basic theory of TCM.The result indicate that the symptoms of Xiaochaihutang decoction and that of Chaihujialugumulitang decoction are similar to some extend. They both include chest coerce bitter, fidgety and anorexia. Xiaochaihutang decoction is mainly applied in febrile diseases, with the main symptoms like anorexia, vomiting, chest coerce bitter, exchanged fever and chill syndrome. The main syndromes it covers are within the scope described in Shanghanlun. The main etiology of Chaihujialugumulitang decoction syndrome is psychiatric stimulation, and the main diseases are psychiatric diseases, with the main symptoms like chest coerce bitter, fidgety, insomnia, constipation, stony expression, frightening, depression, etc. The main mechanisms is the stagnation of liver-Qi. Its range has been greatly expanded from missed cases to psychiatric diseases.It also indicates that the mean dosage of chaihu in Xiaochaihutang decoction is about 10 to 20 grams. Other drugs’ dosages do not differ much. The added drugs are mainly antipyretics and diaphoretics. In chaihujialugumulitang decoction, the dosage of chaihu is about 10 grams. The dosages Longgu and muli are mainly 15 or 30 grams, and other drugs’ dosages do not differ much.. The main added drugs are herbs for calming the liver to stop endogenous wind and tranquillizers. It shows that the difference between the syndromes of Xiaochaihutang decoction and chaihujialugumulitang decoction are closely correlated with drugs and change of the two formulae.更多还原