清燥救肺汤的理论与临床应用文献研究

【作者】 赖建志；

【导师】 李刘坤；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2010， 硕士

【摘要】 清燥救肺汤出自《医门法津·卷四·伤燥门》,为清代医家喻嘉言所创制。原方由桑叶、煅石膏、人参、甘草、胡麻仁、真阿胶、麦门冬、杏仁和枇杷叶等九味药物组成,具有清宣燥热,益气生津,润肺止咳,降逆平喘之功,主治温燥伤肺所致诸气膹郁,诸痿喘呕等证。自其创制以来,后世医家又不断对其进行临床应用和理论等方面的研究,并取得了丰硕的研究成果。本文检索了1999-2009年间的医学文献,搜集到清燥救肺汤治疗各种疾病的相关文献128篇,通过对这些文献的研究,初步弄明了清燥救肺汤在现代临床上的应用范围、主治病证的证候特点、药物使用情况及治疗效果等,可作为今后临床应用清燥救肺汤的重要依据。128篇文献资料显示,清燥救肺汤加减治疗的病证极为广泛,涉及呼吸、消化、皮肤、五官等系统的疾病30余种,远远超出了原方所治的病证范围。如清燥救肺汤治疗呼吸系统疾病11种,其中治疗咳嗽和急性支气管炎患者最多。所治咳嗽大部分属于燥热伤肺而咳,临床以干咳为主症,方中石膏、麦冬的使用率最高,治疗有效率为95%。所治急性支气管炎以干咳,或咳粘痰或脓性痰为主症,方中石膏、麦冬、甘草使用频次最高,治疗有效率为96%。治疗五官科疾病6种,其中治疗慢性咽炎、鼻衄的病例数最多。所治咽炎证型多为肺胃燥热,火热上蒸,主症为咽痛、咽干、咽痒、干咳少痰、咽部灼热感,方中麦冬、甘草、枇杷叶、桑叶使用率最高,治疗有效率达96.2%。所治鼻衄,主症为鼻子出血,方中麦冬、甘草、杷叶和桑叶的使用率最高,治疗有效率达91.9%。治疗皮肤科疾病6种,以老年皮肤瘙痒症为最多。患者以皮肤干燥脱屑为主症,方中石膏、桑叶、杷叶、杏仁、麦冬的使用率较高。研究还表明,清燥救肺汤在现代临床上应用,很少照搬原方,而绝大多数为加减使用。尤其是方中的石膏,基本上不用煅石膏,而是使用生石膏。在证候选择方面,并不拘泥于温燥伤肺所致的诸气膹郁,诸痿喘呕等证,而是根据疾病的病机和临床表现,不管何种疾病,无论发生于哪个季节,也不拘泥于某个系统,而只要是病机属于燥热伤肺、气阴两伤,临床表现为一派津亏燥热症状的,均可遵照“燥者濡之”的原则应用本方加减进行治疗。更多还原

【Abstract】 Decoction for Reliving Dryness of the Lung (DRDL) was created by a physician named Yu Jiayan in volume four in "Axioms of Medicine". The formula is composed with mulberry leaf, gypsum, ginseng, licorice, black sesame, ass hide glue, ophiopogon, apricot kernel, and loquat leaf. Its main function is to cure all qi huffing and depression and all wilting, panting, and retching ascribed to the lung invaded by dryness-heat. The indications of this formula are clearing dryness, diffusing lung heat and moistening the lung. Because of its precise compatibility and well curative effect, Physicians of past generations had expanded its field of application, continued their clinical and theoretical aspects of the study and achieved significant results. This paper will be a generalization and reduction to DRDL with the theory and preliminary clinical study and summarized.In this paper, we have collected 128 articles between 1999-2009 about DRDL addition and subtraction treating each kind of disease in clinic. From our study, we preliminarily dissect its applied range, indications syndromes, service conditions of the medicine and treatment effet, according to which can indicate us applying this prescriptions in future.The study showed that the scope of DRDL is extremely widespread by addition and subtraction, which involved in respiratory system, digestive system, skin disease, facial features division and infection in more than 30 kinds of diseases, which exceeded the scope of original formula in treating diseases.For example, DRDL by addition and subtraction can treats 11 kinds of diseases in respiratory system, which is mainly consisted of the chronic cough and acute bronchitis patients. Most of cough patients belong to the syndrome of hyperactivity dry cough; the main symptom is dry cough, the utilization ratio of gypsum and dwarf lilyturf is the highest. And the effective rate 95%. The main symptoms are dry cough and mucosity or pus phlegm, the utilization ratio of gypsum, dwarf lilyturf and liquorice is the highest, and the effective rate achieved 96%.DRDL with addition and subtraction treats 6 kinds of diseases in facial features system, the patients with chronic pharyngitis and epistaxis are most in treatment. Most of pharyngitis patients belong to the syndrome of dry heat in lung and stomach; the main symptoms are angina, dry or itch in pharynx dry cough with little phlegm in clinic. The utilization ratio of dwarf lilyturf, liquorice, the leaves of loquat and mulberry is highest, the treatment effectiveness is 91.9%.Beside this, DRDL is also used in facial features division and infection, in which elder cutaneous pruritus occupy the most. The main symptoms are dry and fur of skin, the utilization ratio of Radix Ophiopogonis, Folium Mori, loquatleaf and almond is the highest.The study also showed that clinical physicians applicate this decoction mostly in the forms of altered prescription but not original prescription, especially that most physicians selected calcined plaster instead of Gypsum. In syndrome aspects, they also didn limited to all qi huffing and depression and all wilting, panting, and retching ascribed to the lung invaded by dryness-heat. It was also used to cure other disease. No matter what the cause of pathogenic factors are, and in which season the disease onsets, the application of DRDL are not rigidly adhere to a system. When using this decoction, we should take attention to the clinical manifestations and the pathogenesis. And we may follow the principle "dryness is treated by moistening" according to syndrome differentiation and treatment.更多还原