桂枝茯苓白术细辛汤治疗腰痛临床体会  

Clinical Experience of Treating Lumbago with Guizhi Fulling Baizhu Xixin Tang

作　　者：殷鸣[1] 赖宇[1] 

机构地区：[1]成都中医药大学,四川成都610075

出　　处：《河南中医》2016年第7期1234-1236,共3页Henan Traditional Chinese Medicine

基　　金：成都中医药大学科技发展基金(编号:ZRMS201225)

摘　　要：近代以来,《桂林古本伤寒杂病论》现世,载有通行版《伤寒论》中未有之方剂,如桂枝茯苓白术细辛汤等。《桂林古本伤寒杂病论》的真伪考据并不重要,重要的是其理论与临床价值。桂枝茯苓白术细辛汤功能温阳除湿,通络止痛,临床用于治疗湿气在下之腰痛,疗效满意。但在临床运用时应注意:1脉象,患者尺脉需见滑脉等反映下部湿气明显之脉象,其疗效方好;若尺脉沉弱无力,腰痛以肾虚为主因,则效果不佳。2细辛用量,对于湿气较重的患者,可以用到每日10 g,但必须先煎20 min以减其毒。3用药时间,此方以祛湿通络见长,久服易损伤正气,应中病即止,以7天以内为度,若疼痛明显减轻,可减去细辛,以它药替之;若无效,应考虑换方。4临床加减,若患者肾阳虚明显,可酌情加入炒杜仲、菟丝子、炒续断、仙灵脾、鹿角霜;肾阴虚者加生地黄、石斛;湿瘀互结加赤芍、川牛膝、鸡血藤、川芎;寒湿重症加生麻黄、独活、羌活、王不留行;湿郁化热加败酱草、大血藤、薏苡仁、土茯苓。In modern times, Guilin Ancient Book of Treatise on Cold Damage and Miscellaneous Disease has been published, in which the formulas beyond Treatise on Cold Damage （general version） are included,like Guizhi Fulling Baizhu Xixin Tang （GZ- FLBZXXT）. The textual research of this formula is not important, but the theory and clinical value of it is of great importance. GZ- FLBZXXT can warm yang, remove dampness, dredge collaterals and relieve pain, applicable to lumbago due dampness in the lower part of the body. Attentions should be paid in the clinical application ： 1 ） Pulse. Slippery pulse of the Chi part reflects obvious dampness in the lower part of the body. If the chi pulse is weak and feeble, himbago is mostly due to kidney deficiency and in this case the effects are not good. 2） Usage amount of Xixin （Radix et Rhizoma Asari）. For patients with severe dampness can take 10 g every day, and this herb must be decocted for 20min fir toxin reduction. 3） Time of administration. This formula has excellent effects of removing dampness and dredging the collaterals, but long-time use of it may impair the healthy qi. Therefore, the medica- tion should be stopped as soon as getting effect. Limit the medication within 7 days. If the pain is greatly relieved, Xixin （ Radix et Rhizoma Asari） can be reduced and replaced by other herbs. If there is no effect, other formulas can be taken into consideration. 4） Clinial modification. For obvious kidney yang deficiency,fried Duzhong （Cortex Eucommiae） ,Tusizi （Semen Cuscutae） ,fried Xuduan （ Radix Dipsaci ）, Xianlingpi （ Radix Dipsaci ） and Lujiaoshuang （ Cornu Cervi Degelatinatum ） can be added. For kidney yin deficiency, Shengdi （Radix Rehmanniae） and Shihu （Caulis Dendrobii） can be added. For intermingling dampness and blood stasis, Chishao （ Radix Paeoniae Rubra）, Chuanniuxi （ Radix Cyathulae）, Jixueteng （ Caulis Spatholobi ） and Chuanxiong （ Rhizoma Chuanxiong） can be added. For severe cold dampness, raw Ma

关 键 词：《桂林古本伤寒杂病论》 桂枝茯苓白术细辛汤 湿气 腰痛 

分 类 号：R274.34[医药卫生—中医骨伤科学]