黄芪建中汤辨治正虚气逆顽固性呃逆  

Experience in Clinical Effects of Treating Qi Deficiency and Qi Counterflow Type Intractable Hiccup(IH) by Huangqijianzhong Decoction

作　　者：王见文 张怡[2] 郑育卿[1] 陈冠儒[1] 

机构地区：[1]成都中医药大学临床医学院 [2]成都中医药大学临床医学院中医内科学教研室,成都610075

出　　处：《实用中医内科杂志》2017年第12期67-69,共3页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：顽固性呃逆(呃逆≥24h未停止)病程长,持续耗损正气,加之素体虚弱,脾阳虚衰或突发情志不遂,阳虚及阴,阴不涵阳,正虚气逆;呃声响亮有力,形神未衰者属实证;呃声低闷无力,神疲形枯者属虚证。"虚劳里急,诸不足,黄芪建中汤主之",黄芪建中汤温中补虚,降逆止呕,以小建中汤加黄芪为用:黄芪一两半,桂枝三两,炙甘草二两,芍药六两,生姜三两,大枣十二枚,饴糖一升。针对脾胃虚弱加减,脾胃气虚加人参、白术及甘草,以甘温益气;兼有恶寒或腹痛遇寒加重生姜换干姜以温中散寒;吴茱萸、丁香、柿蒂则可温胃平呃;生湿使脘腹胀闷去大枣加茯苓;聚积成痰痰加陈皮、枳壳、瓜蒌皮化痰行气;化火必有结加黄柏、浙贝母,此火多是下焦虚火,故用黄柏;伤阴加知母、麦冬;久则生瘀轻加丹参;瘀重加五灵脂、莪术、桃仁;瘀血愈重,元气愈虚,党参换为人参;肺虚损不足酌添半夏;气虚及血,血虚加当归,补血降逆,血可载气,逆气归元,具补中益气汤的意义,当归亦可降逆。附呃逆(顽固性膈肌痉挛)验案1则。Intractable hiccups（hiccups≥24 h not stopped）is a kind of disease with long course. It will sustained damage the Yangqi, coupled with the weak body, spleen Yang deficiency or sudden sentiment.Because Yang deficiency then Yin deficiency that Yin couldn＇t support Yang. If the sound of hiccups were loud and powerful, moreover the body and the spirit were not weak, it belongs to excess syndrome. If the sound of hiccups were low and weak, the body and the spirit were not well, it belongs to deficiency syndrome. ＂Using Huangqi Jianzhong decoction if people feel weak, tired and endo-pain or lack of Qi.＂ Huangqi Jianzhong decoction not only could warm the middle and tonify the Qi, but also stop the vomit and balance the Qi.It is using Xiao Jianzhong decoction to add Huangqi. Use Huangqi 1.5 liang, Guizhi 3 liang, Zhigancao 2 liang, Shaoyao 6 liang, Ginger 3 liang, Dazao 12 grains, caramel 1 sheng. To make some plus or minus in the formula for the spleen deficiency. If people who were spleen and stomach Qi deficiency could add Rensheng,Baizhu and Gancao to tonify the Qi because of the sweet and warm quality. If there were also coupled with cold afraid or abdominal pain when met cold will be worsen, here could change Ginger to Ganjiang to warm the middle and remove the cold. Wuzhuyu, Clove, Shidi could warm stomach and release hiccups. If there were dampness to make abdominal distension could change Dazao to Fuling. Use Chenpi, Zhiqiao, Gualoupi to remove the phlegm and move the Qi if the dampness gather to be phlegm. The phlegm stay long time would be heat fire. There is fire will be a nodule then could use Huangbo, Zhebeimu. This kind of fire is deficiency fire in Xia-jiao so using Huangbo. If hurt Yin could add Zhimu, Maidong. After long course it will be a stasis.If the stasis is soft could use Dansheng, if the stasis is heavy could use Wulingzhi, Ezhu,Taoren. More heavy stasis, more Qi deficiency then Daneheng change to Rensheng. If there is lacking of Qi of the lungs could use a little Banxia. When Qi def

关 键 词：顽固性呃逆 正虚气逆 黄芪建中汤 温中补虚 降逆止呕 虚劳里急 小建中汤 补中益气汤 顽固性膈肌痉挛 

分 类 号：R259.731[医药卫生—中西医结合]