浅析柴胡四物汤的方源、方证及方药特点  

Analysis of Origin,Adaptation Syndrome and Characteristics of Chaihu Siwu Decoction

作　　者：柳琳[1] 刘松林[1] 岳滢滢[1] 许乐思[1] 周贤[1] 林云崖[1] LIU lin;LIU Songlin;YUE Yingying;Xu Lesi;ZHOU Xian;LIN Yunya(Hubei University of Chinese Medicine,Wuhan Hubei China 430061)

机构地区：[1]湖北中医药大学,湖北武汉430061

出　　处：《中医学报》2021年第6期1164-1167,共4页Acta Chinese Medicine

基　　金：国医大师传承工作室建设项目{国中医药办人教函〔2018〕119号};湖北中医药大学“青苗计划”项目(201922X015)。

摘　　要：柴胡四物汤从最初的治妇人产后虚劳、复感外邪,扩展为治血虚或阴虚发热、疹后余热、热入血室、三阴温疟、伤损之证等,其病机不外乎“虚”“瘀”两端。方药组成也在小柴胡汤、四物汤的基础上灵活加减化裁,或易熟地黄为生地黄,或用赤芍以代白芍,或去参、姜、枣等。运用本方时,亦当遵循古法,结合患者具体证候,如血虚偏重者,可选择熟地黄;血热偏重者,则选用生地黄;血瘀血热偏重者,可选用赤芍;阴血不足偏重者,则选用白芍;明显气虚之人,可保留人参;若虑红参太过温燥,可改用生晒参;若兼见气阴不足,则用西洋参;若兼脾胃失调,湿邪内蕴,气机不畅者,则考虑去参、枣等;若外邪不重,又无明显呕恶,则可去生姜。如此紧扣病机,随证加减,柴胡四物汤才能活用于各科,扩大其临证运用范围。Chaihu Siwu Decoction was originally used to treat women's postpartum consumptive disease,reoccurrence of exogenous evil,then expanded to treating of fever caused by Blood deficiency or Yin deficiency,residual Heat after rash,heat invading blood chamber,three-yin-warm malaria,injuries,etc.However,its pathogenesis is still confined in"deficiency"and"stasis".The prescription composition is also flexibly modified based on Xiaochaihu Decoction and Siwu Decoction,such as replace Radix Rehmanniae Preparata with Radix Rehmanniae Recens,or replace Radix Paeoniae Alba with Radix Paeoniae Rubra,or remove Radix Ginseng,Rhizoma Zingiberis Recens,jujube and so on.While using this prescription,the ancient method and the specific symptoms should be obeyed and considered.Cases with Blood deficiency can use Radix Rehmanniae Preparata,while Blood heat patients can choose Radix Rehmanniae Recens.If Blood stasis and Blood heat are the main symptoms,one can choose Radix Paeoniae Alba.For those with Yin and Blood deficiency,Radix Paeoniae Alba should be adopted.While people with obvious Qi deficiency can reserve Radix Ginseng.If Radix Ginseng Rubra is too warm and dry,then replace it with dry Radix Ginseng.Cases combined with Yin and Qi deficiency,Radix Panacis Quinquefolii should be used.With cases of spleen and stomach disorder,internal dampness,and Qi movement blockage,consider removing Radix Ginseng,Rhizoma Zingiberis Recens,and Jujube are often used;If the external evil is not severe and has no obvious nausea,Rhizoma Zingiberis Recens can be removed.Above all,closely following the pathogenesis and syndrome while modifying the prescription,only in this way Chaihu Siwu Decoction can be used wildly and expand its adaptation syndrome application in clinical treatment.

关 键 词：柴胡四物汤 方源 方证 方药特点 

分 类 号：R281[医药卫生—中药学]