运用柴胡加龙骨牡蛎汤治疗心悸病医案一则  

One case of applying the Chaihu Longgu Muli decoction in treating heart palpitations

作　　者：陆海楠 沈琳[2] 张懿 LU Hai’nan;SHEN Lin;ZHANG Yi

机构地区：[1]上海中医药大学,上海201203 [2]上海中医药大学附属龙华医院,上海200032

出　　处：《中医临床研究》2023年第9期24-27,共4页Clinical Journal Of Chinese Medicine

基　　金：上海市科学技术委员会科研计划(18401971500)。

摘　　要：柴胡加龙骨牡蛎汤为汉代张机(字仲景)所创,用于治疗伤寒误下,邪入少阳之证。古代医家多以此方治疗不寐、郁证、狂证、癫痫等精神、神经系统疾病,鲜有此方论治心悸病的记载。通过观察现代人日常生活和工作发现,生活节奏快、工作压力大是现代都市人普遍的特点,因此尤易出现焦虑、紧张、担忧等异常情绪,长此以往,首先会影响人们的气机运行。气郁首先犯于肝脏,肝气郁滞,气机不畅,则无力运行血液,心脏失于气血的濡养而发为心悸;此外肝气郁滞,日久化火,肝火上扰心神,加之气血涌盛,扰乱心神而致心神不宁,故在临床上治疗心律失常时,沈琳教授多主张心病从肝论治,心肝同治。在运用柴胡加龙骨牡蛎汤时,沈琳教授坚持方证辨证这一核心要点,领悟张机“但见一症便是,不必悉具”的核心思想,牢牢把握“胸满烦惊心悸”为关键点,临床但见因焦虑、受惊、疲累或寐差等所致心悸烦躁来诊者,以柴胡加龙骨牡蛎汤寒温并用,攻补兼施,肝胆调和,热祛魂安,使错杂之邪得以解除,其中以忧思、紧张等情志不悦为突出表现者,系气郁有热,魂神不定之象,以柴胡加龙骨牡蛎汤加减投之,取其疏肝清热,安神定悸之意,再配伍情志疏导,每每效如桴鼓。The chaihu Longgu Muli decoction(柴胡加龙骨牡蛎汤)is created by ZHANG Ji in Han Dynasty to treat the syndrome of typhoid fever and evil into Shaoyang(少阳)meridian by mistake.Ancient doctors mostly applied it in treating mental and nervous system diseases such as insomnia,depression syndrome,crazy syndrome,epilepsy,etc.There are few records of treating arryhythmia with this recipe.By observing the daily life and work of modern people,it is found that the fast pace of life and high work pressure are the common characteristics of modern urban people,so it is easy to cause anxiety,tension and worry.In the long run,the living environment will first affect people’s functional activities of vital energy.Generally speaking,depression and stagnation of Qi(气)firstly invade the liver.If functional activity of Qi is not smooth,it lacks strength to circulate Qi and blood,resulting in the insufficient nourishment of heart which brings about palpitations.Then long term liver Qi stagnation will transform into hepatic fire,which disturbs the mind and causes disconcertment.And the surge of Qi and blood can destabilize the state of mind,which can lead to disconcertment too.Consequently,in the opinion of Professor SHEN Lin,in dealing with the cardiac arrhythmia,treating Qi and blood of liver to ameliorate treatment of heart disease can mostly get good results,which means concurrent treatment of heart and liver.In applying the Chaihu Long­gu Muli decoction,Professor SHEN Lin insists on the core point of prescription and syndrome differentiation,grasping the core idea of Seizeing one main symptom instead of knowing all symptoms to treat the disease,firmly grasping the key symptoms such as stuffy chest,vexation and shock,throbbing in the heart.When patients are with vexation and palpitations due to anxieties,fears,fatigues or poor sleep,Professor SHEN Lin clinically applies the Chaihu Longgu Muli decoction to remove the mixed evils with cold medicines plus warm med­icines,tonification and purgation in combination,liver

关 键 词：柴胡加龙骨牡蛎汤 心悸 心肝同治 

分 类 号：R256.21[医药卫生—中医内科学]