探析小柴胡汤证“但见一证便是”  

Prescribing Principle of"Any One Manifestation of Xiaochaihu Decoction Syndromes Suggesting the Use of It"

作　　者：孙嘉慧 李浩 SUN Jiahui;LI Hao(Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing China 100102)

机构地区：[1]中国中医科学院望京医院,北京100102

出　　处：《中医学报》2024年第6期1200-1203,共4页Acta Chinese Medicine

基　　金：国家重点研发计划“中医药现代化”重点专项项目(2022YFC3501400)。

摘　　要：《伤寒论》第101条言:“伤寒中风,有柴胡证,但见一证便是,不必悉具。”其中,“但见一证便是”之“一证”指“往来寒热,胸胁苦满,嘿嘿不欲饮食,心烦喜呕”之一或几证相合。小柴胡汤非独主少阳一经,伤寒中风,传变迅速,“一证”表现迥异,仲景提出“但见一证便是”的本意或指若无法辨明病在何经,见柴胡证“一证”即可用小柴胡汤,以求疾病速愈。小柴胡汤证“但见一证便是”原则的使用需以伤寒中风为前提,临证时需辨病与辨证相结合,不可仅见“一证”便贸然施治。先辨病,尊重不同疾病的发展规律和治疗原则,“急则治其标,缓则治其本”,明晰不同疾病的轻重缓急;后辨证,综合运用辨证方法,重视整体病机,明确治则、治法,运用“方证结合”完成近似方剂的优选过程。It is said in the 101 article of Shang Han Lun that"in Cold damaging or Wind attacking syndromes,any one manifestation of Xiaochaihu Decoction syndrome suggests the use of it.In other words,it is not necessary to find all the symptoms in clinical practice".Accurately,"any one manifestation of Xiaochaihu Decoction syndrome"refers to one or several syndromes including alteration of chill and fever,fullness and discomfort in chest and hypochondria,apathy/indifference,upset or lost in appetite as well as nausea and vomiting.In essence,Xiaochaihu Decoction is not only the prime curative of Shaoyang syndrome,but also can be used in other six-meridian disease.It is usually fast of transmitting and changing in Cold damaging or Wind attacking cases and the manifestations are quite different.If it is difficult to identify the meridian of the disease and there is a definite manifestation of Xiaochaihu Decoction syndrome,the decoction can be prescribed to cure the disease quickly,which is what Zhang Zhongjing really meant.In clinical practice,the prescribing principle of"any one manifestation of Xiaochaihu Decoction syndrome could determine the use of it"should be applied on the premise of Cold damaging or Wind attacking symptoms.It is necessary to combine the disease differentiation with syndrome differentiation.However,it is inadvisable to rashly treat where there is only one symptom of the syndrome.Based on disease differentiation,the development rules and treatment principles of different diseases should be respected.In addition,clarify the priorities of different diseases and"relieve treetop in acute cases and treat root aspect in moderate cases".Secondly,the methods of syndrome differentiation should be applied comprehensively.Pay attention to the overall pathogenesis to clarify treatment principles and methods,to select the best prescription among similar formulas,using the theory of"prescription syndrome".

关 键 词：小柴胡汤证 “但见一证便是” 《伤寒论》 张仲景 伤寒中风 

分 类 号：R222.16[医药卫生—中医基础理论]