二陈汤的应用心得

杏林小草 · 2009-10-11T10:07:00+00:00

[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤，方出《和剂局方》，由制[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao299.htm]半夏15g，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao202.htm]陈皮、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao160.htm]茯苓各12g，炙[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao379.htm]甘草6g组成。方中制[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao299.htm]半夏燥湿化痰，和胃降气为主药；[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao202.htm]陈皮行气化痰，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao160.htm]茯苓渗湿化痰为辅药；炙[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao379.htm]甘草补益脾胃，调和诸药为佐使。故合之，为燥湿化痰，和中降气之良方。痰湿内停，既可阻滞气机，壅塞经络，寒化热化，生风致瘀，兼挟外感、内伤等，以此方为基础，随证加减出入，灵活化裁，常可用于多种疾病的治疗。如今，本方加减广泛用于慢性支气管炎、慢性胃炎、消化道溃疡、神经性呕吐、神经衰弱、甲状腺肿及小儿流涎等病。痰湿滞胃，气机受阻，其证胃脘胀痛，嗳气稍舒，食少乏味，厌吃油腻，苔白腻，脉缓濡等。应除痰湿，消胀痛，和胃气。此病笔者常用[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao154.htm]苍术、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao376.htm]白术、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao205.htm]木香、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao156.htm]砂仁各9g治之，每收良效。嗳气食臭者，挟食滞也，宜加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao225.htm]山楂、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao227.htm]麦芽、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao226.htm]神曲各15g；自感脘部发凉者，痰湿寒化也，宜加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao192.htm]干姜9g、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao155.htm]厚朴15g；痛而拒按者，挟有瘀血也，宜加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao208.htm]川楝子、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao267.htm]延胡索各12g。痰湿中阻不解，又见胃脘胀闷发热，吞酸吐酸，苔色变黄，脉来滑数者，痰湿化热也。笔者遇此病，每用[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao45.htm]黄连9g、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao44.htm]黄芩12g治之，数剂即效。若痰湿化热，伤及胃络而呕血色黑者，宜上方再加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao204.htm]枳实15g，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao310.htm]竹茹、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao247.htm]侧柏叶炭、荷叶炭各9g，甚验；若呕吐不止，大便干结不下者，加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao104.htm]大黄9g治之，得泻病减。痰湿不解，阻滞经络，致阳气不得通畅者，其证尚见身麻或肢麻。应祛除痰湿，通经活络。此病笔者常用[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao154.htm]苍术、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao362.htm]天麻、胆南星各12g，橘络、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao275.htm]丹参各18g，并坚持守方，每获良效。中焦痰湿不解，蒙被清阳而致眩晕者，其证除痰湿中阻外，尚有眩晕，如坐舟车，甚则恶心呕吐等，当涤除痰湿，用[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao376.htm]白术、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao362.htm]天麻各12g，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao23.htm]蔓荆子9g，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao380.htm]大枣4枚治之，其效颇佳。苔白腻变黄，又心烦口若者，痰湿化热也。宜加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao24.htm]柴胡15g，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao44.htm]黄芩12g。恶寒发热，无汗，头身不适者，挟有外感风寒也。宜加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao6.htm]荆芥、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao7.htm]防风、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao3.htm]紫苏各12g治之。手足厥冷由痰湿内聚所致者，可急用[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao154.htm]苍术、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao152.htm]藿香各9g，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao311.htm]竹沥、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao4.htm]生姜汁各30滴，以除湿逐痰，痰湿去则手足厥冷自除。若上证继而又见汗出不止，脉来沉弱者，为痰湿致少阴阳虚欲脱之候也。宜用[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加附片(久煎)、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao375.htm]黄芪、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao192.htm]干姜以祛痰除湿，回阳救逆。痰湿内聚，浊气上攻而头痛者，其治应以祛痰除湿为主，止痛为辅。用[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao154.htm]苍术9g、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao266.htm]川芎12g、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao9.htm]白芷5g治之，数剂即见著效。若只见偏头痛者，挟少阳风热也。宜于[url]https://www.tcmbe.com/ShuJuKu/FangJiSuoYin/zzFangJiTongMing7452.htm]二陈汤加[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao24.htm]柴胡15g，[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao44.htm]黄芩、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao266.htm]川芎、[url]https://www.tcmbe.com/userReg/JiaoCai/ZhongYaoXue/zzZhongYao7.htm]防风各12g治之。久病头风不愈，用此方治之，也有一定效果。