孙建光教授以四逆二陈汤加减治疗肝郁气滞型胁痛临证经验
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摘要
胁痛是指以一侧或两侧胁肋部疼痛为主要表现的病证,常见于西医学的多种疾病之中,如各种急慢性肝炎、肝硬化、肝癌、胆囊炎、胆石证、肋间神经痛等。孙建光教授认为本病基本病机为肝失疏泄,肝络失和。肝郁气滞证是其临床最常见证型之一,临床表现为情志抑郁,善太息,嗳气后觉舒,两侧胁肋或少腹胀痛,走窜不定,甚则连及胸肩部,或有乳房胀痛,且情绪激动则痛剧,伴有纳呆,脘腹胀痛,舌苔薄白,脉弦。孙建光教授根据多年临床经验,善用四逆二陈汤加减治疗本证,取得了较好的临床疗效,常用药物包括柴胡、白芍、枳壳、陈皮、半夏、茯苓、炙甘草、佛手、威灵仙等。凡肝炎、肝硬化、肝癌、胆囊炎、胆石症、肋间神经痛等疾病,临床以胁痛为主要症状,中医辨证属肝郁气滞者,皆可参考四逆二陈汤之法随证加减治之。
Hypochondriac pain refers to rib pain in one side or both sides, and it is common in western diseases, such as all kinds of acute or chronic hepatitis, liver cirrhosis, liver cancer, cholecystitis, cholelith disease, intercostals neuralgia, etc. Professor Sun Jianguang believes that the basic pathogenesis of the disease is liver pathogenesis and liver collaterals estrangement. The syndrome of liver depression is one of the most common syndromes in clinic. Clinical manifestations includes common affective depression, deep sigh, feeling good after belching, both sides pain of the side rib or less abdominal distension, which may cause pain in the chest and shoulders, chest or breast tenderness, which aggravate during and emotional pain and it is accompanied by anorexia, abdominal fullness and distention; thin white fur of tongue and the string pulse. According to many years of clinical experience, Professor Sun Jianguang has obtained better clinical efficacy in the treatment of this syndrome by applying modified Sini Erchen Decoction(四逆二陈汤), which includes Radix bupleuri, white paeony root, Hovenia dulcis, pericarpium citri reticulatae, Pinellia ternata, Poria cocos, honey-fried licorice root, bergamot and Clematis root. All hepatitis, liver cirrhosis, liver cancer, cholecystitis, cholelith disease, intercostals neuralgia and other diseases show clinical side pain as the main symptom, TCM syndrome differentiation classifies it into liver depression and qi stagnation, which can be treated by applying modified Sini Erchen Decoction(四逆二陈汤).
Hypochondriac pain refers to rib pain in one side or both sides, and it is common in western diseases, such as all kinds of acute or chronic hepatitis, liver cirrhosis, liver cancer, cholecystitis, cholelith disease, intercostals neuralgia, etc. Professor Sun Jianguang believes that the basic pathogenesis of the disease is liver pathogenesis and liver collaterals estrangement. The syndrome of liver depression is one of the most common syndromes in clinic. Clinical manifestations includes common affective depression, deep sigh, feeling good after belching, both sides pain of the side rib or less abdominal distension, which may cause pain in the chest and shoulders, chest or breast tenderness, which aggravate during and emotional pain and it is accompanied by anorexia, abdominal fullness and distention; thin white fur of tongue and the string pulse. According to many years of clinical experience, Professor Sun Jianguang has obtained better clinical efficacy in the treatment of this syndrome by applying modified Sini Erchen Decoction(四逆二陈汤), which includes Radix bupleuri, white paeony root, Hovenia dulcis, pericarpium citri reticulatae, Pinellia ternata, Poria cocos, honey-fried licorice root, bergamot and Clematis root. All hepatitis, liver cirrhosis, liver cancer, cholecystitis, cholelith disease, intercostals neuralgia and other diseases show clinical side pain as the main symptom, TCM syndrome differentiation classifies it into liver depression and qi stagnation, which can be treated by applying modified Sini Erchen Decoction(四逆二陈汤).
引文
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[7]张仲景.金匮要略[M].何任,何若苹,整理.北京:人民卫生出版社,2005:3.
[2]田代华,刘更生整理.灵枢经[M].北京:人民卫生出版社,2005:36.
[3]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:258.
[4]张红娥,王树鲜.浅谈慢性胆囊炎的中医治疗[J].中医临床研究,2014,22(6):39-40.
[5]张炜,王俐琼.胁痛诊疗指南[J].中国中医药现代远程教育,2011,9(16):117-118.
[6]孙建光.王文正治疗慢性肝病经验[J].四川中医,2004,22(11):5-7.
[7]张仲景.金匮要略[M].何任,何若苹,整理.北京:人民卫生出版社,2005:3.