柴胡桂枝干姜汤治疗损美性疾病验案举隅
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原榕珍，钟东君，张其鹏，丘小荣，吴美达
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广州市天河区中医医院，广东广州，510655
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摘要：柴胡桂枝干姜汤系张仲景《伤寒论》所载经典方剂，兼具疏解少阳郁热与振奋太阴脾阳之功效，现代临床广泛应用于因胆热脾虚所致的消化系统疾病（如慢性胆囊炎、乙型肝炎、肠易激综合征）及内分泌系统疾病（如糖尿病、甲状腺功能减退）的治疗。本方由小柴胡汤演变而来：去半夏、人参、大枣，以干姜代替生姜，并增桂枝、牡蛎、瓜蒌根等药，共七味。张仲景记载此方用于伤寒五、六日发汗复下后夹太阴之复杂病证：此时患者出现胸胁痞满、心下微结、小便不利、渴不欲饮、头汗出以及寒热往来、心烦不安等症状。方中柴胡、黄芩疏解少阳之邪热，桂枝、干姜温散太阴之寒凝，牡蛎软坚敛阴，天花粉清热生津，加以甘草调和诸药，使汗下后津亏脾阳虚的情况得到改善，兼并祛除少阳郁热与太阴寒饮。本方通过清上温下、调和表里，能够平调少阳与太阴之病机，尤适用于“上热下寒”证型。虽此方源于伤寒杂病中少阳-太阴合病的思路，但笔者临床观察发现，许多皮肤科损美性疾病（如痤疮、黄褐斑、脱发等）患者也常呈现上热下寒、肝郁脾虚的证候。以柴胡桂枝干姜汤加减治疗此类患者，常收良效，故值得在临床进一步推广应用。
关健词：柴胡桂枝干姜汤；损美性疾病；肝郁脾虚；上热下寒证
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Clinical Cases of Chaihu Guizhi Ganjiang Decoction in theTreatment of Cosmetic Diseases
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Rongzhen Yuan,Dongjun Zhong,Qipeng Zhang,Xiaorong Qiu,Meida Wu
Guangzhou Tianhe District Hospital of Traditional Chinese Medicine, Guangzhou Guangdong 510000, China
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Abstract：Chaihu Guizhi Ganjiang Decoction is a classic formula recorded in Zhang Zhongjing's "Treatise on Cold Damage Diseases," which combines the effects of dispersing constrained heat in Shaoyang and invigorating spleen yang in Taiyin. In modern clinical practice, it is widely used to treat digestive system diseases (such as chronic cholecystitis, hepatitis B, and irritable bowel syndrome) and endocrine system diseases (such as diabetes and hypothyroidism) caused by gallbladder heat and spleen deficiency. This formula evolved from Xiaochaihu Decoction: Pinellia (Banxia), ginseng (Renshen), and jujube (Dazao) were removed, while ginger (Ganjiang) replaced fresh ginger (Shengjiang). Additionally, cinnamon twig (Guizhi), oyster shell (Muli), and trichosanthes root (Gualougen) were added, resulting in a total of seven herbs. Zhang Zhongjing documented thisformula for treating complex syndromes involving Taiyin after sweating and purgation methods were applied on the fifth or sixthday of cold damage. In such cases, patients present with symptoms such as chest and hypochondriac fullness, mild epigastrictightness, scanty urine, thirst without desire to drink, sweating on the head, alternating chills and fever, and restlessness. In the formula, Bupleurum (Chaihu) and Scutellaria (Huangqin) disperse pathogenic heat in Shaoyang, while cinnamon twig (Guizhi) and dried ginger (Ganjiang) warm and dissipate cold stagnation in Taiyin. Oyster shell (Muli) softens hardness and astringes yin, and trichosanthes root (Tianhuafen) clears heat and promotes fluid production. Licorice (Gancao) harmonizes the other herbs, addressing conditions of fluid deficiency and spleen yang deficiency after sweating and purgation, while simultaneouslyeliminating Shaoyang constrained heat and Taiyin cold-damp. By clearing the upper body and warming the lower body, as well as harmonizing the exterior and interior, this formula balances the pathogenesis of Shaoyang and Taiyin, making it particularlysuitable for the "upper heat and lower cold" syndrome pattern. Although this formula originates from the treatment of Shaoyang-Taiyin complex diseases in cold damage and miscellaneous disorders, the author's clinical observations have foundthat many patients with dermatological conditions affecting beauty (such as acne, melasma, and hair loss) also often exhibitpatterns of upper heat and lower cold, liver constraint, and spleen deficiency. Modified Chaihu Guizhi Ganjiang Decoction hasshown significant efficacy in treating such patients, making it worthy of further clinical application and promotion.
Keywords : Chaihu Guizhi Ganjiang Decoction; Dermatological conditions affecting beauty; Liver constraint and spleendeficiency; Upper heat and lower cold syndrome
参考文献
[1] 韩晓晴.基于网络药理学探讨枇杷清肺饮加减治疗肺经风热型痤疮的临床疗效及机制研究[D].广州中医药大学,2022.
[2] 贾淑琳,范瑞强,禤国维,等.国医大师禤国维教授滋阴清热法治疗痤疮理论探讨[J].南京中医药大学学报,2016,32(03):207-209.
[3] 许子铭,李昭凤.中医外治法治疗气滞血瘀型黄褐斑的现状及展望[J].中国美容医学,2023,32(07):194-198.
[4] 薛文辉,张雪琴.中医治疗黄褐斑[J].中国麻风皮肤病杂志,2001,17(04):293-294.
[5] 钟程,张子圣,刘城鑫,等.国医大师禤国维教授治疗脂溢性脱发经验[J].中华中医药杂志,2018, 33(01):133-135.
[6] 欧阳欢,王雪茜,程发峰,等.国医大师王庆国辨治脂溢性脱发[J].中国皮肤性病学杂志,2024, 38(02):168-170+176.
[7] 王海亮,李博琪,杨忠义,景瑛.温清汤联合克痤隐酮凝胶治疗上热下寒型痤疮临床疗效观察[J].四川中医,2024,42(02):168-172.
[8] 石灿,唐毅博,马天明.中医外治法治疗黄褐斑的 研究 现 状[J]. 临 床医 学 进 展,2024,14(11):1121-1126.
[9] 何明珠,高芳.中药治疗黄褐斑研究进展[J].中医皮肤科杂志,2020,17(06):76-79.
[10] 黄俊杰,王晓青.中药内服结合外敷治疗黄褐斑100 例疗效观察[J].陕西中医药,2016,37(07):889-892.
[11] 吴盘红,王丽,杨晓红,等.火针浅刺在治疗血瘀型黄褐斑中的增效作用评估[J].中国医疗美容,2019,9(7):88-94.
[12] 罗玲,唐勇,曾芳,等.独特的皮部治疗——滚针疗法[J].上海针灸杂志,2008,27(9):37-38.
[13] 李静,张伟.脂溢性脱发病因病机及治疗新进展[J].中医杂志,2015,56(24):2056-2058.
[14] 张从正.诸病源候论[M].北京:中医古籍出版社, 1999.
[15] 叶天士.医学入门[M].北京:人民卫生出版社, 2005.
[16] 龚中军,李晶.雄激素性脱发病因及治疗概述[J]. 中国皮肤性病学杂志,2018,32(12):715-718.
[17] 张琳,张斌.中医治疗脂溢性脱发 28 例临床观察[J].辽宁中医药大学学报,2017,19(4):10-12.
[18] 高雷,孙鹏.中西医结合治疗雄激素性脱发的疗效分析[J].中国实用内科杂志,2019,39(5):350-352.
[19] 张虎,王明.补益肝肾养血法治疗雄激素性脱发的临床研究[J].中医药信息,2020,37(10):58-60.
[20] 吴小云,陈亮.上热下寒证病机分析[J].中医药临床杂志,2018,30(2):45-47.
[21] 王冰,朱丹.黄帝内经·灵枢[M].上海:上海古籍出版社,2015.
[22] 傅铖,杨刚.中医学阴阳学说及其临床应用[J]. 中医基础理论研究,2021,26(1):40-42.
[23] 何宁.中医寒热错杂证候研究[J].医学综述, 2016,22(24):4668-4670.
[24] 王丽丽.方剂学[M].上海:上海科技出版社, 2011.
[25] 朱熙,夏婷.中医方剂学[M].北京:中国中医药出版社,2013.
[26] 李晨,张燕.柴胡桂枝干姜汤治疗肝郁脾虚型疾病临床观察[J].中华中医药杂志,2019,34(2):485-487.
[27] 张霞.现代生活方式对中医体质的影响[J].中国中医药信息杂志,2022,29(3):67-69.
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