黄连阿胶汤方证指征新解及其治疗顽固性失眠体会
Huanglian Ejiao Decoction formula syndrome and its application for refractory insomnia
DOI:10.19540/j.cnki.cjcmm.20201030.501
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1.中国中医科学院广安门医院,北京 100053
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熊兴江. 黄连阿胶汤方证指征新解及其治疗顽固性失眠体会[DB/OL].(2021-11-02)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.19540/j.cnki.cjcmm.20201030.501
Xing-jiang XIONG. Huanglian Ejiao Decoction formula syndrome and its application for refractory insomnia[DB/OL].(2021-11-02)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.19540/j.cnki.cjcmm.20201030.501
熊兴江. 黄连阿胶汤方证指征新解及其治疗顽固性失眠体会[DB/OL].(2021-11-02)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.19540/j.cnki.cjcmm.20201030.501 DOI:
Xing-jiang XIONG. Huanglian Ejiao Decoction formula syndrome and its application for refractory insomnia[DB/OL].(2021-11-02)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.19540/j.cnki.cjcmm.20201030.501 DOI:
黄连阿胶汤出自张仲景的《伤寒论》,主治少阴热化证。黄连阿胶汤方证特征包括①在现代医学的疾病方面,可用于治疗失眠、心律失常、口腔溃疡、下利、血证等疾病;②在症状指征方面,主要用于烦乱不宁,坐起不安,片刻不得安宁,脾气急躁,动辄易怒;失眠,睡眠不安,每逢深夜辗转反侧,入睡极其困难,甚至彻夜不寐,或仅能睡1~2 h;白天精神不减,精力旺盛,不影响日常活动,锻炼、饮食等一切如常;可合并出现心慌,心电图可正常,也可出现房性早搏、室性早搏等心律失常;可伴见胃胀痞闷,胃痛,呕吐,腹痛,抽筋,下利,或大便干结;脸红,唇红,甚至唇色如妆;容易出血;舌质红,舌苔薄少或无苔,舌面干燥少津;或舌质淡红,或暗红,舌苔薄白;脉数。研究发现,①虽然该方原文述证极为简略,但临证时绝不可仅凭“心中烦,不得卧”处方用药;②现今临床多认为舌质红,舌苔薄少或无苔,舌面干燥少津,为黄连阿胶汤辨证关键,但经笔者反复体会,发现舌象并非该方证辨证关键;③少阴证本质不完全为心肾阳虚,与现代医学的休克最为接近,包括感染性休克、低血容量性休克及心源性休克;④少阴寒化与热化的本质区别在于休克的不同类型,其中寒化以心源性休克为主,而热化则以感染性休克为主;⑤少阴热化证多见于感染性休克后期,部分也可见于心力衰竭合并交感活性兴奋阶段;⑥常以山药、生地黄替代鸡子黄以养阴润燥;⑦黄连阿胶汤起效迅速,疗程较短。
Huanglian Ejiao Decoction, firstly recorded in, Treatise on Febrile Diseases, could be used to treat heat-conversion syndrome of Shaoyin.It has been identified that, the indications of Huanglian Ejiao Decoction include:①in modern medicine, it can be used to treat insomnia, arrhythmia, oral ulcer, Xiali, blood syndrome and other diseases;②in terms of symptoms and signs, it is mainly used for restlessness, ritability, insomnia, extremely difficult to fall asleep, palpitation, atrial premature beat, ventricular premature beat and other arrhythmias, stomach distension and stuffiness, stomach pain, vomiting, abdominal pain, cramps, lower edge, constipation, blush, red lips, easy bleeding, red tongue, thin or no coating, dry tongue surface, or light red tongue, or dark red, thin white tongue coating, and rapid pulse.It has been also identified that, ①although the original statement of Huanglian Ejiao Decoction is very simple, it can not only be used according to irritability and insomnia;②tongue image is not the key to syndrome differentiation of this prescription;③the essence of Shaoyin syndrome is not completely heart kidney Yang deficiency, which is closest to shock in modern medicine, including septic shock, hypovolemic shock and cardiogenic shock;④the essential difference between Shaoyin cold and heat conversion syndrome of Shaoyin lies in the different types of shock, in which cardiogenic shock is the main cold type, while septic shock is the main heat shock;⑤heat-conversion syndrome of Shaoyin is more common in the late stage of septic shock, and part of it can be seen in the stage of heart failure combined with sympathetic activation;⑥Dioscoreae Rhizoma and Rehmanniae Radix are often used to replace egg yolk;⑦Huanglian Ejiao Decoction takes effect quickly and the course of treatment is short.
黄连阿胶汤《伤寒论》失眠
Huanglian Ejiao DecoctionTreatise on Febrile Diseasesrefractory insomnia
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