方剂和病案(高级).doc

【病案】【Case Studies】寒闭失音：汪之常养鸭为业。残冬寒风凛冽，雨雪交加，整天放鸭奔走道途，不胜其劳。某晚归时，感觉不适，饮冷茶一大盅。午夜恶寒发热，咳嗽声嘶，既而语言失音。曾服姜汤冲杉木炭数盅，声哑如故。据其父代述失音原委，因知寒袭肺金，闭塞空窍，故咳嗽声哑。按脉浮紧，舌上无苔，身疼无汗，乃太阳表实证。其声喑是由形寒饮冷伤肺，是金实不鸣之故。治宜开毛窍宣肺气，疏与麻黄汤。麻黄9g，桂枝、杏仁各6g，甘草3g。服后，温复取汗，易衣二次，翌日外邪解、声音略扬，咳仍有痰，胸微胀，又于前方去桂枝，减麻黄为4.5g，加贝母、桔梗各6g，白蔻仁3g，细辛1.5g，以温肺化痰。续进2帖，遂不咳，声音复常（赵守真治验回忆录北京:人民卫生出版，2008：12-13）。按语：通过问诊和切脉，知其得病原委，又表现出典型的风寒表实证，麻黄汤用得非常恰当，至表解后，方去桂枝，减麻黄量，又加桔、贝、蔻、辛等，恐寒邪郁久化热，故于辛开中佐润肺化痰利咽之品以善其后。2过敏性鼻炎：张某，男，61岁。3年前因感冒鼻塞，流涕，经某院诊为过敏性鼻炎。经用抗生素、滴鼻净、鼻通等治疗，开始有效。近1年来，只有口服强的松才能勉强控制症状，停药后立即复发。诊见：面色欠荣，鼻塞，流清涕，咳嗽，痰少，耳、鼻、口唇、咽部发痒，遇寒加重。舌淡，苔白润，脉弦紧。证属风寒袭肺，鼻窍不利。治以祛风散寒，宣肺通窍。处方：麻黄13克，桂枝15克，炙甘草10克，杏仁、防风各15克，全蝎5克，蜈蚣2条。二诊：服药3剂后，鼻通痒减，停服强的松。继服6剂，诸症悉除而愈，随访8个月，未再复发（孙广全. 麻黄汤加味验案举隅. 辽宁中医杂志.1989；（12）:20）。按语：肺开窍于鼻。鼻塞，流清涕，乃是风寒袭肺，肺窍不利，不能单纯治鼻，应该治肺。局部发痒，偏于风故用麻黄汤宣肺，散寒，通窍，加防风、全蝎、蜈蚣以祛风搜邪止痒。【病案】【Case Studies】寒闭失音：汪之常养鸭为业。残冬寒风凛冽，雨雪交加，整天放鸭奔走道途，不胜其劳。某晚归时，感觉不适，饮冷茶一大盅。午夜恶寒发热，咳嗽声嘶，既而语言失音。曾服姜汤冲杉木炭数盅，声哑如故。据其父代述失音原委，因知寒袭肺金，闭塞空窍，故咳嗽声哑。按脉浮紧，舌上无苔，身疼无汗，乃太阳表实证。其声喑是由形寒饮冷伤肺，是金实不鸣之故。治宜开毛窍宣肺气，疏与麻黄汤。麻黄9g，桂枝、杏仁各6g，甘草3g。服后，温复取汗，易衣二次，翌日外邪解、声音略扬，咳仍有痰，胸微胀，又于前方去桂枝，减麻黄为4.5g，加贝母、桔梗各6g，白蔻仁3g，细辛1.5g，以温肺化痰。续进2帖，遂不咳，声音复常（赵守真治验回忆录北京:人民卫生出版，2008：12-13）。1. Loss of voice due to cold blockage: Wang Zhi-chang raised ducks as his profession. In cold and windy late-winter days when there was snow mixed with the rain, he herded ducks everyday on the road and it was exhausting. One night when he got home, he felt uncomfortable and drank a big cup of cold tea. By midnight, he had aversion to cold, fever, and cough with hoarse voice, then loss of voice. He took several cups of ginger decoction with cedar charcoal, and his voice was still harsh. His father stated the reason behind his aphonia on his behalf. Thus, the conclusion was that he had cold invading the metallic lung, blocking the facial orifices, and causing cough and loss of voice. His superficial and tight pulse taking, no tongue coating, body ache, and no perspiration were indications of exterior excess pattern of tai yang. The loss of voice was because of the damage of the lung owing to external cold and cold drinks, further causing the muffled metal failing to sound. The appropriate treatment was to open the pores and facial orifices to ventilate lung qi. Therefore, he was prescribed M Hung Tng. The ingredients are m hung 9 g, gu zh 6 g, xng rn 6 g, and gn co 3 g. After taking the decoction, the patient covered up with extra blanket to help induce the sweat and changed wet clothes twice. The next day he was relieved from external pathogens with slightly improved voice, still had sputum while coughing, and mild distending pain in the chest. He was prescribed the previous formula by subtracting gu zh, reducing m hung to 4.5 g, adding bi m (贝母, Bulbus Fritillaria) 6 g, ji gng (桔梗, Radix Platycodonis) 6 g, bi ku rn (白蔻仁, Fructus Amomi Rotundus) 3 g, and x xn (细辛, Radix et Rhizoma Asari) 1.5 g. With that, the formula could warm the lung and resolve phlegm. He took two doses and stopped coughing, and his voice became normal (Memoirs of Effective Treatment by Zhao Shou-zhen, The Peoples Medical Publishing House, Beijing, 2008: 12-13)按语：通过问诊和切脉，知其得病原委，又表现出典型的风寒表实证，麻黄汤用得非常恰当，至表解后，方去桂枝，减麻黄量，又加桔、贝、蔻、辛等，恐寒邪郁久化热，故于辛开中佐润肺化痰利咽之品以善其后。Comments: Through inquiry and pulse taking, it was understood how the patient got ill. The patient also had typical external excess wind-cold pattern. Thus, M Hung Tng was exactly the right formula. After eliminating the exterior symptoms, the prescription was altered by removing gu zh, decreasing m hung, and adding bi m, ji gng, ku rn, and x xn. With lung-moistening, phlegm-resolving and throat-comforting ingredients assisting acrid-opening herbs, the formula further prevented cold pathogen from being stressed for too long and transforming to heat.2过敏性鼻炎：张某，男，61岁。3年前因感冒鼻塞，流涕，经某院诊为过敏性鼻炎。经用抗生素、滴鼻净、鼻通等治疗，开始有效。近1年来，只有口服强的松才能勉强控制症状，停药后立即复发。诊见：面色欠荣，鼻塞，流清涕，咳嗽，痰少，耳、鼻、口唇、咽部发痒，遇寒加重。舌淡，苔白润，脉弦紧。证属风寒袭肺，鼻窍不利。治以祛风散寒，宣肺通窍。处方：麻黄13克，桂枝15克，炙甘草10克，杏仁、防风各15克，全蝎5克，蜈蚣2条。2. Allergic rhinitis: Zhang, male, age 61. He was diagnosed allergic rhinitis in a hospital three years ago while having cold with stuffy and runny nose. Medications such as antibiotics, Naphazoline and nasal decongestants were initially effective for him. However, his condition could barely be controlled only with oral prednisone since nearly a year ago, but it recurred shortly after whenever he stopped taking it. Signs and symptoms: pale facial complexion, stuffy nose with clear nasal mucus, lack of sputum, and itchiness on ears, nose, lips and throat that worsens when it turned cold. His tongue was pale with white and moist coating, and his pulse wiry and tight. The pattern was invasion of the lung by wind-cold with nasal cavity blockage. The correct treatment should dispel wind, dissipate cold, ventilate lung and free the nasal cavities. Prescription: m hung 6 g, gu zh 15 g, zh gn co 10 g, x rn 15 g, fng fng (防风, Radix Saposhnikoviae) 15 g, qun xi (全蝎, Scorpio) 6 g, and w gng (蜈蚣, Scolopendra) 2 pieces.二诊：服药3剂后，鼻通痒减，停服强的松。继服6剂，诸症悉除而愈，随访8个月，未再复发（孙广全. 麻黄汤加味验案举隅. 辽宁中医杂志.1989；（12）:20）。Second visit: After taking three doses of the medicine, his nasal cavities were free, his itchiness was alleviated, and he stopped taking prednisone. He took another 6 doses and all symptoms were eliminated. The follow-up lasted for eight month, and his condition did not reoccur.(Successful Sample Cases of Using M Hung Tng with additions by Sun Guang-quan, Liaoning TCM Ma