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gui zhi long gu mu li tang 桂枝龍骨牡蠣湯

Translated and edited by: Joe Hing kwok Chu

 

朱興國編譯            (in English and Chinese 中英文)   按此看中文

 

Name of Formula: gui zhi long gu mu li tang 《source:Jin Gui Yao Lue》

 

Composition:

gui zhi 9 g, bai shao 9 g, gan cao 6 g, sheng jiang 3 slices, da zao 5 pieces (cut open),

 

long gu 12 g, mu li 15g.

 

Add about 1,200 c.c. of water. Simmer long gu and mu li for 20 minutes then add all other herb. Simmer for another 45 minutes. Use as tea while warm.

 

The original writing in the medical classics, Jin Gui : "When one loses his/her essence, the syndrome includes: tightness in low abdomen, anxiety, cold glans (of penis), blurry vision, thinning hair, hollow pulse that causes the tightness (in pulse). Men will have spermatorrhea, and women will dream of sexual intercourse. Use gui zhi long gu mu li tang. "

 

Medical cases and commentaries

 

(1) Wind chill cold, spitting blood and spermatorrhe

 

Record of Zhang Lu Yi (1617~1698)

Patient:  the middle son of Mr. Shen Mao Fu, age 17,

Every time when the patient got wind chill, he spitted blood and had wet dream. I prescribed gui zhi tang with added long gu and mu li. After using 4 doses, the cold was gone and the wet dream stopped. Gui zhi tang harmonizes the blood vessels and rid of infection. Adding long gu and mu li will calm the mood and the mind. If one deems that the fever is high and use zhi mu, huang bai type of herbs, often it will weaken the body.

 

Commentary: in this case the "hiding fire in the liver" is deficient fire  (xu huo). From gan shen yin xu (liver-kidney yin deficient), liver yang ascending and then turning into feng re (wind heat type syndrome).   As Xu Zhong Ke said: "Gui zhi tang when used in external syndrome (like common cold), it can sooth the muscle and rid of infection . When used in internal syndrome, it can be tonifying and balance yin and yang. With added  long gu and mu li it can be used in spematorrhea and in dreaming of sexual intercourse.

 

(2) Instant sweating

 

Yue Mei Zhong medical record:

Patient: Mr. Li, age 46

He came on June 11, 1972 for treatment. The patients had all day nonstop instant sweating on the neck, wiping all day. The diagnosis showed floating and weak pulse, instant sweating. In analysis it was found that the neck is where the taiyang channel (meridian) passes through and the chronic sweating caused weakness. I prescribed gui zhi long gu mu li tang. After 4 prescriptions the instant sweating stopped. Another 4 stabilized the result.  (Yue Mei Zhong Medical Record 1978 edition)

 

(3) Night sweating

Fu Meiqing medical records:

Patient: Mr. Liu, M, 78 years old man.

Mr. Liu ame on June 10, 1987 for consultation. He had 8 years of intermittent night sweats and recently increased During his sleep he sweated as if like washing. He had had a thorough examination and found no organic disease. Western medicine diagnosed as idiopathic hyperhidrosis but the treatment was not effective and seeked traditional Chinese medicine treatment. The first prescription was  dang gui liu huang tang but not effective; mu li san was prescribed and with no effect. He had no energy, fatigue, pale complexion,  ong urination, pale tongue, thin white fur, floating,  slightly thin and stringy pulse, and no chill nor fever. I thought it is circulation and nervous systems are not harmonious  and, due to yang was not enough to affect yin. I prescribed gui zhi jia long gu mu li tang with added sang ye.

The prescription:

gui zhi 10 g, bai shao 10 g, san ye 10 g, zhi gan cao 3 g, sheng jiang 5 g, da zao 5 pieces, sang ye 10g, long gu 30 g, mu li 30 g.

One prescription per day.  Boiled with water and made into 2 servings.

After one prescription, the sweating was less. After 2 prescription, the sweating stopped. Then there was no recurrence afterward. (New Traditional Chinese Medicine 1992;(6):44)

 

(4)  Sweating on one portion of the body, Menopausal Symptoms
Zhang Xiuyun medical record:

Patient: Ms. Wie, female, 48 years old, cadres,

Ms. Wie came for examination in February 1994. During the past six months, her upper body was baking hot, sweating, lower body was normal. Every time before sweating her whole body felt  irritable, feeling full and uncomfortable, and within minutes,  the upper body sweating profusely. After sweating, the body was normal again. It happened irregularly. Emotional stress became more profound.  Frequent attacks happened in  2 recent months, 1 or 2 times daily, with insomnia, dreams, irregular menstruation. The Western medical diagnosis was "menopause syndrome". She was prescribed and taken oryzanol tablets, vitamin tablets and was not effective. She showed red tongue, thin white fur, slow and thready pulse. The patient was close to 50 years old, at the age of menopause, the liver qi stagnation affected the harmony of Yin and Yang. The treatment was to disperse the  stagnation of liver qi. . Prescription: gui zhi 10 g, bai shao 9 g,  gan cao 10 g ,sheng jiang 3 slices , da zao 3 pieces,raw long gu raw mu li 20g,20g, chao zao ren 15g,  he huan pi 15g. After using 5 doses of the above formula sleep became better and less sweating. ,Tongue and pulse was the same as before. Prescribe the same formula for 6 more doses and healed. (Henan Chinese Medicine 1995; (6): 343)
Commentary:  (will be uploaded)

 

 

(5) Spermatorrhea

 

(6) Dreams of sexual intercourse

Xu Bolun Medical Records:

Patient: Ms. Gao, female, aged 34, farmer.

Every night, she dreamed of having sexual intercourse till dawn. It had been going on for about  4 to 5 years, mistaken believed it was a "fox spirit" having sex with her. It was difficult for her to talk about it. At the beginning she did not think it was serious. After sometimes she began to have palpitations, fright. Because of not seek treatment, the sickness became worse by the days. She took refuge and slept at her neighbor's house but still having the same problems.  She lost a lot of weight and became thin. lack of energy, lack of breath and did not like to speak, dizzy, blurry vision, weakness in loin and knees, vagina discharge was clear and abundance, tongue was pink with thin white fur, pulse was thin and weak. It was yin and yang both deficient,

I prescribed gui zhi long gu mu li tang: Twig keel intended oyster soup: 18 grams of cassia twig, peony root, the keel of the 20 grams, licorice, ginger, 9 grams, 30 grams of raw oysters, red dates 7. 5 after the elimination of all evidence, to Guipi consolidation effect. 1 year follow-up without recurrence. (Zhejiang Traditional Chinese Medicine 1984; <1): 46)
Commentary: (will be uploaded)

 

(7) Bed wetting

 

(8) Postpartum vagina bleeding

 

(9) Vagina discharge

 

(10) Fright

Luo Weidong medical case

Patient: Mr. Liu, male, 22 years old, soldier

The patient came on 17 May 1985 for examination. He had had palpitation, shortness of breath for more than six months. His  ECG shows: pre-excitation syndrome associated with transient supraventricular tachycardia. Did not have good result with after a month of using Western medicine. In the follow diagnosis, it showed: heart palpitations,  easily panic, extremities were cold, tightness in chest area, shortness of breath, sweating occurred with physical movements, dizziness and blurry vision, tongue was pale and tender with thin white fur, rapid pulse. Diagnosed as fright, and identified as heart yang deficient.  The treatment was warming the heart yang, calming the nerves to get rid of fright.

Prescription: gui zhi 12 g, bai shao 12 g,  zhi gan cao 10 g , sheng jiang 6 g, da zao 10 g,  pieces, raw long gu 20g, ,raw mu li 20g,  dang shen 10 g, chao zao ren 15g. Five doses. One dose per day. Boiled with water.
On second clinical visit and diagnosis: heart palpitations had improved, cold extremities turned warm, still had the feeling of shortness of breath, sweating occurred with physical movements. The  tip of the tongue edge there were some small purple spots, a sign of yang deficient with blood stasis, continued with the previous formula with added dan shen, tao ren, and served more than 20 doses. All the syndromes disappeared. The  ECG result was normal. (National Medical Forum 1995; (6): 18)
Note: (original commentary):  New recruits got excessive sweating due to military training, which can damage heart yang (resulted in heart yang deficient). When this happens it may result in heart sickness. Following the principle of the medical classics, Nan Jing, "If heart is injured, treat the blood vessels and the nervous system." , I prescribed gui zhi long gu mu li tang,  with added dang shen, tao ren, dan shen, tao ren to nourish the heart qi and promoting blood circulation to rid of blood stasis)  All syndromes matched (the classics). The result was satisfactory.
 

(11) Insomnia
Dr. Ye Yifeng Medical Records:
Patient: Hua XX, female, 48 years old. The patient came on September 12, 1980 to seek treatment.
Due to anxiety, overwork, she suffered from insomnia for more than a year. When sound asleep, chaotic dreams occurred. She has panic anxiety, dizziness, sweating, pale complexion, dazzlingly white, pale tongue, thin, slow weak pulse. Diagnosis was heart yin deficiency, xinyangxu (heart yang deficient), distracting.  gui zhi 5 g, gan cao 5 g,bai shao
yuan zhisuan zao ren10 g of each,long gu, mu li 30 g each,raw ginger 3 slices,da zao  10 pieces (cut open). Healed after taking 10 prescriptions.[1]

 

more are being uploaded, , translating and proofreading              in progress

(12) Dizziness

 

(13) Deranged

 

(14) Epilepzy

 

(15) Cold groin

 

(16) "bentun" , mood and/or circulation problem

 

(17) Sudden blindness

 

(18) losing hair

 

 

药方名:桂枝龍骨牡蠣湯出自《 方源:金櫃要略,血痹虚勞》

 

組成:

桂枝 9 克 , 白芍 9 克 , 甘草 6 克 ,生 薑 三 片 , 大棗 五 枚 切 開,龍 骨 12 克,牡 蠣 15 克。

加水先煎 龍骨牡 蠣 20 分鐘,再入其他各藥。再煎45分鐘。温服。

 

原文云:夫失精家,少腹弦急,陰頭寒,目眩,髮落,脈極虛,芤 ,遲,為清榖亡血失精。脈得諸芤微緊, 男子失精,女子夢交,桂枝龍骨牡蠣湯主之。

該方實為桂枝湯加龍骨,牡蠣而成,雖有桂枝,非治傷寒,而是用來 治虛勞的。
【運用】
  一,傷風吐血夢泄
  張路玉(1617~1698年)醫案:沈懋甫仲子,年17,每傷風,即吐血夢泄,此肝臟有伏火,火動則招風也。蓋肝為藏血藏魂之地,肝不藏則血隨火炎,魂不寧 則精隨夢泄。遂與桂 枝湯龍 骨牡 蠣,4劑而表解血止。桂枝湯主和營散邪,加龍,牡以鎮肝安魂,封藏固則風不易入,魂夢安則精不妄 動矣。若以其火盛而用, 柏之屬,鮮有不成虛損者。(《古今醫案按》1959:10)
  按語:本案所謂 肝臟有伏火者,乃虛 火 肝腎陰虚陽亢化 為風 火。蓋風邪侵襲,最易耗傷肝臟陰精,《素問生氣通天論》云:風客淫氣,精乃亡,邪傷肝也。風邪外擾,肝精內虛,致吐血,夢泄迭現,故 用桂枝加龍牡湯外解風邪,內調陰陽,佐以潛鎮,一舉數得。正如徐忠可所說:桂枝湯外証得之,能解肌去邪念;內証得之,能補虛調陰陽;加龍骨,牡蠣者,以失精夢交 為神精間病,非此不足以收斂其浮越也。

 

  二,自汗
  岳美中醫案:李某某,年46歲,男性,於1972年6月11日就診。患項部自汗,竟日淋漓不止,頻頻作拭,頗感苦惱,要求治療。診其脈浮緩無力,汗自出。分析 病情,項部是太陽經所過,長期汗出,系經氣向上沖逆,持久不愈,必致虛弱。因投以張仲景之桂枝龍骨牡蠣湯和陽降逆,協調營衛,收斂浮越之氣。先服 4劑,自汗止, 再服4劑,以鞏固療效。(《岳美中醫案集》1978年版)
  按語:本案言簡意賅,醫理甚明,將本方用於自汗,擴大了仲景方運用范圍。


  三,盜汗
  付美青醫案:劉某,男,78歲,1987年6月10日診。間歇性盜汗8年,近日加重,寐時汗出如洗。曾做全身檢查,未發現器質性病變,西醫診為特發性多汗症。 經治療效果不佳,而就診於中醫,先投以當 歸六黃湯無效,再進牡蠣散出入不應。細察:神疲乏力,面色萎黃,無寒熱,小便清長,舌淡,苔薄白 ,脈浮細略弦。竊思此乃營衛不和,陽不攝 陰所致。治宜調和營衛,養陰潛陽。方用桂枝加龍骨牡蠣湯加桑葉治之。
  處方:桂 枝白芍 ,      桑 葉各10克,甘 草 3 克 ,生 薑 5 克 , 大棗 五 枚, 生龍 骨, 生牡 蠣 ,各30克。每日1劑,水煎分2次服。1劑汗減,2劑汗止,以後一直未發。(新 中醫1992;(6):44)

 
  按語:老年元陽虧損,陽不護陰,方中桂枝甘草辛甘化陽,芍藥甘草酸甘化陰,寓補陰求陽之義,再加龍骨牡蠣潛陽斂陰,桑葉意在通因通用故取效甚捷。
  四,偏沮(更年期綜合症)
  張秀雲醫案:魏某,女,48歲,部,1994年2月初診。患者近半年來出現陣發性上半身烘熱,汗出, 下半身如常,每次汗出前,周身煩躁,悶脹不舒,繼則數分 鐘內上半身大汗出,汗後如常,發無定時,精神緊張時加重。近2個月發作頻繁,日發1~2次,伴失眠,多夢 ,月經不調。經西醫診為更年期綜合症,曾服谷維素片, 維生素片等療效不顯。舌尖紅,苔薄白,脈細緩。患者年近五十歲,處更年期,肝 氣失調,致陰陽逆亂,治以調 理陰陽,調疏肝氣。方用桂 枝 10克, 白芍 9 克,  甘 草 10 克 ,生 薑 3 片 , 大棗 3 枚, 生龍 骨, 生牡 蠣 ,各20克,棗 仁15g,生 薑3片 ,大 棗 3枚, 合歡皮15g。 復診:前方服5劑 後睡眠佳,出汗次數明顯減少,舌脈同前,原方再服6劑而愈。(河 南中醫1995;(6):343)
  按語:半身出汗,《內經》謂之偏沮,為陰陽失調,營衛不和之表現,如不積極治療,可發展為半身不遂。《素問生氣通天論》云:汗出偏沮,使人偏枯。治 療常以調和營衛陰陽為法,桂枝湯為首選之方。本案因伴煩躁,精神緊張,故加龍牡以潛鎮安神,斂澀止汗,一舉兩得。

 

 五,遺精
  趙守真醫案:黃某,青年工人,不知愛身,姿意情欲,又因勞動不節,以致精神不固,心火妄奇,夜不能寐,寐則夢遺,頭暈身倦,氣短息低,診脈,尺寸皆虛,左關獨 弦細數,口苦心煩,有潮熱,小便黃等証象惟患者贏孱如斯,為救眉計,先用金鎖固金丸,安神丸合劑(改為湯劑),固精安神,滋陰清火,以治其標,三劑煩熱,口苦 悉退,而夜夢尤多,遺無虛夕,再進固精丸(改湯),藥為牡蠣,菟絲子,韭子,龍骨,五味子,桑螵蛸,白石脂,茯苓等。又二劑不唯未減少,而遺尤甚,因而用之無益也。 改處清心飲:黨參9克,當歸9克,生地15克,甘草3克,茯神12克,棗仁12克,蓮肉12克,遠志5克,黃連2.4 克,水煎服,日2劑,三日無寸效,精遺如故 。
  因思《金匱》桂枝龍骨牡蠣湯有治失精之明文,玩味其方藥,此屬 心陽之虛並 水氣上逆之患而與上方之唯一補養有間,且桂枝湯原為調和營衛,如易其分兩,則可變為益 陽和陰之用,加之龍牡鎮心安神,核於本証殊可適應。桂 枝5克,白芍15克, 甘草9克,大棗9克,生姜3片,龍骨,牡蠣各18克並加茯神15克,辰砂末3克(另沖)以 為鎮降寧神之助。首2劑效不顯,3劑方乃著,夢 少能睡,遺可相間,三數 日不等。除仍服原湯外,早晚用蓮心,金櫻子煎湯送服妙香散15 克,以增強鎮心固精力量,半 月精不遺,嗣後自固其本,擬歸脾湯配吞都氣 丸,持續一月,神旺體健, 大異疇昔。(《治驗回憶錄))1962:63)
  按語:經云:損其心者調其營衛,損其腎者益其精,失精夢交之証乃屬心腎不交虛陽浮越的疾病,桂枝湯能調其營衛,龍骨牡蠣既能固其腎精,又可鎮其心神,故本 方治療本病最為合拍。

xinyangxu (heart yang deficient)
  六,夢交
  徐伯倫醫案:高某某,女,34歲,農民。入夜每與人交,天明始去,已4,5年,誤為狐仙,羞愧難言。初則不以為然,久則心悸膽怯,延期失治,病情日重。避 臥於鄰家,仍糾纏不散。形體消瘦,困倦乏力,少氣懶言,頭暈眼花,腰膝酸軟,帶多清稀,舌質淡紅,苔薄白,脈細弱。系陰陽兩虧,心腎不交,屬夢交症。擬用桂枝加龍 骨牡蠣湯:桂枝18克,白芍,龍骨各20克,甘草,生姜各9克,生牡蠣30克,紅棗7枚。5劑後,諸証消除,予歸脾丸鞏固療效。隨訪1年未復發。(浙江中醫雜志1984;<1):46)
  按語:夢交一証,古今有之,因隱情難言,就診者不多。本例早婚多育,腎精不藏,又房勞過度,耗傷心血;心腎虧損,陰虛及陽,陰陽氣血俱虛,致心腎不交。故用桂 枝湯調和營衛,龍骨,牡蠣潛鎮攝納。《素問生氣通天論》陰陽之要,陽密乃固,陽失陰之涵養,浮而不斂;陰失陽之固攝,走而不守,心腎不交則男子失精,女子夢 交。藥後陽固陰守,心腎相交而病愈。


  七,遺尿
  葉益豐醫案:李某某,男,14歲,1980年4月3 Et診。從小至今每夜尿床,雖多方求醫,遍服單驗方亦未見效,面色灰黯,小腹常拘急動悸,頭暈耳鳴,舌質 淡,苔薄白,脈遲緩。乃陰陽兩虛,氣不固攝之証。治宜扶陽益陰,固脬止遺。桂枝,白芍各5克,甘草3克,生姜3片,大棗10枚,龍骨,牡蠣各20克,豬脬一隻(另 煮湯),湯和藥汁服,豬脬亦可同服,囑晚間禁服茶水。1劑後,遺尿即止。服10劑而愈。至今未復發。
  (山東中醫雜志1985;(5):20)
  按語:本案加豬脬者,取以形補形,同氣相求之意,亦可作為引經之藥。
  八,產後血崩
  連建偉醫案:馮某某,女,28歲,1971年10月20日診。患者系初產婦,產後惡露已淨,少腹不痛。突然於產後第26天晚上暴崩不止j急送某醫院。經西醫用 止血劑治療並輸血400毫升,病情有所好轉,但漏下仍未止。又服當歸炭,炒白芍,生地炭,丹參炭等養血止血之劑,反增心悸怔忡,飲食減少等証。改邀筆者診治。患者 脈來細弱,舌質淡白少華。辨証論治:產後暴崩,無腹痛,為氣虛不能攝血之証。氣為血之帥,氣虛則血不循經而妄行。此証本應益氣攝血,反投養血止血,滋膩之性,損傷 陽氣,心陽受損則心悸怔忡,脾陽不振則納食少進。脈來細弱,舌質淡白少華,均為氣血大虛之象。治擬益氣養營,引血歸脾。處方:桂枝4.5克,炒白芍9克,炙甘草4.5克 ,生姜3片,大棗5枚,龍骨15克,牡蠣24克,黨參12克,炙黃芪12克,炒白術9克,廣皮6克,黑歸脾丸12 克(吞)。3劑。
  10月23日復診:漏下漸止,納食漸增,怔忡亦有好轉,再服原方3劑,諸症悉愈。(《金匱方百家醫案評述》1991:75)
  按語:本案根據氣為血之帥,陽生陰長的理論,用桂枝加龍骨牡蠣湯益氣血,調營衛,止崩漏,合參芪,白術益氣攝血,黑歸脾丸引血歸脾,治血証而不用血藥,其血自 止,體現了治病求本的治療原則。
  九,帶下
  葉益豐醫案:呂某某,女,45歲,1979年3月14日診。帶下清稀,綿綿不斷,時達兩年,屢經醫治,時緩時劇,面色觥白,頭暈乏力,亂夢驚悸,黎明盜汗,小 腹冷痛,腰痛如折,舌質淡,苔薄白,脈沉弱。此為久帶耗陰,陰損及陽,帶脈失約之証。治宜扶陽攝陰,固澀止帶。藥用桂枝,白芍各10克,甘草5 克,生姜3片,大 棗10枚,鹿角膠,菟絲子,蘇芡實各20克,煅龍骨,煅牡蠣各30克。連服10劑而愈。(山東中醫雜志 1985;<5>:20~21)
  按語:帶下為病,總屬帶脈失約,故《婦人良方》日:人有帶脈,橫於腰間,如束帶狀,病生於此,故名為帶。本例久帶耗陰,陰虛陽衰。桂枝龍骨牡蠣湯扶陽益陰 ,更佐鹿膠,菟絲,芡實益精壯陽,補養帶脈。陽充陰足。陽斂陰固,帶脈約束,故諸疾自愈。
  十,驚悸
  羅衛東醫案:劉某,男,22歲,戰士,1985年5月17日初診。患心慌,氣短半年余,查心電圖示:預激症候群伴短暫性室上速。西藥治療月余療效欠佳。刻診: 心悸易驚,四肢末端冷而不溫,胸悶氣短,動則汗出,頭昏目眩,舌質淡嫩,苔薄白,脈細數。診為驚悸,辨屬心 陽不足。 治宜溫補心陽,安神定悸。方藥:桂枝12g,白 芍12g,炙甘草10g,龍骨20g,牡蠣 20g,生姜6g,大棗10g,黨 參10g,棗 仁15g。5劑 ,日1劑,水煎服。
  二診:心悸好轉,肢冷轉溫,仍覺氣短,動則汗出。細察舌邊尖有小紫色斑點,此乃陽 虛也 ,續用上方加丹 參桃 仁, 連服20余劑,以上諸症消失,復查心電圖正 常。(國醫論壇1995;(6):18)
  按語:(原按)本例系新兵入伍,因軍訓汗出過多,損傷心陽,心失溫養而發病。遵《難經》損其心者調其營衛之法,選桂枝湯調和營衛,龍骨,牡蠣安神定驚,增黨 參棗 仁丹 參桃 仁以 補養心 氣,, 活血化。 藥証相符,收效甚佳。


  十一,失眠
  葉益豐醫案:華某某,女,48歲,1980年9月12日診。因煩勞過度,失眠年余,寐則亂夢,驚惕不安,頭昏汗多,面色晃白,舌淡苔薄,脈緩弱。乃心陰不足,
心陽虛,神不安舍。治宜益陰扶陽,養心安神。   桂枝甘 草各5克,白 芍遠 志酸 棗各10克,龍 骨牡 蠣各30克,生 薑 三 片,大 棗10枚切,連服 10劑而愈。(山 東中醫雜志1985;(5):21)
  按語:心主血,藏神,為五臟六腑之大主。蓋心以血為本,以氣為用,神志為其表現。煩勞過度,耗損心陰,傷及心陽,則神失其主,不能安舍,故見失眠亂夢,驚悸不 安,頭暈汗多。桂枝龍骨牡蠣湯加酸棗仁,遠志益陰扶陽,收斂心氣,重鎮安神,俾心陰足,心氣充,神得安舍,則病愈。
  十二,眩暈
  葉益豐醫案:程某某,男,56歲,1981年10月8日診。眩暈月余,診為高血壓病,服降壓藥眩暈益甚。現症:眩暈耳鳴,心悸寐差,汗多怕風,面色萎黃,舌淡 白,脈浮緩,血壓180/96毫米汞柱。乃陰虛陽浮,虛陽上越之証。治宜益陰扶陽,鎮納潛陽。桂枝,白芍,甘草各10克,龍骨,牡蠣各50克,生姜5片,大棗10枚 。3劑汗止,心悸除,略感眩暈,血壓150/90毫米汞柱。繼服5劑,眩暈消,血壓正常,諸恙悉瘥。(山東中醫雜志i985; (5>:21)
  按語:《素問陰陽應象大論》日:陰在內,陽之守也;陽在外,陰之使也。本例陰陽兩虛,陰不足內使,故心悸寐差;陽不足外守,則汗出怕風;陰不戀陽,虛陽上 越,則眩暈耳鳴,血壓升高。桂枝龍骨牡蠣湯益陰扶陽,鎮攝潛陽。陰平陽秘,則諸症自除,血壓復常。
  十三,癲狂
  張季雲醫案:孟某,女,53歲,農民,1993年12月2日初診。患者半年前喪子悲傷過度,情志抑郁,默默不語,繼則煩躁,精神錯亂,喋喋不休,13 服肌注 鎮靜藥物症狀緩解,以後每因情志不舒即復發。3天前又復發此症。伴頭暈,脹痛,雙下肢沉脹,失眠,舌尖紅,苔薄白,脈細弦。患者悲傷過度,致陰陽氣血逆亂,治療重 在調整陰陽。處方:桂枝,白芍各15g,生龍骨,生牡蠣各20g,甘草10g,生姜10g,大棗10枚。
  復診:服6劑後,患者言語平穩,頭脹痛明顯減輕,舌淡紅,苔薄白,脈沉細,上方加磁石15g,龜板10g,以加強重鎮之功,7劑後症狀消失,追訪1年未再復發 。(河南中醫1995;(6>:343)
  按語:對癲狂之証,葉天士主張應察形証,診脈候,以辨虛實。但總由陰陽失調而發,故葉氏在治療上指出:醫者惟調理其陰陽,不使有所偏勝,則郁逆自消,而 神氣得返其常焉矣。本案即為調理陰陽治癲狂証的具體運用。
  十四,昏厥(癔病)
  付美育醫案:吳某某,女,36歲,營業員,1986年6月24日就診。5年前因與人口角而突然暈倒,不省人事,四肢僵硬,約數分鐘後蘇醒,但仍覺頭暈乏力,後 反復發作,每月2~3次,每逢情志不暢則發作頻繁,多種檢查未發現器質性病變。西醫診斷為癔病。5年來,服多種中西藥罔效,遂求診於余。刻診:發作後2天,表情抑 郁,少語寡言,時時驚恐,伴頭暈,時自汗出,舌淡,苔薄白,脈弦略浮。予桂枝加龍骨牡蠣湯治療。處方;桂枝10克,白芍,炙甘草各20 克,生龍骨,生牡蠣各30克 ,生姜5克,大棗30枚。每日1劑,水煎分2次服。服藥5劑,自覺諸症消失,效不更方,守原方續進30余劑,5年沉疴遂愈,隨訪至今,未再復發。(新中醫1992;<6):44)
  按語:本案辨証眼目是時自汗出,此為營衛陰陽失調之表現,故用桂枝龍骨牡蠣湯而取效。
  十五,陰冷
  醫案:李某,男,29歲。一年多來陰囊,陰莖及小腹冰冷,經用附 子,肉桂,小茴香,吳萸:巴戟天,大.茴香,硫磺等藥及八味地黃丸,黑錫丹,龜齡集,附桂理中 丸 等無效。舌苔白,脈弦緩。心火浮越於上,腎陽虧損於下 。擬桂枝龍牡湯攝浮陽,調陰陽。桂枝12克,白芍12克,龍骨12克,牡蠣12克,生姜 12克,甘草6克 ,大棗10個。服藥30劑痊愈。(山西醫藥雜志1976;(4>:31)
  按語:陰冷而服溫熱藥不效,証見陰陽失調。臨証不失為一重要思路。
  十六,發熱
  葉益豐醫案:金某某,女,32歲,1978年3月4日診。產後半月,發熱十天,汗多一lflgL,心悸納呆,口淡不渴,頭暈耳鳴,面色蒼白,兩顴泛紅,二便調 和,舌淡苔白,脈浮大,按之芤,體溫395C。此乃產後陰血內虧,陽氣外浮之証,若誤用表散,有漏汗亡陽之危。宜益陰扶陽,鎮攝收斂。桂枝,白芍,t~-O--~-10克 ,生姜5片,大棗10枚,龍骨,牡蠣各30克,黃芪40克,當歸10克。2劑熱退汗止,繼服3劑而愈。-
  按語:《素問.生氣通天論》日陰者,藏精而起亟也;陽者,衛外而為固也。產後陰血內虧,故心悸;陰不戀陽,虛陽外浮,則發熱;虛陽上越,而頭暈鳴,面白顴紅 。桂枝龍骨牡蠣湯合當歸補血湯,有補陽氣,益陰血,鎮攝虛陽之功,故獲捷效。
  十七,奔豚
  張德超醫案:陳姓婦女,42歲。因受驚後,始感頭昏,頭痛,夜眠不寧,繼則感氣從少腹上沖,如奔豚之狀,上至心胸則驚恐不安,甚則汗出,發則幾乎欲死,移時沖 氣漸平,精神亦漸復。苔白而潤,脈沉弦。如是者三年,時愈時發。証系心陽本虛,腎之陰氣上逆。予本方重用桂枝加味。遂疏:桂枝15克,自芍i0 克,炙甘草5克, 龍牡各30克(杵,先煎),紫石英15克,生姜4片,紅棗7枚。服至20余劑,沖氣漸平。後以甘麥大棗湯調理善後,竟收全功。(北京中醫1984;(3>:34~35)
  按語:《靈樞》云:心,怵惕思慮則傷神。《金匱》云:奔豚從驚發得之。患者因驚恐而傷心陽,腎中寒水之氣,隨沖脈上逆,而為奔豚之証,故用桂枝加 龍牡湯,獨加重桂枝用量,取桂枝加桂之法,以復心陽,溫腎寒,降沖逆,龍牡,石英以收鎮心安腎,平沖降逆之效。
  十八,暴盲
  葉益豐醫案:黃某某,男,38歲。1989年11月2日診。患者遺精5年,屢治不愈。2月來視力逐漸下降,昨起兩眼失明,僅呈見光感,來延余治。時見除上証外 ,察其兩眼外形正常,伴見面色不華,形體瘦弱,頭髮稀疏干枯,汗出怕風,小腹拘急,腰酸陰冷,頭暈耳鳴。舌淡少苔,脈遲弦大,按之無力。此乃陰陽兩虛,固攝失職, 精氣衰弱,不能上營。治宜益陰固陽,扶陽攝陰。投桂枝龍骨牡蠣湯加味。桂枝,白芍各10克,甘草5克,龍骨,牡蠣,黨參,熟地各30克,生姜5片,大棗5枚。水煎 服,日1劑。服藥5劑,視力好轉,遺精一次,諸症減輕。效不更方,守方服35劑,兩眼視物如常,視力恢復為1.5,遺精未作,諸症消失。(江蘇中醫1993;(4):18)
  按語:遺精日久,陰精耗損,陰損及陽,陰陽兩虛。今陽失陰養,浮而不斂,陰失陽攝,走而不守,故投桂枝龍骨牡蠣湯斂陽攝陰,加黨參,熟地滋陰精益陽氣,使陽守 陰固,陰充陽旺,陰陽平調,則目視復明,遺精諸症自愈。
  十九,脫髮
  陳兆祥醫案:劉某某,男,41歲,幹部,1982年10月15日初診。素體不健,經常罹病感冒。此次發病纏綿不愈,繼而頭髮成片脫落,呈不規則形。脫處頭皮光 滑,無痛痒。前醫曾用首烏片,桑麻丸,神應養真丹等治療,病情反復,頭髮將近脫光。伴有畏寒汗出,神疲乏力,形體消瘦。舌質淡胖,苔薄白,脈沉無力。脈証合參,辨 為衛陽虛弱,髮失溫煦而脫落。治宜溫衛固髮。方用桂枝加龍骨牡蠣湯加味治之:桂枝10克,赤芍10克,炙甘草6克,生龍骨10克,生牡蠣 10克,炮 附子10克 , 黃芪15克,生姜6克,大棗10克 。水煎服,15劑。
  藥後患者精神振作,脫髮處已有絨毛狀毛髮長出。原方加當歸10克,繼服30劑。半年後隨訪:自述服上方20劑後,頭髮全部長出,且逐漸變黑。現髮黑光澤如常人 ,未再脫落。(北京中醫雜志1988;(1>:52),
  按語:衛氣者,所以溫分肉,充皮膚,肥腠理,司開闔者也。衛氣的強弱,直接關系到毛髮的生長,潤澤和牢固。今患者除脫髮外,經常感冒,加之畏寒汗出,神疲 乏力,舌淡脈沉等,顯是衛陽虛弱所致。衛虛不能溫養皮毛,根不牢固而脫落。《金匱要略方論》說:目眩髮落桂枝龍骨牡蠣湯主之。故投以桂枝加龍骨牡蠣湯溫衛 固髮,再加 附子, 黃芪溫陽益氣。衛陽充,皮 毛固,則脫髮自然痊愈。
  二十,小兒咳喘(小兒肺炎)
  魏如恢醫案:劉某某,男,2歲,於1980年4月10日入院。小兒入院時咳嗽氣喘,汗出,低熱,面色蒼白,煩躁啼哭,西醫診斷為小兒肺炎。給青,鏈霉素注射, 口服小兒四環素,氨茶鹼之類,汗出不止,曾用阿托品注射。當時汗出雖止,藥效消失後又大汗淋漓,特邀請中醫會診。証見身熱而面色觥白?咳嗽氣喘,汗出淋漓,四肢欠 溫,消瘦神倦,舌淡而嫩,指紋沉而色淡,乃為後天失調,稚陽不足,受邪之後顯現正氣不支,營衛失和之証,擬桂枝加龍牡湯,重用龍骨,牡蠣。處方:桂枝6克,白芍9克 ,龍骨18克,牡蠣18克,甘草3克,紅棗2枚,生姜2片,紫菀6克,川貝母3克。經服3劑,諸症消失。適當調理痊愈出院。(江西中醫藥1985;(4):64)
  按語:(原按)小兒肺炎,本以熱証居多,但有些患兒出現心陽不振,營虛衛弱之証者,乃為正虛邪戀,虛多實少的一種變証,多由嬰幼兒平素體質虛弱,稚陰稚陽之體 ,無力抗邪外出所致。運用本方治療小兒肺炎必須辨証清楚,方不致誤。我們體會必須掌握如下幾個辨証要點:1.年齡幼小,體質素弱,病程較長;2.有汗而熱不解,面 色蒼白,舌質淡嫩無華,脈細弱無力;3.身熱起伏不退,熱勢雖高,但無面赤,口渴,舌紅,苔黃等化燥傷陰趨勢;4.全身有汗,汗出粘涼,汗後皮膚四肢欠溫。我們體 會,肺炎後期,若見髮熱起伏,有汗熱不解,舌質淡嫩,面色蒼白等,服用本方一般在三天左右發熱漸退,諸症亦隨之消失。若患兒神倦汗出,倍用龍骨,牡蠣,加黃芪,浮 小麥以益氣固表;兼咳嗽不爽加貝母,橘紅,杏仁,紫菀以化痰止嗽;肺虛喘促者加五味子,麥冬以補益肺氣;痰多而稀食少者加蘇子,白前,半夏,陳皮以化痰和胃。
  【補述】有學者認為,本方組方嚴謹,在治遺精等証中不宜加減,固守原方每獲卓效,指出經方之加減與否,須視病情而定,非必加減而後效,故古方不治今病論,亦屬 無稽之談。並舉兩遺精病案而闡述之。
  李某某,男,40歲,湘林汽車五中隊工人,遺精半載,諸治不效,於82年4月13日來院就診。証見:頭暈神疲,面色萎黃,遺泄無夢,陽痿不舉,舌存常薄苔,脈 濡軟如爛棉。証屬腎元虛衰,相火不蟄,由精傷導致氣餒。治宜引納固下,益氣調中,與桂枝加龍骨牡蠣湯再加黃芪,黨參。進4劑,遺泄依然。籌思再三,以為病深藥少, 囑其再進4劑,仍無寸效。於是以原方去參,芪與之。三劑知,六劑愈,至今未發。
  又齊某某,男,53歲,黔陽縣竹器廠篾工。遺精十余年,多方治療而效不顯。於82年7月14日來院就診。証現頭暈目眩,虛贏少氣,腰酸肢冷,小便頻數不禁,寢 難成寐,遺泄無夢,近來幾無虛夕。脈來弦細而弱。此亦精氣神俱虛之候,亦與桂枝加龍骨牡蠣湯再加參,芪。並非故蹈復轍,以圖再試耳!誰知進4劑後,不效依然。遂於 原方去參,芪與之,進三劑,遺泄戛然而止。續進十余劑,諸証尋愈。隨訪至今,情況良好,間或一遺,不藥而愈。(劉雪堂經方加味而效不顯江西中醫藥1984;(6):36)

 

[1]  Shandong Traditional Chinese Medicine 1985; (5): 21
 

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