方剂学 77 邓中甲

方剂学 77 邓中甲 温胆汤 《三因极?病証方论》 主证 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 胆郁痰扰证。 胆气不足 胆为邪扰，胆怯易惊，心烦不眠 胆胃不和 痰浊上逆,头眩心悸,呕恶呃逆,虚喘、苔 情志不遂、气郁生痰 白腻，脉弦滑 上节课讨论到温胆汤证的病机分析，证候分析，从温胆汤证的病机分析来看，它是胆郁痰扰证。证候分析集中反映在以无形之痰为患，这个为主。我们前面在概述里曾经讨论了，痰有有形之痰和无形之痰两大类。有形之痰，往往是以从肺咳出来，随着肺气上逆，咳嗽，咳出的排泄物为主。无形之痰是在证候反应上。所以我们这里所提到的，胆郁痰扰，引起胆怯易惊，心烦不眠。以及呕恶呃逆，头眩心悸，癫痫，这些都属于一种无形之痰为主的范围。所以这个温胆汤在临床用得比较广泛，对于痰热引起有形之痰也有作用。但临床上更多的应用用于无形之痰。 功用 理气化痰，和胃利胆。 根据这个病机分析，我们来看看它这个治法和这个方的功用。从原因来讲，根本的还是痰，所以要理气化痰，由于痰郁造成了这种胆胃不和，要清胆、利胆、和胃。 从温胆汤的构成来讲，微微偏凉。《三因极?病証方论》的这个温胆汤，我们前system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 面谈到偏凉的。当在这个用量的灵活运用及配伍，它可以调整的，或者减少凉性，或者增加清热力量。所以现在把它治疗痰热，相比之下，用得比较多。 方解 半夏 燥湿化痰(辛温) 君 竹茹 偏寒，清热化痰，利胆和胃 陈皮 理气化湿 臣 枳实 行气，降气，导滞，清热 佐 茯苓 健脾治疗生痰之源，渗湿化痰 生姜 调和脾胃，配半夏相须相制 佐2 大枣 和甘草联用，调和脾胃 佐使 甘草 调和药性 怎么体现出理气化痰，清胆和胃这种作用呢,温胆汤仍然是在二陈汤，燥湿化痰二陈汤的基础上，发展来的。竹茹偏寒凉，可以清热化痰，同时它又利胆、和胃。所以对于胆胃不和，这种偏于痰热的比较适宜。半夏竹茹连用之后，加上后面加了枳实，全方就偏凉。 臣药是陈皮和枳实，陈皮理气化湿，和半夏相配，体现了治痰先治气，气行痰自消这个原理。是治痰的一个常用配伍组合。枳实呢，可行气、降气，可以导滞，也有清热作用。和竹茹相配，对于全方清化痰热、消痞、导滞，有协助作用。 佐药茯苓，然然是二陈汤原方里的含义，茯苓在这里，一个健脾治疗生痰之源，一个渗湿，协助半夏的燥湿，增加化痰力量。脾为生痰之源。一方面茯苓还擅长于平冲逆逆，降水气之上逆。在这哩，刚才证候分析我们分析到，它涉及到一个痰气凌心，痰气上逆凌心，上干清阳，头晕目眩，心悸。所以茯苓这个平冲降逆，有助于和竹茹、枳实配合，有助于能够降痰气，它治疗很多精神系统疾病，也是靠的这个机理。 system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 生姜大枣调和脾胃，生姜配合半夏，两个既有相须，有助于和胃降逆，有助于化痰。又能够相制，消除半夏的一些毒性，大枣能够补脾，和甘草联用，主要能够补脾胃，考虑脾为生痰之源。而且防止温燥之品伤中焦，这是甘草又可以作为使药，调和药性。 整个方体现了理气化痰，和胃利胆，过去很多教材也提到了，理气化痰，清胆和胃。这要看你的用量把握，如果使这个方凉性突出，治疗痰热，现在临床用的很多。用它清化痰热为主。那就竹茹、枳实量增大。这是灵活运用的范畴了。 临床运用 辨证要点(使用基本依据) 心烦不寐，眩悸呕恶，苔白腻，脉弦滑。 心烦不寐，用来反应一个精神方面疾患的一个代 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf ，痰热扰心造成心烦不寐，痰热随着痰气上逆，眩悸呕恶，也是痰气上逆，造成眩晕、心悸、呕吐、恶心。痰气上逆，胃气不和，苔白腻，脉弦滑。这是反映白腻，痰湿较重。弦滑反应的是既有胆胃不和这种痰浊内涌。 随证加减 , 心热烦盛，加黄连(加黄连，这个名称就叫黄连温胆汤)、栀子、豆豉(栀 子豉汤，有助清热，宣发解除胸中的烦热) , 失眠(痰热扰心)，加琥珀粉、远志(安神药) , 惊悸，加珍珠母、生龙骨、生牡蛎。 温胆汤用于治惊悸，用得很多，报导很多，镇惊安神。 , 呕吐恶逆，加苏叶或梗、枇杷叶、旋覆花 胃气上逆比较突出，大剂量苏叶是解表发散，中等剂量往往侧重在理气。小 剂量可以解郁。在此，苏叶用中等剂量，或者用苏梗，它主要可以理气、和 胃。枇杷叶是降气的药，能够降肺气，也有和胃作用。旋覆花，前面在张仲system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 景的经方旋覆代赭汤里，曾经讨论过，旋覆花擅长于降胃气之上逆。这在旋 覆代赭汤里大家可能还记得，它可以治疗噫气不足，心下痞，噫气不足，也 就是胃气上逆。在这哩，如果痰浊停滞，引起痰气上逆，造成胃气不和，呕 吐、呃逆，可以进行这样的加味。 , 眩晕，加天麻、钩藤; 眩晕突出，痰浊上犯引动风邪，这也是内风的一类，加天麻可以平肝熄风， 钩藤也是熄风的要药。这在前面治风剂我们讨论过天麻钩藤饮。是以天麻、 钩藤为君药的。天麻钩藤饮治疗现代高血压的头痛、眩晕、失眠。也是利用 这两味药的熄风作用。所以如果痰浊上逆，引起动风，那我们可以两个结合， 解除这个风痰问 题 快递公司问题件快递公司问题件货款处理关于圆的周长面积重点题型关于解方程组的题及答案关于南海问题 。 , 癫痫抽搐，加胆星、钩藤、全蝎。 癫痫一般认为和风痰有关。癫痫、抽搐和风痰有关。可以加擅长于清热化痰、 祛风痰的胆星、钩藤、全蝎。全蝎还能有比较强的镇惊作用。 这是临床较多的使用，当然这是一些举例，临床应用的报导，可以说温胆汤非常多。报导各种各样的怪病，充分体现了治疗无形之痰这个方面的特点。而且体现了怪病多痰。 我举几个治疗无形之痰的例子。一个痰核，痰核包括我们现在说淋巴结核，皮下脂肪瘤，这一类在中医都归属于痰核、瘰癧，这类范围，都和痰有关。不是咳出来的痰。而是证候反映出来的这个痰。八十年代，我们遇到一个年青人，他背部长了大的小的有五个皮下脂肪瘤。因为他父亲是当时还是比较地位高的医院，省医院省直属门诊部，给省领导看病的门诊部的外科主任，他说这皮下脂肪瘤不要紧，做个手术就可以。就把最大的一个皮下脂肪瘤做手术摘除了。因为手术也不复杂。摘除之后，三个月左右，背部又长出大大小小很多，然后就经人介绍找我来看。我数了数，有20多个，没有他做手术那个大，但是它在长，大大小小20多个，那这种他就不敢再做手术了。经过手术一刺激，原来五个，大小，后来变20多个。我说我给你消，所以从用这个温胆汤。因为使用的根据，这个小伙子身体又壮，又有点胖，苔腻，微微有点黄，脉弦数有力的。所以这个判断它痰郁，system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 但是呢，偏热，所以温胆汤里还加了黄连。而且加软坚散结的，也包括当时使用夏枯草、海藻、昆布。 这些配合使用。要求服用时间坚持，所以背部发生了皮下脂肪瘤，通过治疗大致前后一年，最后一个最大的，摸着还有一点点小的，手感感觉到有一点点痕迹，其他基本上消完了。所以他当时对这个中医觉得很感兴趣，因为有个做手术和吃中药的对比。后来他主动说，我原来当厂里的技术员，我愿意去学中医，到厂里卫生科帮忙，然后他去考中医的函授大学，原来四川省第一期函授大学。他第二期的入学，后来毕业了，现在自己当了个中医了。这个病例，反映了这个温胆汤，它可以治疗痰核、瘰癧一类的。关键是服用时间长一些。配伍呢，要配软坚散结的药，这是一类病。 这个方很擅长于治疗失眠。我们说失眠证，它有个总体的心神不安，心神不安应该说有虚实两大类。一类呢，心血不足，心阴不足，偏虚。心血不足，心阴不足，心神得不到涵养，那就心神不安，水火不能既济，所以这方面的，就要用滋阴、养血、安神的方法。我们前面讲到的，比如天王补心丹、酸枣仁汤这一类的。还有一类失眠，心火偏亢，这种情志郁结化火，引起心火偏亢，然后导致心神不安，阳热偏亢。“阳气者，精则养神，燥则消亡。”相当于我们前面安神剂讲的，像硃砂安神丸一类的。用清心安神为主的方法。但是还有一类，心是属于，过去说清宁，君主之官，清宁之地，对外虚灵万应，所以最怕秽浊，在讲到开窍的时候，我曾经讲到过，安宫牛黄丸、紫雪丹、至宝丹，这凉开三宝里边，开窍、醒神，醒神力量最强的是至宝丹，因为它的祛痰力量最大，豁痰开窍的力量最大。清热解毒这类力量，不如安宫牛黄丸，熄风镇惊不如紫雪丹，但是它开窍力量强。所以有些乙脑、流脑，这个涉及到湿浊、痰浊，蒙蔽清窍，造成昏迷程度深，这样的小孩，用至宝丹这类效果比较好。 这个道理也是这样。如果痰热蒙蔽，或者热痰扰乱心神，那同样也可以造成心神不安，这类心神不安而且很顽固，症状很剧烈，顽固失眠。所以温胆汤证，主治证候当中很突出，有这个失眠。既不同于阴虚、血虚的失眠，又不同于单纯的气system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 郁化火，情志郁结，情志不遂，化火扰乱心神，而且它兼挟痰浊，痰火扰心，或者痰热扰乱心神，所以它这个要安神和清化痰热相结合。那我们在用这个方治疗失眠，当然报导很多了。关键是掌握这类失眠的一个特点，才能正确使用这个方。 比如我们当时教研室，那时带领年轻老师一起看病，有一位成都钢管厂的女工，她有剧烈的那种失眠连续三个月，一了解病情，这个失眠不是一般的，人家睡不着觉，最多在床上反复，不能颠到，或者难以入睡，或者早醒，她这个失眠，烦燥非常突出，而且经常晚上爬起来，在房里走来走去，走来走去到筋疲力尽，人家到早上了，她很累，倒下去，能迷迷糊糊睡一下，因此从发病以后，逐渐加重了。有两、三个月已经不能上班，也到处求医，吃镇静剂，逐渐量加大，能够控制一下，以后又发生，要加量，所以像这个用中药来治，她当时也有吃这个补心安神丸，有很多中药的成药，当时我们判断，她这个实际上是一种痰热，痰火扰心，继续发展就可能成狂证，所以采取黄连温胆汤为主，结合用镇潜安神的药物，用像珍珠母、龙骨、牡蛎，同时像这类病证，还增加清热化痰力量。因为她舌苔黄腻，白天也就是心悸，所以增加清化痰热的力量。比如说，像竹沥水，天竺黄，这里都可以适当地加进去。经过治疗，逐渐病情可以缓解，所以这个病人，最后逐渐能够上班，但是经常还吃一点安定片。 这类病人根治，我个人体会呢，非常难。我们过去还治了许多有关精神系统方面的疾病。根治很难，特别是时间久长吃过镇静剂，这个想摆脱镇静剂很难。只能减量，减到一定程度就不错了。因为中西医在治疗这种精神症状方面，中医是剔痰，开窍这种方法，现代医学镇静，正好两种作用方向相反，一大剂量镇静用下去，看起来她不闹了，不是正常的。这痰还是伏在里面。一诞诱发因素，情志刺激，或者劳倦等等，痰随气生，又可以爆发出来。中医强调治本，要祛痰。所以这也是一个用于无形之痰的例子。 用温胆汤也用来治疗过狂证。狂燥性精神疾病。当时像病人用现代医学治疗当中用最多，像安定片一类的镇静剂。平时维持量给他用到最多17片，一般人根本受不了。这个人人高马大，是个公安人员。但是一烦躁起来，发狂起来，到最后system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 找人打人了。后来吃中药时间都很长。用黄连温胆汤和大柴胡汤相配。因为他伴随有腑实，经常大便秘结。黄连温胆汤和大柴胡汤结合。能使痰热有出路，能痰热从谷道、从肠道排出，增加出路。这个效果也很好。后来能够一次降到9片。能够维持正常生活。 所以这个温胆汤，上面举了一些，治疗无形之痰的一些例子。以便于同学们理解无形之痰的一些特点。这个方的一个长处。因为温胆汤是一类方，重点方。前面讲燥湿、化痰两个方面，二陈汤、温胆汤都是一类方，重点方。 第二节 清热化痰 适用病证 痰热证。 组方用药 清热化痰药 + 理气药 (治痰先治气) 这里所说痰热证，主要是指有形之痰。现在教材说的这个方，我们要讲的两张方，主要是有形之痰。 清气化痰丸 《医方考》 主证分析 痰热咳嗽。 痰阻气机，郁而化火 ? 痰热证 外邪化热，炼液成痰 常用方。痰热证它的表现，咳出来的是热痰。痰热怎么造成的呢,有两种可能。 (1)本身痰湿，本身有湿痰郁而化热。 system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology (2)外邪入里化热。然厚热邪煎灼津液为痰。 不管哪个原因，总之归宿到痰热的形成，那痰热，这种热痰在肺，引起肺失宣降就要咳嗽了。热痰的特点，痰热壅肺以后，肺失宣降，咳嗽气喘，咳喘，痰热特点，咳痰黄稠，典型的痰热，应该说咳痰黄稠量还是比较多的。主要体现在黄稠特点上。只要有痰，痰就阻滞气机，可以胸膈满闷，这是在前面讲到二陈汤，包括温胆汤共同的痰热阻滞气机，是它的一个特点。痰湿阻滞，造成肺胃之气上逆，气急严重的可以喘，呕吐恶心，这也是痰证常见的。痰热要扰乱心神，程度较轻的，体现出一种烦躁，心神不安，烦躁不宁，这有热，心烦，是一般热证都可以发生的。舌质红，苔黄腻，脉滑数。这是典型的痰热证的舌脉表现。 通过清气化痰丸的证候分析，我们可以看到这是痰的瘀滞部位，主要是在肺，造成肺失清肃，连带引起了胃气不和。但因为有热像，所以邪热，痰热扰心，有一些兼证，主要是在肺。咳吐，咳出来的这个热痰。 功用 清热化痰，理气止咳。 方义分析 胆南星 苦寒化痰(擅长风痰，痰热) 君 瓜蒌仁 清化热痰，宽胸除满 黄芩 善于清肺热，上焦之热，增强君药的清痰作用 臣 半夏 燥湿化痰，增强化痰力量 杏仁 苦平，化痰降气止咳 佐1 陈皮 理气化湿，有助于化痰 枳实 降气导滞，又能清热，偏寒性 茯苓 渗湿，帮助消痰 佐2 姜汁 散水，有助于消痰，还能防止胃气上逆 清气化痰丸仍然是在二陈汤的基础上，加减化裁而来。胆南星瓜蒌仁联合，针对system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 了痰热咳痰黄稠，甚至于量多，针对性很强。虽然是热痰，痰来源仍然是一种湿聚成的。整个方既是属于凉性的，半夏是温性的，在这里，大队的凉性药当中，配伍一定的温性药，它起到去性取用的作用。留下来它化痰的力量，突出这个用。抑制了它辛温燥烈之性。这是一个配伍当中，扬长避短的一个方法。 佐药，这个方里有三味药，杏仁苦平，平性药，寒痰、热痰，各类痰它都可以使用。化痰，长于降气，降气止咳。枳实和陈皮结合，能增强理气作用。姜汁散水，有助于消痰，还能防止胃气上逆，因为这个痰湿重了，痰热可以引起呕恶，姜汁有和胃作用。 清气化痰丸实际上是在二陈汤基础上，去掉甘草，再加上清化热痰的一组药构成。为什么去甘草呢,要注意这个方里痰量，应该说痰热，咳痰黄稠，量比较多，要去掉甘草，前面讲到二陈汤的时候，你联系到二陈汤后面的第一个附方，导痰汤。也是利用了二陈汤去甘草再加味。所以痰湿较重，阻滞在肺胃的，甘草可以不用，可以去掉甘草。这是对清气化痰丸的方义分析。 清气化痰丸是临床常用方，我们教学大纲把它定为一类方。重点掌握的方。代表了咳嗽，兼有热痰，这是代表性治疗方法。 配伍特点 化痰和理气清热并用。或者说化痰理气清热并进。化痰为主，治痰要治气，而且针对热痰要清热，所以它是化痰理气清热结合的。 临床运用 辨证要点 咳痰黄稠，胸膈痞闷，舌红苔黄腻，脉滑数。 一个是从痰的性质来辨，咳痰黄稠是热痰的基本表现，胸膈痞闷反映了痰热阻滞气机，阻滞气机，所以这个方里才要陈皮、枳实这些行气药。舌脉像，这是典型system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 的痰热表现。 随证加减 , 痰多气急(咳喘)，加鱼腥草、桑白皮。(加强清热解毒，排痰力量) 鱼腥草临床上既能清热解毒，也有一定排脓作用。桑白皮降气，清肺热。增 加降气平喘，排痰清热力量。 , 痰稠较黏难咯者，减半夏用量，加青黛、蛤粉。 痰热黏滞，难以咳出，半夏辛温，往往比较燥，就适当减量，蛤粉有化痰作 用，也有一定的软坚散结。青黛增加清热力量，因为热灼津液，容易使痰胶 黏难咯。 , 恶心呕吐明显者，加竹茹。 胃气上逆突出，恶心呕吐明显，加竹茹清化痰热和胃，加强和胃的力量。 , 烦躁不眠，去黄芩，加黄连，山栀，并酌加琥珀粉，远志。 痰热扰心，烦躁不眠，这方里去黄芩，加黄连，黄连增加清心力量，栀子清 热利水，增加热邪从小便排出的出路。而且可以加一些安神药。琥珀粉，远 志是养心安神的药。 清气化痰丸是一类方、重点方，也是我们清化痰热方面，选择的唯一的一个一类方。 小陷胸汤 《伤寒论》 主治证候 痰热互结之小结胸病。结胸病，病位在胸，结胸，大结胸是水热互结，小结胸病示痰热互结，这里指的是痰热互结。痰热互结它的表现，由痰热引起，心胸痰热在肺，引起肺失宣降，咳痰黄稠，从咳痰黄稠可以反映出痰热特点。痰热阻滞胸中气机，胸脘痞闷，按之则痛，或者心胸闷痛，这是小陷胸汤的使用当中，很重要的一个特点。也就是所谓小结胸，痰热互结在胸脘，轻则痞闷，重则心胸可以闷痛，痞闷按之则痛，里面按之则痛，有实邪。实邪是什么呢,是痰热互结心胸，心胸当然包括肺。治疗呢，对这类证候，小陷胸汤是个小的基础方，实际上反应system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 一种清化痰热的一种基本结构。这种结构往往可以配在其他复方当中。 功用 清热化痰，宽胸散结。 因为痰热引起胸痛，胸部闷痛。或者痞闷，按之则痛，按之则痛说明痰热是个实邪。你再结合它的咳痰黄稠，舌苔黄腻，脉弦滑数，这个可以判断出来。 方解 君 瓜蒌 清热化痰，宽胸散结 臣 黄连 苦寒清热，配伍半夏，辛开苦降 佐 半夏 辛温化痰，增加瓜蒌清热化痰作用 瓜蒌为君，两个作用，(1)清热化痰，针对痰热这个是常用的。(2)宽胸，瓜蒌有宽胸散结作用。对于痰热互结胸中，导致胸中痞闷，按之则痛，或者闷痛，它通过散结，通过化痰，可以解除痰热互结，做为君药。 黄连可以清热，增加瓜蒌的清热作用，半夏化痰，它是辛温的。这方是寒热并用的。半夏辛温，擅长于化痰，化痰这一点，可以增强瓜蒌的清热化痰作用。同时半夏辛温的，辛可以开，可以散，黄连是苦寒的，苦可以降，半夏黄连相配，这在张仲景的配伍结构里，是个基本结构。是个辛开苦降的常用结构。在我们学到这个方要注意的。要回过来看看，前面学的半夏泻心汤，黄芩、黄连、半夏、干姜相配，曾经我们归纳过配伍特点，有辛开苦降的特点。这里通过黄连半夏的相配伍，辛开苦降，解除痰热互结。辛开苦降，辛可以开，可以散，苦可以降，可以解除痰热互结，畅通气机。再加瓜蒌的宽胸，清热化痰。解除痰热互结胸中。这三个药的一个小的组合。从中可以体会这种基本配伍结构，配五关系。同时这个基础方，常用于其他痰热证的过程当中，针对胸痛，做一个小的组合，配伍在其中。 配伍特点 system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 辛开苦降，润燥相得。 辛开苦降，刚才我们提了。润燥相得，这方中，半夏可以燥湿化痰，是温燥的。瓜蒌呢，有一定的清化痰热，宽胸行气。它有一定润燥作用。所以润、燥相互影响，相互制约，这样半夏既帮助瓜蒌化痰，又可以是瓜蒌黄连这些，不至于过份温燥。所以这个小方，是清热化痰，开结消痞的常用组合。开结消痞这里指的胸脘，痰热互结引起的胸脘痞结。痞闷，按之痛。可以清热化痰，开结消痞。这也是我们临床上经常作为一个药组，用在一些复方中。 临床运用 辨证要点 胸脘痞闷，按之则痛，舌红苔黄腻，脉滑数。(痰热证基本表现) 随证加减 , 加枳实，让枳实降气，开结消痞。消除痰热互结胸中这个力量更强。 , 心胸闷痛，平常按之则痛，如果痛明显，加柴胡、桔梗、郁金、赤芍这些。 道理是这样的，小陷胸汤靠半夏黄连辛开苦降，从病位来讲，气机升降。恢 复气机升降，力量稍嫌不足，行气力量稍嫌不足，它毕竟是个基础方。痰热 互结胸脘，造成气机升降失常，加柴胡、桔梗，增加宽胸、开胸、行气作用。 当然和枳壳相配，柴胡、枳壳可以一升一降，桔梗、枳壳也能一升一降。那 是畅通气机。解除胸脘的痰热互结形成气机不通，不通则痛。解除这些证候 效果更好。郁金还有活血行气解郁的特点，在这里增加这种在畅通气机基础 上，郁金、赤芍还可以增加这种活血。气血兼顾，增加止痛作用。 咳痰黄稠，难以咳出，减少半夏的用量，增加清化痰热力量。清化痰热药， 比如胆南星、杏仁、贝母。既能清化痰热，又能像杏仁增加降气止咳。这样 全方可以更好体现清热化痰理气止咳这个作用。全方增加清化痰热作用以后， 就配合辛开苦降。来解除痰热郁阻胸中这个胸痛。 system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 这是第二节，我们主要就讨论这两个方子。一个一类方，清气化痰丸。第二个是二类方，是一个基础方，小陷胸汤。 第三节 润燥化痰 我们作一些简单的提示。为什么呢,对于燥痰来讲，润燥化痰的方，痰，本身是湿痰凝聚而成。燥痰，既涉及化痰，又涉及润燥。所以这个方呢，这一方面比较典型的方较少。我们教材以贝母瓜蒌散为代表。这个方把它并为二类方。 贝母瓜蒌散 二类方 《医学心悟》 适用病证 燥痰证。润燥化痰，燥痰证。 配伍组成 化痰药 + 润燥药。 根据燥的情况生津润燥，生津润燥之品和宣肺利气之品，宣肺利气止咳。《医学心悟》上的贝母瓜蒌散，这个方一般认为主要用于燥痰咳嗽。燥痰，这里所说燥，主要还是外邪，气候燥热，燥热伤肺，煎灼肺中津液为痰，造成一种燥痰。燥痰的特点，既是痰阻滞在肺，引起肺气上逆就要咳嗽，但是燥痰咳痰不爽，艰涩、难以咳出，而且伴随有咽喉干燥，甚至于干燥哽痛，干燥疼痛。舌苔白而干，就是燥像十分严重。当然这个伴随症状也可以有口干，甚至于燥热影响也可以大半秘结，小便短少，所以燥像一般可以存在，但从燥痰引起的咳痰不爽，涩而难吐，咽喉干燥，甚至于哽痛。这都是燥热之邪伤及肺中津液，炼液为痰。既伤津液，又炼液为痰，造成燥痰。 治法 system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology 润肺清热，理气化痰 这种燥热，偏于热，要润肺清热，理气化痰。既要化痰，更要润肺清热，再结合理气。 方解 贝母 润肺化痰 君 瓜蒌 清热化痰，宽胸散结，又能润肺 天花粉 润燥 臣 橘红 理气化痰 茯苓 渗湿利水，有助于化痰 佐 桔梗 宣肺止咳化痰 贝母瓜蒌联合，共同有化痰和润肺作用。全方润肺清热，理气化痰。功用十分清楚。组成上、配伍上还很精当。考虑到一个痰热为患，同时燥伤津液，痰阻气机，这几个方面。贝母瓜蒌散是二类方。方义分析就讨论到这里。 system construction, on the planning and design of the platform, ensure clear functional distinction, develop clear direction, focusing on the development characteristics of the industry and professional incubator. Economic development zone, Riverfront area based on its characteristic, perfect the function of sci-tech enterprise incubator facilities, increased carrying capacity, provide better service for enterprise development and innovation, carry out more cooperation in science and technology projects and attract more business to the Dongping transformation, work hard to establish a science and technology innovation in our County leaders and emerging industry clusters and intensive development of demonstration areas. Dongping Lake surrounding tourism, global tourism concept of wisdom, combined with the Dongping Lake tourism priorities, as requested by the platform construction, planning, construction, management and use of integrated information platform, targeting the introduction of tourism and culture of high-tech projects. 3, pay special attention to cooperation in science and technology, promote achievements. For county-level science and technology innovation, and use of College talent, technology, facilities, and carry out extensive and in-depth cooperation in science and technology