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加减普济消毒饮 - 医学百科

加减普济消毒饮


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清•吴鞠通温病条辨

银花一钱 连翘一钱 薄荷五分 荆芥穗五分 牛蒡子六分 元参一钱 苦桔梗一钱 生甘草五分活水芦根一两,煎汤代水,一日三剂,约2时服一剂。

【主治】温毒咽疼喉肿,耳前后肿,颊肿,面正赤,或喉不痛,但外肿,甚则耳聋,俗名大头瘟,虾镆温者。

方论选萃

  • 清•吴鞠通:温毒者,秽浊也。凡地气之秽,未有不因少阳之气而自能上升者,春夏地气发泄,故多有是证;秋冬地气,向有不藏之时,亦或有是证;人之少阴素素,不能上济少阳,少阳升腾莫制,亦多是证;小儿纯阳火多,阴未充长,亦多有是证。咽痛者……盖少阴之脉,皆循喉咙,少阴主君火,少阳主相火,相济为灾也。耳前后颊前肿者,皆少阳经脉所过之地,颊车不独为阳明经穴也。面色赤者,火色也。甚则耳聋者,两少阳之脉,皆入耳中,火有余则清窍闭塞也。治法总不出普济消毒饮之外。其方之妙,妙在以凉膈散为主,而加化清气之马勃、僵蚕、银花,得轻可去实之妙;再加元参、牛蒡、板蓝根,败毒而利肺气,补肾水以上济邪火;去柴胡、升麻不用者,以升腾飞越太过之病,不当再用升也(《温病条辨》)。

近代•何廉臣:此方以凉膈散为君;以化清气之马勃、僵蚕、银花为臣,走上焦而开天气;再加元参、牛蒡子、板蓝根为佐使,清热毒而肃肺气。去原方中升麻、柴胡者,以升腾飞越太过之病,不当再用升提也。又去黄芩、黄连者,以芩、连为苦寒清里,此病初起,宜用辛凉开达,不得先用苦寒里药,故犯中焦也(《重订广温热论》)。


【近代验证】


患者于两天前自觉两腮部肿胀,疼痛,发热(T38℃)。今日因体温升高,两腮部胀疼加剧而来院急诊。T38.7℃,血液化验白细胞3500,中性77%,淋巴20%,大单核2%,嗜酸性1%。

体检:T39℃,P104次/分,咽部充血,扁桃体未肿大,无渗出。两侧腮部肿胀,肿势以耳垂为中心,向周围扩散,触痛明显。心肺(-)。诊断:流行性腮腺炎。予中药治疗,服药二剂后疼止,三天后体温正常,肿势消退。 初诊:1976年12月30日,形寒身热,头痛鼻塞,两颐肿胀疼痛,妨碍咀嚼,翕张为难。舌尖嫩红、苔薄黄,脉形浮数,此因温毒上犯肺胃两经,引动少阳胆火上冲,壅滞经络使然。今拟辛凉疏风,清解热毒。

薄荷叶3克(后下) 炒大力子9克 象贝母9克 连翘12克 玄参9克 马勃3克(包)板蓝根9克 山豆根9克 夏枯草12克 荆芥穗9克 三帖

复诊:1977年1月1日,前投辛凉疏风,清解热毒之剂。头痛已止,两颐肿疼亦见轻减。拟于原方撤去疏风之品。原方去荆芥、薄荷,加蒲公英12克、地丁草12克,三帖

三诊:1月4日,温毒已从外解,少阳胆火亦平,两颐肿疼已消,惟大便燥结,小溲色黄,口干渴饮,余热未清,肺胃阴津已伤。拟予甘凉益胃,轻清余热。 京玄参9克 川石斛12克 天花粉9克 银花12克 马勃3克(包) 北沙参12克 破麦冬9克 干芦根30克 生甘草4.5克 三帖。

【按语】 温毒发颐,由风毒上犯肺胃,引动胆经伏火上冲使然。考前人治法,《东垣十书》有普济消毒饮一方。吴鞠通氏非之。谓升腾飞越太过之病,不当再用升、柴;;且病在上焦,早用芩、连苦泄,有故犯中焦之嫌。吴氏于《温病条辨》中订加减普济消毒饮一方,颇为公允。此案首诊用药,得力于吴氏;二诊头痛已止,热退肿退,即撤去风药,恐辛散太过,伤其正也;末诊以清养肺胃收功,以温病伤人之阴耳。

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