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半夏泻心汤应用要点 - 版本历史
2026-04-12T22:24:39Z
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2022年11月6日 (日) 06:17 明华
2022-11-06T06:17:20Z
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<td colspan="2" style="background-color: white; color:black; text-align: center;">←上一版本</td>
<td colspan="2" style="background-color: white; color:black; text-align: center;">2022年11月6日 (日) 06:17的版本</td>
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<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">半夏泻心汤</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">半夏泻心汤出自《伤寒论·辨太阳病脉证并治》149条：“伤寒五六日，但满而不痛者，此为痞，柴胡不中与之，宜半夏泻心汤。”组成为半夏、黄芩﹑人参﹑干姜、黄连、甘草、大枣，是为伤寒误下导致脾胃虚弱、寒热错杂、气机不畅的心下痞而设，是集辛开苦降、寒热补泻于一体的代表方剂。《金匮要略》中论述：“呕而肠鸣，心下痞者，半夏泻心汤主之。”笔者临证四十余年，半夏泻心汤是治疗胃肠病相关症状，如吞酸、痞满、胃脘痛、腹痛、呕吐、泄泻、便秘、痢疾等的常用方剂之一。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">半夏泻心汤方证要点</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">①呕可以是呕吐，也可以是干哕或恶心。②痞是中医学专用术语，病人一般不会说出痞的概念，但其症状包括胸腹满闷、其触之无形、压之无痛、按之柔软，多因气滞、食滞、寒湿上壅、湿热困阻等导致脾胃升降失常，气机阻滞。③肠鸣，是肠间辘辘有声，还包括下腹部有胀气，大便不成形、次数多、黏腻不爽。④舌苔必须为厚腻，可以黄白相间，也可黄厚腻或白厚腻。⑤半夏泻心汤舌象应重于脉象，舌苔必须为厚腻，或白或黄均可，呕、痞、鸣但见一症即可。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">半夏泻心汤加减运用</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">半夏泻心汤是治疗寒热错杂的主要方剂，方中半夏、干姜、黄芩、黄连辛开苦降化寒热错杂之邪。临证中根据舌苔白腻还是黄腻、口苦与不苦判断病证的寒热偏性，处方时调整黄连、黄芩、干姜的用量。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">半夏泻心汤使用要点：①余临证运用半夏泻心汤的人群多为青壮年，所以方中一般不用人参，多以炒枳壳、炒白术代替。枳壳行气导滞、白术补脾化饮，二者相互导气滞，行水饮。②使用半夏泻心汤时，要加一些行气药，如枳壳、炒白术、厚朴、陈皮，使得气机调畅，湿浊得化，脾胃复健，诸症自除。③用半夏泻心汤治疗幽门螺旋杆菌阳性时，余常加蒲公英10克、仙鹤草10克。现代药理研究显示：黄芩、黄连、蒲公英、仙鹤草均有抗幽门螺旋杆菌作用，但量不宜大，量大反而无功。④用半夏泻心汤治疗糜烂性胃炎、胃溃疡，可加白及、木蝴蝶，白及有收敛、止血、生肌的功效。现代药理研究表明白及可以促进胃黏膜再生修复，木蝴蝶亦有“护膜医疡”的称号。⑤若遇青壮年患有胆汁反流性胃炎或反流性食管炎，大柴胡汤的作用优于半夏泻心汤。临证时，此二方加减后经常你中有我、我中有你，故还须辨证使用。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">总之，凡属于脾胃气机升降不利，气机痞塞，寒热错杂者，用半夏泻心汤加减确有良效。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">验案</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">徐某[方剂汇www.fane8.com]，女，32岁。2018年11月28日初诊。主诉：上腹部胀满不适1年余，加重伴口淡无味1周。现病史：患者近1年来上腹部经常胀满不适，食后更甚，郁闷不舒，心中嘈杂，晨起恶心，偶见呕吐宿食，四肢欠温。胃镜检查结果显示：浅表性胃炎伴胃食管反流。上腹部彩超未见明显异常。刻下症见：口淡乏味，食后胃脘胀满，郁闷不舒，心中嘈杂，晨起恶心，呕吐酸水，食欲不佳，自觉消化困难，四肢欠温，望其面色萎黄，舌质淡苔薄黄，脉沉细。诊断：痞满（寒热错杂证）。治疗：寒热平调，和胃降逆。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">处方：半夏10克，黄芩10克，黄连6克，干姜10克，枳壳20克，木香15克，吴茱萸6克，海螵蛸10克，炒山楂10克，炒麦芽15克，炒神曲15克，甘草10克。7剂。水煎服，日1剂，早晚分服。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">2018年12月7日复诊。经上方治疗以后，患者胃脘部胀满、口淡无味明显减轻，心中嘈杂缓解，晨起恶心好转，偶见呕吐酸水，但仍觉消化困难。处方：上方加鸡内金20克、炒白术15克，7剂。</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">2018年12月16日三诊。患者诉胃脘部胀满明显减轻，口淡乏味症状消失，心中嘈杂已除，食欲改善，服药期间未见呕吐酸水，四肢欠温改善。再次嘱患者注意饮食结构和饮食量，保持心情舒畅。嘱上方继服7剂，不适随诊。（赵永强 山西省长治市中医院）</ins></div></td></tr>
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明华：创建页面，内容为“https://www.fane8.com/read/7bf59e156f090fdc.html”
2022-11-06T06:15:02Z
<p>创建页面，内容为“https://www.fane8.com/read/7bf59e156f090fdc.html”</p>
<p><b>新页面</b></p><div>https://www.fane8.com/read/7bf59e156f090fdc.html</div>
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