苓桂朮甘湯治療痰飲病的文獻回顧與臨床驗案解析

苓桂朮甘湯，出自後漢張仲景《傷寒雜病論》，典籍中揭示苓桂朮甘湯適用於心下逆滿、頭眩、氣短等痰飲病之時機。本方重用茯苓甘淡為君，健脾運濕，滲濕化飲，通調水道；桂枝為臣，溫陽化氣，通經行水，加強化飲利水之力；佐以白朮健脾燥濕，助脾運化以杜絕生痰之源；炙甘草則甘溫補脾益氣，兼調和諸藥為使。四藥共奏健脾利濕，溫陽化飲之功。吾等認為：臨床使用本方時，只要掌握「痰飲為患」的主要病機，臨證能夠分清主訴病位（在臟腑或經絡），辨明與次要病機之聯結關係（風、寒、濕、熱、虛、瘀），審慎分析辨證，靈活處方加減，其實可以廣泛應用於冠心病、關節風濕痹痛、高血壓、攝護腺肥大頻尿、腸胃病、鼻病⋯等痰飲病的治療。本文舉出五個驗案為例，此五案疾病不同，臨床表現各異，但其中陽不振，痰飲為患之病機則相同。五案皆以苓桂朮甘湯為主方加減治療，均獲良效，體現了中醫「治病求本，異病同治」之理。

關鍵字

苓桂朮甘湯；傷寒雜病論；痰飲病；異病同治

並列摘要

Linggui Zhugan Decoction is a Chinese herbal formula from an ancient traditional Chinese Medicine book titled Shang Han Zabing Lun in which noted that this decoction is mainly applied to phlegm-related diseases such as epigastric distention, dizziness and shortness of breath. The formula comprises four Chinese herbs: Poria, Ramulus Cinnamomi, Rhizoma Atractylodis Macrocephalae and Radix Glycyrrhizae. Poria strengthens the spleen, drains dampness, and transforms phlegm; Ramulus Cinnamomi warms the Yang, facilitates the flow of Qi through channels, and helps to resolve congested fluids; Rhizoma Atractylodis Macrocephalae strengthens the spleen and dries dampness. Radix Glycyrrhizae supplements spleen Qi and harmonizes other herbs. These four herbs work together to strengthen spleen, resolve dampness, warm and transform the phlegm. Only when we identify the phlegm pattern, distinguish the key mechanism, the position of illness (in organs or channels), the influence of other causes (wind, cold, damp, heat, vacuity, stasis), we could flexibly apply Linggui Zhugan Decoction in treating other clinical diseases including coronary diseases, impediment or muscle pain, hypertension, frequent urination, gastrointestinal diseases, nasal diseases and so on. In this article, we presented five effective cases using Linggui Zhugan Decoction to show that despite of different signs and symptoms, they all suffered from phlegm and dampness due to a common mechanism of devitalized middle Yang, reflecting the principles of Traditional Chinese Medicine: to treat the root; to treat different diseases with same method.