<p class="ql-block">陳常富</p><p class="ql-block">重慶開州陳常富診所，重慶 405400</p><p class="ql-block"> </p><p class="ql-block">作者簡介：陳常富（1968—），大專，主治中醫(yī)師。研究方向：中醫(yī)婦科、消化系統(tǒng)疾病。</p><p class="ql-block">E-mail:542943818@qq.com</p><p class="ql-block"> </p><p class="ql-block">摘要</p><p class="ql-block"> </p><p class="ql-block">目的：總結(jié)柴胡桂枝湯合陰毒湯、柴葛解肌湯、敗毒散化裁治療新型冠狀病毒感染疫邪犯表、營衛(wèi)壅滯證的臨床經(jīng)驗。方法：選取1例照料新冠患者后感染的中年女性病例，主癥見頭脹昏痛、咽部吞咽疼痛、肩背痛、無涕無汗、周身不適、失眠，舌淡苔薄，脈細滑；辨證為疫邪犯表，營衛(wèi)壅滯，素體不健，陰陽難辨；治以祛疫解表、調(diào)和營衛(wèi)、入陰托毒、顧護氣血，予柴胡桂枝湯合陰毒湯化裁方治療，3劑，水煎頻服。結(jié)果：患者服藥當晚癥狀即見緩解，次日諸癥顯著減輕；其姐、其夫出現(xiàn)同類證候，予同方治療，均1劑而愈。結(jié)論：新冠感染屬中醫(yī)“疫毒”范疇，對于素體不健、疫邪犯表、營衛(wèi)氣血失和者，采用柴胡桂枝湯調(diào)體、陰毒湯托毒、柴葛解肌湯與敗毒散止痛解表，調(diào)體與祛疫并重，可快速緩解癥狀、截斷病勢，臨床療效確切，值得推廣應(yīng)用。</p><p class="ql-block"> </p><p class="ql-block">關(guān)鍵詞：新型冠狀病毒感染；疫邪犯表；營衛(wèi)壅滯；柴胡桂枝湯；陰毒湯；經(jīng)方化裁；驗案</p><p class="ql-block"> </p><p class="ql-block">Abstract</p><p class="ql-block"> </p><p class="ql-block">Objective: To summarize the clinical experience of modified Chaihu Guizhi Decoction combined with Yindu Decoction, Chaige Jieji Decoction and Baidu Powder in treating COVID-19 with syndrome of pathogenic pestilence attacking the exterior and stagnation of nutrient-defense system. Methods: A middle-aged woman infected with COVID-19 after nursing patients was selected as the case. The main symptoms included distending and dizzy headache, sore throat, shoulder and back pain, no nasal discharge, no sweating, general discomfort and insomnia, with pale tongue, thin coating and thready slippery pulse. The syndrome was diagnosed as pathogenic pestilence attacking the exterior, stagnation of nutrient-defense system, deficient physique and indistinguishable yin and yang. The treatment was given with modified Chaihu Guizhi Decoction combined with Yindu Decoction, 3 doses, taken frequently. Results: The symptoms were relieved significantly on the second day. Her elder sister and husband with the same syndrome were all cured with only 1 dose. Conclusion: COVID-19 belongs to the category of "pestilential toxin" in traditional Chinese medicine. For patients with weak physique, pathogenic pestilence attacking the exterior and disorder of qi-blood, the treatment of regulating physique combined with eliminating pestilence can quickly relieve symptoms and block the progress of disease, which is worthy of clinical promotion.</p><p class="ql-block"> </p><p class="ql-block">Key words: novel coronavirus infection; pathogenic pestilence attacking the exterior; stagnation of nutrient-defense system; Chaihu Guizhi Decoction; Yindu Decoction; modified classical prescription; verified case</p><p class="ql-block"> </p><p class="ql-block">1 引言</p><p class="ql-block"> </p><p class="ql-block">新型冠狀病毒感染具有傳染性強、發(fā)病迅速、易兼夾體虛的特點，屬中醫(yī)“疫戾之氣”“疫毒”范疇。臨床中密切接觸者、勞累體虛人群感染后，多表現(xiàn)為表里同病、營衛(wèi)不和、樞機不利，無典型寒熱偏盛表現(xiàn)，常規(guī)解表、清熱、散寒治法往往效果不佳。</p><p class="ql-block"> </p><p class="ql-block">柴胡桂枝湯出自《傷寒論》，為太陽少陽合病、表里不和之代表方，具有和解少陽、調(diào)和營衛(wèi)、扶正祛邪之功；陰毒湯（升麻鱉甲湯化裁）出自《金匱要略》，長于入陰托毒、養(yǎng)血和血，針對疫毒深伏、氣血受損之證。筆者臨床以柴胡桂枝湯為基礎(chǔ)，合陰毒湯、柴葛解肌湯、敗毒散化裁，治療新冠感染疫邪犯表、營衛(wèi)壅滯、素體偏虛者，療效顯著，現(xiàn)結(jié)合驗案總結(jié)如下。</p><p class="ql-block"> </p><p class="ql-block">2 臨床資料</p><p class="ql-block"> </p><p class="ql-block">2.1 病案資料</p><p class="ql-block"> </p><p class="ql-block">患者，女，中年，因照料90歲新冠陽性高熱譫語老母，輪流照料4日后自測新冠陽性。</p><p class="ql-block">主訴：頭脹昏痛、咽部吞咽疼痛、肩背痛1d，伴周身不適、失眠。</p><p class="ql-block">現(xiàn)病史：無咳嗽、無腹瀉、無流涕、無汗出，納食可，二便調(diào)。</p><p class="ql-block">舌脈：舌淡苔薄，脈細滑。</p><p class="ql-block">辨證：疫邪犯表，營衛(wèi)壅滯，素體不健，陰陽難辨。</p><p class="ql-block">治則：祛疫解表，調(diào)和營衛(wèi)，入陰托毒，顧護氣血。</p><p class="ql-block"> </p><p class="ql-block">2.2 治療方藥</p><p class="ql-block"> </p><p class="ql-block">柴胡20g，黃芩10g，法半夏10g，黨參10g，桂枝15g，白芍15g，升麻15g，鱉甲10g，當歸10g，花椒5g，甘草10g，川芎12g，葛根30g，羌活8g，白芷8g。</p><p class="ql-block">用法：3劑，水煎服，癥狀未減輕時2～3h服藥1次，頻服以持續(xù)祛邪。</p><p class="ql-block"> </p><p class="ql-block">2.3 治療結(jié)果</p><p class="ql-block"> </p><p class="ql-block">患者傍晚取藥，夜間服藥2次，次日頭脹昏痛、咽痛、肩背痛明顯減輕，周身不適及失眠緩解；后其姐、其夫相繼出現(xiàn)同類證候，予上方服用，均1劑而愈，一診治三人，效捷而穩(wěn)。</p><p class="ql-block"> </p><p class="ql-block">3 方藥解析與臨證思辨</p><p class="ql-block"> </p><p class="ql-block">3.1 組方思路</p><p class="ql-block"> </p><p class="ql-block">本案以柴胡桂枝湯為核心，合陰毒湯、柴葛解肌湯、敗毒散化裁，采用祛邪解表、調(diào)和營衛(wèi)、扶正托毒三法并用，緊扣疫邪犯表、營衛(wèi)壅滯、素體偏虛之核心病機。</p><p class="ql-block"> </p><p class="ql-block">3.2 方義分析</p><p class="ql-block"> </p><p class="ql-block">方中柴胡、黃芩、法半夏、黨參取小柴胡湯之意，和解少陽、扶正祛邪；桂枝、白芍取桂枝湯之意，調(diào)和營衛(wèi)、解肌發(fā)表，二者合用為柴胡桂枝湯，適用于素體不健、陰陽難辨之外感疫邪患者。升麻、鱉甲、當歸、花椒仿陰毒湯（升麻鱉甲湯）之意，入陰托毒、養(yǎng)血和血、溫通行滯，使疫毒由深出淺。葛根、羌活、白芷、川芎解肌止痛、疏散表邪、通利咽喉，專治頭身疼痛、肩背拘急不適。甘草調(diào)和諸藥。全方不峻汗、不苦寒，扶正而不斂邪，祛邪而不傷正，共奏調(diào)體祛疫、表里雙解之功。</p><p class="ql-block"> </p><p class="ql-block">3.3 病機核心認識</p><p class="ql-block"> </p><p class="ql-block">疫邪侵襲人體，必累及氣血，導(dǎo)致氣血運行失常、循環(huán)失暢。陽熱體質(zhì)者，易見淋巴循環(huán)不利而表現(xiàn)為胸脅苦滿，治宜小柴胡湯；陽虛體質(zhì)者，易見血液循環(huán)不暢而表現(xiàn)為臍腹搏動亢進、少腹拘急壓痛，治宜桂枝湯；素體不健、陰陽莫辨者，以柴胡桂枝湯調(diào)和陰陽、疏利樞機，佐以陰毒湯托毒護氣血，則可一劑取效。本案患者舌淡苔薄，無明顯寒熱偏頗，營衛(wèi)壅滯而正氣偏虛，故以調(diào)體與祛疫并重，收效迅速。</p><p class="ql-block"> </p><p class="ql-block">4 討論</p><p class="ql-block"> </p><p class="ql-block">新型冠狀病毒感染臨床以邪實正虛、表里同病為多見，尤其勞累體虛、密切接觸人群，常表現(xiàn)為頭身疼痛、咽痛、無汗、周身不適、失眠等，證候不典型、辨證難度較高。柴胡桂枝湯既能和解少陽，又能調(diào)和營衛(wèi)，現(xiàn)代藥理研究表明其具有解熱、抗炎、鎮(zhèn)痛、調(diào)節(jié)免疫等作用，契合病毒感染性疾病的病機特點。陰毒湯（升麻鱉甲湯化裁）針對疫毒深伏、入陰傷血之病機，托毒外出而不傷正，可彌補單純解表、清熱之不足。</p><p class="ql-block"> </p><p class="ql-block">本案一診治三人，均1劑而愈，提示經(jīng)方合方治療新冠感染具有顯著優(yōu)勢。臨床不必拘泥于單一治法，當遵循辨證論治原則，調(diào)體與祛疫并行，扶正與祛邪同施，方能快速緩解癥狀、截斷病勢、提高療效。</p><p class="ql-block"> </p><p class="ql-block">參考文獻</p><p class="ql-block"> </p><p class="ql-block">[1] 國家衛(wèi)生健康委員會,國家中醫(yī)藥管理局.新型冠狀病毒感染診療方案(試行第十版)[J].中華臨床感染病雜志,2023,16(1):1-7.</p><p class="ql-block">[2] 仝小林,李修洋,趙林華.新冠肺炎核心病機與“寒濕疫”論治體系[J].中醫(yī)雜志,2020,61(6):461-465.</p><p class="ql-block">[3] 南京中醫(yī)藥大學國際經(jīng)方學院.新型冠狀病毒肺炎(COVID-19)經(jīng)方防治推薦方案(中文版第1版)[J].江蘇中醫(yī)藥,2020,52(4):1-6.</p><p class="ql-block">[4] 王雯蕾,衛(wèi)海琳,蘇勤,等.中醫(yī)藥防治新型冠狀病毒感染的研究進展[J].實用臨床醫(yī)藥雜志,2023,27(24):138-143.</p><p class="ql-block">[5] 葉國強.升麻鱉甲湯臨床應(yīng)用與解析[J].井岡山大學學報(醫(yī)學版),2025,25(2):45-48.</p><p class="ql-block">[6] 伍炳彩.柴胡桂枝湯臨床運用經(jīng)驗[J].江西中醫(yī)藥大學學報,2023,35(3):1-4.</p><p class="ql-block">[7] 王剛,金勁松.新型冠狀病毒肺炎病機演變規(guī)律及經(jīng)方的治療實踐——附驗案4則[J].江蘇中醫(yī)藥,2020,52(5):38-41.</p><p class="ql-block">[8] 朱為坤,張喜奎.《溫疫論》陽氣郁滯理論及其對新型冠狀病毒肺炎防治的啟示[J].北京中醫(yī)藥大學學報,2024,47(8):721-727.</p>