《傷寒卒病論》之小茈胡湯非為肝膽病而設

The Xiaochaihu Decoction from 'Treatise on Febrile and Miscellaneous Diseases' Was Not Found to Treat Liver and Gallbladder Diseases

一提到小茈胡湯，醫家多與「膽腑」一起聯想；或直言能「治療肝炎」、「和解半表半裏」；誤也。縱然少陽病與肝膽病之病位或有類似，然深淺有別（少陽病位較淺）、治則不同（少陽病清裏調中透外而肝膽發炎須攻伐峻下）。 少陽病為外感病，肝膽病為內因而無關於外感，其病因各異。細觀《傷寒卒病論》並無條文言小茈胡湯有前述主治。西漢之前「茈」字讀：皆五出。同「柴」字河洛音。東漢新創舌上音，「茈」字另可讀：璣二曾。與「紫、姊」字讀音相同。「茈」原指短草；可訓為短毛、鮮嫩（隱喻作春天採收）。「疵」字則指小缺點。知「茈胡」不能誤作（柴胡、紫胡）。茈薑、茈胡同以春天採收入藥，質嫩生發而利於宣散走表。仲景是用北茈胡；金元時期補中益氣湯、逍遙散是用南茈胡。少陽病異於足少陽膽經之病，仲景言少陽病而非少陽［經］病。否則針灸足少陽膽經豈不即能治癒少陽病？宋朝成無己釋傷寒為傳經之病，訛指少陽病為膽病。醫家亦有誤言少陽病分為經病、腑病者。甄權（630）最早用南茈胡治勞乏羸瘦而非治肝膽病。又張元素言茈胡入肝膽經是指南茈胡；且歸經理論也未必正確。今茈胡品種不分、採收季節不別；造成日本服小茈胡湯之死亡事件。日本厚生省2000年1月14日發出第158號「醫藥品醫療用具等安全性情報通令」 : 全面禁止肝炎、肝硬化、肝癌患者使用小茈胡湯。其濃縮粉末外包裝，皆加註警語。又中醫中藥即使再如何現代化、科學化；還是不能捨棄經典，以免造成誤治。

Most of traditional Chinese medical doctors think the Xiaochaihu Decoction was found to treat liver-gallbladder diseases and to reconcile exterior and interior. But, this is not correct. The disease locations of Shao Yang sickness and liver-gallbladder diseases are close, but they are at different depths and need different treatment principles. The location of Shao Yang sickness is less deep. Shao Yang sickness should be treated by interior-clearing, center-regulating and exterior-releasing while liver-gallbladder inflammation has to be treated by emergency-attack on drastic precipitation. Shao Yang sickness is a kind of external contraction diseases. Liver-gallbladder diseases are developed from internal causes. They have different causes of disease. There is no mention of any treatment of the Xiaochaihu Decoction on liver-gallbladder diseases in 'Treatise on Febrile and Miscellaneous Diseases'. Chaihu (Radix Bupleuri) is picked to be as medicine in spring. Chihu has a good effect for dispelling and relieving exterior syndrome. Zhongjing Medicine uses North-Chaihu while Xiao Yao San and Bu Zhong Yi Qi Tang use South-Chaihu. Shao yang sickness is different from leg shao yang gall bladder meridian disease. What Zhongjing mentioned was shao yang sickness not shao yang meridian disease. Can Shao yang sickness be cured by acupuncturing leg shao yang gall bladder meridian? The answer is no. Cheng Wuji in the Song Dynasty explained the febrile illness as a kind of meridian disease. He was mistaken in his belief that shao yang sickness was a gallbladder disease. Some doctors were also wrong in dividing the shao yang sickness into meridian disease and Fu-viscera disease. Chen was the frrst man to use South-Chaihu to treat marked vacuity with emaciation not to treat liver-gallbladder diseases. Chang Yuan-su thought Chaihu can enter liver-gallbladder meridian. This 'Chaihu' meant South-Chaihu. By the way, Gui Jing theory is not necessarily correct. Nowadays, people don't differentiate the species of Chaihu and don't care about the season for picking. This is why someone was dead because of taking Xiaochaihu decoction in Japan. According to the Order 158 'Medicines and Medical Implements Safety Information' dated on Jan. 14, 2000, the Japanese Ministry of Health Department completely forbade the patients of hepatitis, liver cirrhosis and liver carcinoma to take Xiaochaihu decoction. The outside package of dense powder also has to carry a boxed warning. Additionally, the classical literature can't be thrown away on the modem and scientific drive in traditional Chinese medicine.