從中醫典籍看龍膽瀉肝湯的方源追溯與臨床應用紀錄

Clinical Review and Origin Tracing of the Long-Dan-Xie-Gan-Tang Decoctions in Ancient Traditional Chinese Medicine Works

龍膽瀉肝湯為中醫治療肝火上炎與肝經濕熱的經典方劑，《醫方集解》記載共三首龍膽瀉肝湯，第一首為目前中醫臨床所習用「原方」，據《醫方集解》記載本方來自《局方》，但經考證《太平惠民和劑局方》並無龍膽瀉肝湯記載。第二首為東垣龍膽瀉肝湯，方源來自《蘭室秘藏》，主治因風濕熱合於下焦所致的前陰熱癢臊臭，第三首龍膽瀉肝湯，據考證可能源自元羅天益《衛生寶鑑》，主要治療治療口苦膽癉。透過整理蒐集歸納明清重要典籍中有關龍膽瀉肝湯的使用記錄，結果顯示：「原方」與「寶鑑方」在明清中醫典籍紀錄中受到比較多醫家採用，「東垣方」組成較簡單，可視為「原方」的基礎。但在臨床使用上，以上三首方劑清利肝膽濕熱的目標並無太大分別。舉凡肝經濕熱下注的囊癰便毒，下疳懸癰，淋症陰瘡，或肝火上炎的口苦耳聾，舌腫牙癰，帶狀皰疹等，均是本方之適用範圍。

Long-Dan-Xie-Gan-Tang (LDXGT) decoction is the typical formula in Traditional Chinese Medicine (TCM) to treat dampness-heat syndrome of liver meridian and upflaming of liver fire. There are three LDXGT decoctions in the work of Yi-Fang-Ji-Jie. The first formula origin was stated that it's from the book Ju-Fang. But we searched the whole book of Tai-Ping-Hui-Min-He-Ji-Ju-Fang, LDXGT decoction is not found. The second formula LDXGT decoction is derived from Lan-Shi-Mi-Cang, which is the works of Li Dong-Yuan. It is used to treat itching of external genitalia. The third LDXGT decoction dictated in the book Yi- Fang-Ji-Jie maybe derived from the book Wei-Sheng-Bao-Jian after our research and is originally used to treat bitter taste of the mouth. We searched the many ancient works of Traditional Chinese Medicine about the use record of LDXGT decoction and found: The first and the third LDXGT decoction are used more frequently. The second LDXGT decoction can be seen as the basis of the first LDXGT decoction. But all the three LDXGT decoctions have the same purpose to clear damp-heat of the liver. So there is no clear distinction in clinical use between three decoctions. We can use it to treat carbuncle of the genital region, urethritis, month bitterness, tongue swelling, herpes zoster.