從近代醫家的醫療論述探索桂枝湯的應用擴展

Research into the widen application of Guizhi Decoction based on the medical statements of Modern Dynasty's Physicians

本研究收集多位清代與民初中醫醫家著作，摘錄書中的桂枝湯臨床醫療論述，發現桂枝湯的臨床使用範圍已經從最初《傷寒》《金匱》所述的各經傷寒表證與妊娠脾虛證，擴大到溫病、破傷風、中風、婦兒科甚至傷骨科疾病。茲將桂枝湯於各科的臨床應用擴展情況分述如下：內科方面，清．吳謙《醫宗金鑑》清楚的鑑別溫病與傷寒的病機，並論述以桂枝湯治療風溫的條件。吳鞠通《溫病條辨》指出桂枝湯除了治療各經傷寒之外，詳細論述以桂枝湯治療太陰風溫、秋燥、寒濕霍亂、溫病癒後等各類溫病。林珮琴《類證治裁》用桂枝湯治療破傷風。費伯雄《醫醇賸義》用桂枝湯加減治療中風，肌肉不仁手足麻木。張錫純《醫學衷中參西錄》將桂枝湯改制成加味桂枝代粥湯，即使不啜粥，亦可發汗奏效。曹穎甫的臨床經驗指出桂枝湯外證治太陽，內證治太陰。婦科方面：葉天士《臨證指南醫案》使用桂枝湯加當歸治療產後外感寒熱身痛。曹穎甫《經方實驗錄》以桂枝湯調經，治療婦女婦女脾虛氣鬱與月經後期，擴展了桂枝湯在婦產科的運用。兒科方面，吳謙《醫宗金鑑》以桂枝湯治小兒表虛自汗。吳鞠通《溫病條辨》：用桂枝湯治小兒柔痙。費伯雄《醫醇賸義》用桂枝湯治療小兒癲癇。傷骨科方面：《經方實驗錄》以桂枝湯治療太陽腦疽病。鄭欽安《醫法圓通》取桂枝湯治療胸腹痛與背痛、腦後瘡瘍與足跟痛。趙濂《傷科大成》治療肩腕關節跌撲脫位，先以手法復位之後內服桂枝湯加減以加速修復。

Our study aims to discover the clinical application trajectory of Guizhi Decoction. After looking into famous medical statements in the Modern Dynasty, we find that: Additional to the records of Treatise on Febrile Diseases and Synopsis Prescriptions of the Golden Chamber, Guizhi Decoction was widely applied in Febrile disease, tetanus, stroke, Gynecology, Pediatrics and Traumatology. But not only for treatment of wind-cold syndrome and the Spleen deficiency during pregnancy. We study and organized the application trajectory of Guizhi Decoction in those clinical divisions as follows: In Internal medicine, Golden Mirror by Wu Qian, the pathogenesis of Epidemic Febrile and Exogenous Febrile was well differentiated, and Guizhi Decoction was prescribed for the Wind-Warm syndrome. Detailed Analysis of Epidemic Febrile Diseases by Wu Ju-tong first extended the application of Guizhi Decoction in Epidemic febrile, include windwarm disease, autumn- dryness disease, diarrhea due to cold and damp, convalescence of the febrile disease. Quasi-symptomatic treatment by Lin Pei-Chin used Guizhi Decoction for Tetanus. Fei Bo-xiong used Guizhi Decoction to treat the extremity numbness due to wind attacking meridians. Zhang Xi-chun adjusted it to Modified Guizhi Daichou decoction, which enhance the ability of perspiring. Cao Ying-fu indicated that Guizhi Decoction can cure Taiyang external syndrome and Taiyin internal syndrome from his experience. In Gynaecology, Ye Tian-shi's Guide to Clinical Practice with Medical Records used Guizhi Decoction plus Angelica sinensis as a remedy for postpartum chills and fever with hyperhidrosis and body aches. Cao Ying-fu administrated Guizhi Decoction to women with delayed menstrual periods. In Pediatrics, Golden Mirror, Wu-Qian used it to treat children's spontaneous perspiration due to deficiency of superficial-Qi. Detailed Analysis of Epidemic Febrile Diseases by Wu Ju-tong treated cold convulsion with Guizhi Decoction. Fei Bo-xiong used Guizhi Decoction to treat epilepsy of the childrens. In traumatology, Cao Ying-fu administrated Guizhi Decoction to relief Brain gangrene of the Tai-yang Meridians. In Yifa Yuantong by Zheng Qin-an, it was used for the treatment of chest and back pain as well as occipital sores and heel pain. In Encyclopedia of Trauma by Zhao Lian, speaking of traumatic shoulder and wrist joints dislocation, patients were given Guizhi Decoction after manual reduction to accelerate the healing of soft tissues.