伤寒论六经辨证与方证新探——经方辨治皮肤病心法

欧阳卫权著

The following translation is taken from Ouyang Weiquan’s ‘Exploration of Cold Damage Six-Conformation Pattern Differentiation and Formula Presentations – Jingfang Approach to the Identification and Treatment of Skin Diseases.’ 

Chaihu Guizhi Ganjiang Tang [柴胡桂枝干姜汤]

皮肤病辨治心法

1.不论何种皮肤病、何种皮损，凡见太阴里虚寒证又见上热表现者，可考虑本方证。

2.年轻女性面部痤疮、脂溢性皮炎患者，使用本方证机会较多，常合用当归芍药散。

3.系统性红斑狼疮经长期激素治疗，常表现出本方证，临床对证用之，可迅速使皮损消退，改善症状。且坚持服用，各项狼疮指标多能转为正常。

4.其他如荨麻疹、慢性湿疹、银屑病等，皆有使用机会。

Approach to Identifying and Treating Skin Diseases

1. Regardless of the type of skin disease or lesion, if there is a presentation of interior cold deficiency in the Taiyin channel along with symptoms of heat in the upper body, this formula can be considered.
2. This formula is frequently used for young women with facial acne or seborrheic dermatitis and is often combined with Dang Gui Shao Yao San.
3. Patients with systemic lupus erythematosus (SLE) who have undergone long-term corticosteroid treatment often present symptoms corresponding to this formula. Clinically, using this formula based on the diagnosis can quickly reduce skin lesions, alleviate symptoms, and, with consistent use, normalize various lupus-related indicators.
4. Other conditions such as urticaria, chronic eczema, and psoriasis may also benefit from this formula.

医案实录

1.系统性红斑狼疮（柴胡桂枝干姜汤合当归芍药散）

杨某，女性，51岁，2005年5月13日初诊。系统性红斑狼疮

（SLE）病史13年。一直在风湿科、内科等中西医治疗，病情较稳定，现服泼尼松用量10mg/d。但患者四肢关节痛、颈、背痛不能缓解已2年余。现双肘、腕、指关节及双膝、踝关节疼痛、颈、背痛。稍怕冷，纳可，口稍干不欲饮，饮则喜温，小便少。舌暗红苔白，脉沉细。处方柴胡桂枝干姜汤合当归芍药散加味：

柴胡10g，桂枝9g，干姜4g，黄芩10g，甘草5g，花粉15g，牡蛎（先煎）20g，当归10g，白芍10g，川芎4g，茯苓15g，白术10g，泽泻10g，葛根12g，7剂。

Case Study

Systemic Lupus Erythematosus (SLE) Treated with Chai Hu Gui Zhi Gan Jiang Tang Combined with Dang Gui Shao Yao San

Yang, female, 51 years old. Initial consultation: May 13, 2005.
History of systemic lupus erythematosus (SLE) for 13 years. Previously treated with both Western medicine and Traditional Chinese Medicine in the rheumatology and internal medicine departments, with relatively stable disease progression. Currently taking 10 mg/day of prednisone.
However, the patient had been experiencing unrelieved joint pain in the limbs, neck, and back for over two years. Symptoms included pain in the elbows, wrists, finger joints, knees, and ankles, along with neck and back pain. She reported slight sensitivity to cold, normal appetite, slight dry mouth with no desire to drink, preference for warm drinks, and reduced urination. Tongue was dark red with a white coating, and the pulse was deep and thin.

Prescription:

Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San with modifications:

• Chai Hu 10g
• Gui Zhi 9g
• Gan Jiang 4g
• Huang Qin 10g
• Gan Cao 5g
• Tian Hua Fen 15g
• Mu Li (pre-cooked) 20g
• Dang Gui 10g
• Bai Shao 10g
• Chuan Xiong 4g
• Fu Ling 15g
• Bai Zhu 10g
• Ze Xie 10g
• Ge Gen 12g

Seven doses were prescribed.

患者服后感觉效果非常好，又自购药服12剂。药后明显好转，四肢关节及颈背痛基本消失，不觉怕冷，精神较佳，口干明显，舌暗红，苔中黄，脉细。前方加生石膏20g。上方服至2005年7月15日。诉服后关节痛全消，无其他不适，精神佳。遂改泼尼松为5mg/d。前方去石膏，继服巩固。

After taking the formula, the patient reported significant improvement. She obtained an additional 12 doses on her own. After taking the formula her joint pain in the limbs and neck/back had almost completely disappeared. Cold sensitivity was no longer noticeable, her energy levels had improved, and her dry mouth had markedly lessened. Her tongue was dark red with a yellowish coating, and her pulse was thin. 20g ofShi Gao was added to the previous formula.

The patient continued this treatment until July 15, 2005. By then, joint pain was completely resolved, and no other discomfort was reported. Her energy levels remained good. The dosage of prednisone was reduced to 5 mg/day. The prescription was adjusted by removing Shi Gao and continued as a consolidation treatment.

【按】

柴胡桂枝干姜汤见《伤寒论》第147条：“伤寒五六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也，柴胡桂枝干姜汤主之。”为治热郁少阳，枢机不利，又兼太阴脾寒，水饮内伏之病变。胡希恕以此方合当归芍药散治疗SLE属血虚水盛、邪郁少阳证者多有效。笔者临床观察，SLE经西药激素控制稳定后常现本方证，依证用药确有效验。

Commentary:

The formula Chai Hu Gui Zhi Gan Jiang Tang originates from the Shang Han Lun, Clause 147, where is says:

“In cold damage that has lasted five or six days, sweating has already been promoted followed by purgation, and there is fullness and mild congestion in chest and ribs, with inhibited urination, thirst but no vomiting, and only the head is sweating, with alternating cold and heat, and heart vexation, this means that [the pattern] has not yet resolved, and Chaihu Guizhi Ganjiang Tang governs.”

 This formula addresses Shaoyang depressed heat with inhibition of the pivot mechanism combined with Taiyin spleen cold and internal deep-lying water-rheum. Hu Xishu frequently combined this formula with Dang Gui Shao Yao San to treat SLE presenting with blood deficiency, exuberant water, and Shaoyang depressed heat, with notable efficacy.

The authors own clinical observations suggest that after systemic lupus erythematosus (SLE) is stabilized with corticosteroid treatment, symptoms often align with the pattern corresponding to this formula presentation. Using the formula according to the pattern has proven to be effective.