乌梅丸临证思考

目的]拓展乌梅丸的临床应用。方法]通过分析临床应用乌梅丸治疗高血压、哮喘-慢性阻塞性肺病重叠、腰痛不寐、皮肤瘙痒的四则验案，总结乌梅丸异病同治的辨治要点。结果]四则验案发病时间多在后半夜，与厥阴病欲解时之丑时至卯时一致，提示病在厥阴；患者症状变化迅速符合风气内动的表现，证型寒热错杂，与乌梅丸主证一致。乌梅丸是厥阴病代表方，全方清上温下、缓肝调中，适用于上热中虚下寒兼肝气上冲之厥阴病。阴阳错杂与风气内动是厥阴病的统一病机，辨证时应抓住以下3个要点:1.舌尖红，舌苔略厚腻，左关弱；2.多后半夜出现相关症状或症状加重(丑时至卯时)；3.寒热错杂，起病突然或者证型变化多端。结论]抓住厥阴病寒热错杂兼风气内动的统一病机，是拓展乌梅丸临床应用的关键，以上经验值得临床推广和运用。

Thoughts on the Clinical Syndrome Differentiation of Wumei Pill

Objective]To expand the clinical application of Wumei Pill. Methods] Through analysis of clinical application of Wumei Pill in the treatment of hypertension, asthma-chronic obstructive pulmonary overlap, lumbago-insomnia and cutaneous pruritus, the main points of same treatment for different diseases of Wumei Pill were summarized. Results]The time of disease attack or symptoms aggravationin the four clinical cases was mostly in the late midnight, according as the time period of Jueyin disease relief from 1 o''clock to 7 o''clock,it suggested that the location of disease was in Jueyin. The quick changes of symptom conformed to the disturbance of endogenous wind, and the syndrome type of cold-heat disorder was consistent with the main certificate of Wumei Pill. Wumei Pill is the representative formula of Jueyin disease, the whole formula has the function of clearing the upper heat and warming the lower cold, nourishing the liver and regulating stomach, which is suitable for Jueyin disease with the syndrome of heat in the upper, deficiency in the middle, and cold in the lower, accompanied with upward flow of liver Qi. The Yin-Yang complex and disturbance of endogenous wind are the unified pathogenesis of Jueyin disease. The main dialectical points are: 1. the tongue is slightly thick and greasy and the tip of the tongue is red, the left guan of pulse is weak; 2. disease attack or symptoms aggravation happens in the middle of night, frequently from 1 o''clock to 7 o''clock; 3. cold-heat disorder, sudden attack or variation of syndrome types are also characteristic.Conclusion]It is the key to expand the clinical application of Wumei Pill, which is closely related to the cold-heat disorder and the disturbance of endogenous wind. The clinical experience is worthy of clinical promotion and application.