摘要
目的:探讨伤寒和中风、麻黄汤证和桂枝汤证的异同及其交叉证候的辨证治疗机理。方法:对《伤寒论》第23条、第25条和第27条进行分析。结果:发现伤寒和中风、麻黄汤证和桂枝汤证有异有同,并有二者的交叉证候需仔细辨证①第23条桂枝麻黄各半汤证是伤寒表实证的卫闭与中风表虚证的营泄两者混合而成。营阴外泄但不能出于皮表,卫气内闭但不能到肌里,卫闭和营泄僵持在肌外皮里,就出现了面红和身痒的典型症状。治疗时麻黄汤、桂枝汤同用,通过小汗出使外泄的营阴复归于脉内,闭阻的卫气敷布与体表,从而达到双管齐下,一举两得的治疗效果。②第25条"服桂枝汤"后出现"脉洪大"是因为用药的方法不当,风邪未祛,加之桂枝汤辛温药物激荡鼓动,且正气未衰,有足够能力抵御邪气,正气不衰、风邪荡漾、药力鼓动,三者合力导致脉象洪大。③第25条"服桂枝汤"后出现"脉洪大",是因为用药的方法不当,风邪未去,加之桂枝汤辛温药物激荡鼓动,且正气未衰,有足够能力抵御邪气,正气不衰、风邪激荡、药力鼓动,三者合力导致脉象洪大。④太阳伤寒表实证和太阳中风表虚证两者,一个是卫气闭合太过,重点在卫气;一个是营阴疏泄太过,重点在营阴,一个无汗,一个汗出,看似截然不同,其实随着病情的迁延,两者有时会出现在同一患者身上,所以在治疗时就不能拘泥于"有汗不得用麻黄,无汗不得用桂枝"的常规。结论:伤寒和中风、麻黄汤证和桂枝汤证及二者的交叉证候需要"平脉辨证",随证而施,辨证论治,不可拘泥。
Objective： To discuss the similarities and differences between typhoid fever and wind-stroke, Syndrome of Mahuang Decoction and Guizhi Decoction,and syndrome differentiation and treatment mechanism of their cross syndrome. Methods：The twenty-third item, the twenty-fifth item and the twenty-seventh item of Treatise on Febrile Disease were analyzed. Results ： It was found that there were similarities and differences between typhoid fever and wind-stroke, Syndrome of Mahuang Decoction and Guizhi Decoction, and cross syn- drome of both needed to be carefully differentiated. （1） Syndrome of Mahuang and Guizhi content equality in the twenty-third item was mixedly composed of defense qi obstruction for exterior excess by cold syndrome and nutrient qi leak for wind-stroke exterior deficiency syndrome. Nutrient Yin leaked out but not dispersing from surface, defense qi obstructed internally but not penetrated in the muscle, therefore, defense qi obstruction and nutrient qi leak were stalemated between surface and muscle, then typical symptoms of flushing and pruritus could appear. Mahuang Decoction and Guizhi Decoction were used simultaneously in treatment could achieved effects of working along both lines and killing two birds with one stone, for externally leaking nutrient yin reverting into pluse and obstructed defense qi dispersing to surface through little sweating. （2）＂ Pulse appeared loud and great after orally taking Guizhi Decoction＂ in the twenty-fifth item was the reason of improper drug-using method. When wind-pathogen had not be removed, pungent and warm drugs in Guizhi Decoction with effects of agitating and arousing were taken next, also healthy qi had not wane and could resist pathogen qi with enough capability, therefore, enough healthy qi plue agitating wind-pathogen plus arousing medicine lead loud and great pulse.（3）＂ Pulse appeared loud and great after orally taking Guizhe Decoction＂ in the twenty-fifth item was the reason of improper drug-using method. When wind- pathogen ha
出处
《中医学报》
CAS
2012年第12期1565-1567,1586,共4页
Acta Chinese Medicine
基金
国家中医药管理局专项课题(编号:2009-0001)
河南省科技厅基金项目(编号:496060303)
关键词
伤寒论
太阳伤寒
太阳中风
麻黄汤证
桂枝汤证
Treatise on Febrile Disease
Taiyang typhoid fever
Taiyang wind-stroke
syndrome of mahuang decoction
syndrome of guizhi decoction
