《伤寒论》上热下寒证探析

Analysis of Shang Re Xia Han Syndrome in Treatise on Febrile Diseases

上热下寒证以上焦现热证、下焦现寒证为特点,属寒热错杂证之一。《伤寒论》中涉及上热下寒证的证候及治则有:热扰胸膈、中焦脾寒证,治宜清上温下,方选栀子干姜汤;胸热腹寒、胃失和降证,治宜清上温下,方选黄连汤;少阳不和、胆热脾寒证,治宜清泻少阳、温补脾胃,方选柴胡桂枝干姜汤;火热上炎、肾阳不足证,治宜清上温下,方选附子泻心汤;寒热格拒、阴阳不交证,治宜苦寒泻降、辛温通阳,方选干姜黄芩黄连人参汤;肺热脾寒、外寒郁闭证,治宜清上温下、发越郁阳,方选麻黄升麻汤;脾肾阳虚、肝胃郁热证,治宜清上温下,方选乌梅丸;阳热内郁、外寒束表证,治宜清里热、散外寒,方选白虎加桂枝汤;阴虚火旺、阳不下达证,治宜滋阴降火,方选黄连阿胶汤;少阳郁滞、气机不畅证,治宜疏通三焦、调和营卫,方选柴胡桂枝汤;脾胃失和、升降不利证,治宜温补脾胃、升清降浊,方可选半夏泻心汤、生姜泻心汤、甘草泻心汤;下焦虚寒、格阳于上证,治宜破阴回阳、交通阴阳,方选白通汤。由于上热下寒证病机复杂多样,治疗时当详辨细审,针对不同病机选方用药,则上热下寒证自解。

It is characterized by Hot syndrome up and Cold syndrome down,which also called mixed syndromes of Cold and Hot.In Treatise on Febrile Diseases,the syndromes and rules concerning the Hot and Cold syndrome are as follows:Heat disturbing chest yet Cold in Zhongjiao Spleen,and the treatment should be clearing the upper part and warming the lower part,with Zhizi Ganjiang Decoction;chest being hot yet abdomen cold as well as Stomach Qi disharmony,and the treatment should be clear upper Heat and warm lower Cold,with Xuanlian Decoction;Shaoyang discord with gallbladder Heat yet Spleen Cold syndrome,the treatment should be clearing the Heat of Shaoyang and warming Spleen and Stomach,with Chaihu Guizhi Ganjiang Decoction;in case of inflammation in upper part yet Kidney Yang deficiency Syndrome,the treatment should be clearing upper part and warming lower part,with Fuzi Xiexin Decoction;as to Cold and Heat refusal Syndrome,or Yin and Yang being apart Syndrome,the treatment should lead the Yang going down with cold drugs and regulate Yang Qi with acrid and warm drugs,with Ganjiang Huangqin Huanglian Ginseng Decoction;with Syndrome of Lung Heat yet Spleen Cold,or external Cold stagnation Syndrome,the treatment should be clearing Heat on the upperpart and warming the lower part to activate the stagnated Yang Qi,with Mahuang Shengma Decoction;for Spleen and Kidney Yang deficiency Syndrome as well as Liver and Stomach Heat stagnation Syndrome,the treatment should be clearing upper Heat and warming lower part,with Wumei Pills;As to Yang Heat stagnation Syndrome and external cold being at skin syndrome,the treatment should be clearing inside Heat and scattering outside Cold,with Baihu plus Guizhi Decoction;for Yin deficiency with Fire as well as Yang does not going down syndroem,the treatment should be tonifying Yin to lead the Fire gongign down,with Huanglian Ejiao Decoction;with Shaoyang Qistagnation Syndrome,the treatment should be dreging the three burners and regulating the Ying Qi and Wei Qi,with Chaihu Guizhi Decoction;with Spleen and Stomach disharmony Syndrome,the treatment should be warming Spleen and Stomach as well as Shengqing Jiangzhuo,with Banxia Xiexin Decoction,Shengjiang Xiexin Decoction,or Gancao Xiexin Decoction;for the lower burner deficiency and Cold as well as Yang Qi is driven to the upper part Syndrome,the treatment should be communicating Yin and Yang,with Baitong Decoction. Due to the complex and diverse pathogenesis of the upper Heat and lower Cold Syndrome,in treatment all factors should be carefully examined,and the prescriptions for different pathological cases are used. Eventually,different kinds of the Hot and Cold Syndromes would be cured.