从汗出发热探讨白虎汤、白虎加人参汤、竹叶石膏汤及四逆加人参汤方证

Study on the Syndromes of White Tiger Decoction and White Tiger Decoction Plus Ginseng and Lophatherum and Gypsum Decoction and Frigid Extremities Decoction Plus Ginseng Based on Sweating and Fever

白虎汤证、白虎加人参汤证、竹叶石膏汤证、四逆加人参汤证均有汗出发热的表现,四种方证的病机根本区别为有无里热、津液与阳气的盛衰。白虎汤证的病机为里热亢盛、津气略损,机体多无休克表现;白虎加人参汤证的病机为热盛津亏、津亏为重,机体多有低血容量休克前兆的表现;竹叶石膏汤证的病机为余热未清、气津两伤,机体多处于疾病将愈的状态;四逆加人参汤证的病机为气随血脱、阴阳两虚,机体多已经进入休克状态。四个方剂的用药区别为清热、补益与回阳的侧重比例不同。白虎汤全方以寒凉药物为主导,共奏清解里热之功;白虎加人参汤清热与补益兼顾;竹叶石膏汤则以补气益津为主,清解里热为辅;四逆加人参汤以回阳固脱为主,补气益津为辅。四个方剂在临床运用时,既要审视病机的不同,也要注重病情的动态变化。

White Tiger Decoction,White Tiger Decoction Plus Ginseng,Lophatherum and Gypsum Decoction,and Frigid Extremities Decoction Plus Ginseng all have sweating and fever as their symptoms.The fundamental difference in the pathogenesis of these four syndromes lies in the presence or absence of interior heat,the excess or deficiency of fluids and yang qi.The pathogenesis of White Tiger Decoction syndrome is excessive interior heat and slight loss of fluids,with the body usually not showing signs of shock.The pathogenesis of White Tiger Decoction Plus Ginseng syndrome is excessive heat and severe deficiency of fluids,with the body often showing preliminary signs of hypovolemic shock.The pathogenesis of Lophatherum and Gypsum Decoction syndrome is excessive heat remaining unresolved and injury to both qi and body fluids,with the body often being in a state of near recovery.The pathogenesis of Frigid Extremities Decoction Plus Ginseng syndrome is deficient qi following blood loss,with both yin and yang deficiency,and the body often being in a state of shock.The differences in drug use among the four formulas lie in the proportion of emphasis on clearing heat,supplementing and restoring yang.The whole White Tiger Decoction is dominated by cold and cooling drugs,with the overall function of clearing interior heat.The whole White Tiger Decoction Plus Ginseng shows a balance of clearing heat and supplementing.Lophatherum and Gypsum Decoction mainly focuses on supplementing qi and tonifying the body fluids,with clearing heat as a secondary function.Frigid Extremities Decoction Plus Ginseng mainly focuses on restoring yang from collapse,with tonifying qi and replenishing fluids as a secondary function.In clinical practice,both the differentiation of pathogenesis and the dynamic changes of the condition should be taken into consideration when these four formulas are used.