对《伤寒论》“麻黄九禁”的再认识

Re-recognition of Mahuang(Ephedra)Nine Prohibitions in Treatise on Febrile Diseases

目的通过对《伤寒论》中"麻黄九禁"的深入分析,总结麻黄汤之禁忌与相关变证以及其以麻黄汤为代表的峻汗之剂的适用范围,明确峻汗之法在临床中的合理应用。方法通过解读《伤寒论》"麻黄九禁"的思想内涵,论述汗法临证使用要点以及误汗原因和后果,探讨仲景运用的汗法原则对中医临床的启示。结果研究认为"麻黄九禁"不仅描述了汗法的适应证和禁忌证,而且体现了仲景临证时"保阳气,护阴精"的学术思想。津液耗伤,营阴亏虚,气血不足,阳气亏虚等兼有表证者当禁用或慎用麻黄汤等峻汗之剂,若误用则会耗伤人体的阴精阳气,加重病势,进而变生他病。汗法运用得当,阴精阳气不被耗伤,才能邪祛正复,药到病除。结论临证时要注意汗法使用中的表里虚实先后治,做到中病即止,时刻顾护病人机体的阴精阳气,使攻邪而不伤正,扶正而不恋邪,以期达到阴平阳秘的状态。

Objective Through the in-depth analysis of Mahuang(Ephedra)nine prohibitions in Treatise on Febrile Diseases,this paper summarized the contraindications and related changes of Mahuang Decoction(麻黄汤),and the applicable scope of it for severe sweating represented by Mahuang Decoction,so as to clarify the rational application of the method of severe sweating in clinical practice.Methods By interpreting the ideological connotation of Mahuang(Ephedra)nine prohibitions in Treatise on Fe⁃brile Diseases,this paper discussed the key points of clinical application of sweating method,the causes and consequences of missweating,and discussed the enlightenment of Zhongjing′s principle of sweating method on clinical practice of traditional Chinese medicine.Results It is believed that Mahuang(Ephedra)nine prohibitions not only describes the indications and contraindications of sweating method,but also embodies Zhongjing′s academic thought of“protecting Yang Qi and protecting Yin essence”.Those who have the symptoms of body fluid consumption,Ying-Yin deficiency,Qi and blood deficiency,Yang Qi deficiency and so on should be forbidden or carefully used.If they are misused,they would damage the Yin essence and Yang Qi of the human body,aggravate the disease situation and cause other diseases.If the sweating method is used properly,Yin essence and Yang Qi will not be consumed and injured,and then the evil can be dispelled,and the disease can be cured.Conclusion In clinical practice,the attention should be paid to the treatment of deficiency and excess of exterior and interior in the application of sweating method,so as to stop the sweating and take care of the Yin essence and Yang Qi of the body at all times,so as to attack the evil without inju⁃ring the right,and support the body without keeping the evil inside,so as to achieve the harmonious state of Yin and Yang.