《伤寒论》呕哕病机探析

Pathogenesis of Vomiting and Hiccup in Treatise on Febrile Diseases

《伤寒论》关于呕吐的叙述包括呕吐、欲呕吐、呕多、呕逆、吐逆、吐利、吐脓血、吐涎沫、吐蛔等,均由胃失和降,胃气上逆所致,其病机辨证以辨虚实为主。实证呕吐有外邪侵袭、水饮内停、邪热内郁、寒热错杂等,总病机为胃气壅滞,失于和降;虚证呕吐多在三阴病,其脏腑以脾、胃、肾为中心,病机表现以阳虚、气虚、阴盛为主。而“哕”证即呃逆,是以气逆上冲,喉间呃呃有声,其声短而频,令人不能自抑为特征的病证,其病机总由胃气上逆动膈而成,以虚实为辨。

Vomiting discussed in Treatise on Febrile Dieases includes vomiting, hematemesis, salivation, vomiting of roundworm etc, which are caused by the failure of the descending of the stomach-qi, and the adverse rising of the stomach-qi. And the differentiation of pathogenesis should be focused on the differention of deficiency and excess. The excess syndrome of vomiting overs the invasion of pathogenic factors, accumulation of excessive fluid, retention of pathogenic heat, simultaneous occurrence of cold and heat. Its total pathogenesis lies in the failure of descending the stomach-qi caused by the excessive stomach-heat. While the deficiency syndrome of vomiting mainly pertains to Three-yin disease. Zang-fu organs are centred on the spleen, stomach and kidney. And its pathogenesis mainly menifest the deficiency of yang and qi, and excessiveness of yin. Hiccup is eharacterised by the reversed flow of qi, the brief and constant hiccup sound from the throat and being out of controt. And its pathogensis is caused by the adverse rising of stomach-qi.