《伤寒论》栀子豉汤证治剖析

Analysis of Zhizichi Decoction Syndrome in the Treatise on Febrile Disease

《伤寒论》中以栀子豉汤为代表方的栀子豉汤类方，由于在理论上对其证治缺乏充分的认识，致使在临床上不能如桂枝剂、柴胡剂等经方那样发挥其应有的作用。本文提出栀子豉汤所治主证是热郁胃中所致的“心中懊”而非热扰胸膈的“虚烦”，而“心中懊”实乃胃中嘈杂。并进而分析了从热郁胃中至阳明腑实证与阳明湿热发黄证之间存在的内在病机演变过程，指出栀子豉汤是治疗阳明热证之第一法。

The prescriptions in the Treatise on Febrile Disease which are represented by the Zhizichi Decoction, have not been brought into full play in the clinic as well as other classic prescriptions like Decoctions of Guizhi and Chaihu . It is due to the inadequate understanding of the syndrome and treatment in theory. The Zhizichi Decoction mainly treats the “vexation and restlessness” caused by the “pathogenic heat lingering in the stomach”, not the “restlessness of deficiency type” caused by the “disturbance of the chest and diaphragm by heat”. In fact, the “vexation and restlessness” means the gastric discomfort. A further analysis on the pathological changes from the “Yangming visceral substantive syndrome” caused by the “pathogenic heat lingering in the stomach”, to the “Yangming syndrome of jaundice” due to “damp heat”, indicates that the Zhizichi Decoction is the first important prescription on the “Yangming heat syndrome”.