伤寒论评话 第8章 治表解肌调营卫,治里补中和阴阳——桂枝汤主治证及其禁忌

Discussion of Shanghanlun Chapter 8,relieving the Superficial Syndrome and Regulating the Ying and Wei for External Syndrome; Nourishing the Interior and Harmonizing Yin ang Yang for Internal Syndrome——Indications and Contraindications of Guizhi Decoctio

目的:探讨《伤寒论》桂枝汤主治证及其禁忌。方法:引《伤寒论》第53条、第54条有关桂枝汤主治证的条文,分析治表治里的原则。结果:①桂枝汤既可治疗六经中风,又可治疗其他众多病证,所以桂枝汤证不能等同于太阳中风证;②六经皆有中风,不唯太阳可有中风;③六经的经络分布既有皮表,也有肌里,还络属脏腑,所以既有经证,也有腑证;经证既有经表证,还有经里证;④阳明中风与太阳中风症状类似,且重是因为太阳主肌表,而阳明主肌肉的缘故;太阴中风是表里同病,既有太阴经经气的失常,也有太阴脾、肺的功能失常;⑤桂枝汤治疗杂病卫气不和的自汗出和发热汗出,其病机失常的表现方式并不相同,虽同是卫外不谐,但分别是卫气浮散和卫气聚集所致。结论:《伤寒论》桂枝汤主治证及其禁忌证的研究,对临床有极其重要的指导意义。

Objective：To discuss the external and internal therapeutic principle of Guizhi Decoction＇s major indication in Shanghanlun. Methods ：The fifty-three and the fifty-fourth articles about the major indication of Guizhi Decoction in Shanghanlun were cited, so as to analyze the external and internal treatment principle. Results ： （1） Guizhi Decoction could not only treat apoplexy in six meridians, but also many other syndromes, therefore, syndrome of Guizhi Decoction could not equal to wind-stroke syndrome of Taiyang meridian;（2） Wind-stroke could occur in any of six meridians and not simply in Taiyang meridian ;（3） Distribution of the six meridians not only went through the external skin but also the internal muscle, and subordinate to five viscera and six-fu organs, so syndrome of Guizhi Decoction included the meridian syndrome and fu-organ syndrome, and the meridian syndrome included external meridian syndrome and internal meridian syndrome as well;（4） Symptoms of wind-stroke in Yangming and Taiyang were similar,because Taiyang dominated the surface of skin and Yangming dominated the internal muscle; wind-stroke of Tanyin was exterior-interior concurrent disease, which not only presented the disorder of Taiyin meridian qi, but also the malfunction of spleen and lung; （5） Guizhi Decoction treated spontaneous sweating and feverous sweating caused by the disharmony of defend qi of miscellaneous diseases, and the pathogenesis of two kinds of sweating were quite different. Though they were all belonged to disharmony of defensive qi＇s function of preventing exogenous pathogens from invading the body,they were caused by dispersion and accumulation of defensive qi respectively. Conclusion：The external and internal therapeutic principle of Guizhi Decoction＇s major indication in Shanghanlun has vitally important guiding significance.