伤寒论评话 第10章 麻黄表实非同证,外感衄血营郁通——太阳伤寒表实证·麻黄汤证·表证衄血

Discussion of Shanghanlun The Tenth Chapter Exterior Excess Syndromes Treated by Mahuang Decoction Are Not the Same Syndrome ;Hemorrhinia Caused by Exterior Pathogens Needs to Circulate and Open Depressed Ying-qi——Exterior Excess Syndrome by Cold in Taiy

目的:探讨太阳伤寒表实证、麻黄汤证、表证衄血的内涵。方法:用现代汉语来阐释中国东汉著名医家张仲景《伤寒论》第35～37条、第46条、第51条、第52条、第55条、第189～191条、第232条、第235条、第264条、第276条等条文中有关太阳伤寒表实证、麻黄汤证、表证衄血的内涵。结果:①太阳伤寒表实证不一定都要用麻黄汤发汗。②麻黄汤所能够治疗的也不一定都是太阳伤寒表实证。③太阳伤寒表实证和麻黄汤证并非是一对一的一个证候的两种表述。④与太阳中风表虚证的病变机理是卫浮营泄,营卫不和,其病理特征是开泄太过不同,太阳伤寒表实证的病变机理就是卫闭营郁,营卫不通,其病理特征是闭合太过,不仅是太阳经的经气不通,同时手太阴肺气也闭塞不通。⑤伤寒表实卫闭营郁的患者,出现汗出是表闭已开,被郁闭的卫阳之气已经敷布,卫闭已开则营郁也随之而通;而出现流鼻血则是肺气已通,被郁闭的营阴已经通畅,营郁既通则卫闭也会随之而开;表闭开通,可以同时通畅肺气;而肺气通畅也同样可以开散表闭;可见汗出和流鼻血同样都是伤寒表实证将解的征兆。⑥同是太阳伤寒表实证,先服药后衄血是卫闭先开,营郁继通;先衄血后服药是营郁先通尔后再开卫闭;单单衄血而愈是营郁通而带动卫闭开。⑦麻黄汤并非仅用于太阳伤寒表实证,同样可以用于外邪初袭的各经表证。⑧麻黄汤是一个退热、解表的有效方剂,不一定局限于脉象浮紧的表实证患者,临床上只要是体质强壮、具有发热的外感风寒的患者均可以使用。结论:有关太阳伤寒表实证、麻黄汤证、表证衄血还需进一步深究。

Objective：To discuss the connotation of exterior excess syndrome by cold in Taiyang meridian, syndrome indicated by Mahuang Decoction and hemorrhinia of exterior syndrome. Methods ： Modem Chinese language was applied to interpret the connotation of exterior excess syndrome by cold in Taiyang meridian, syndrome indicated by Mahuang Decoction and hemorrhinia of exterior syndrome in terms of the thirty-fifth to thirty-seventh, the forty-sixth, the fifty-first, the fifty-fifth, the one hundred and eighty-ninth to the one hun- dred and ninety-first, the two hundreds and thirty-second, the two hundred and thirty-fifth, the two hundreds and sixty-forth and the two hundreds and seventy-sixth of Treatise on Febrile Diseases, written by famous doctor Zhang Zhongjing in Chinese Donghan Dynasty. Re- suits ： （1） Exterior excess syndrome by cold in Taiyang meridian was not all treated by Mahuang Decoction to sweat. （2） Syndromes can be treated by Mahuang Decoction were not all exterior excess syndromes by cold in Taiyang meridian. （3） Exterior excess syndrome by cold in Taiyang meridian and Mahuang Decoction were not two statements of one same syndrome with one-to-one. （4） Pathology mechanisms of exterior deficiency syndrome by wind-stroke in Taiyang meridian were floating of Wei-qi and discharge of Ying-qi, disharmony of Ying-qi and Wei-qi and the pathological feature was excess of discharge;pathological mechanisms of exterior excess syndrome by cold in Taiyang meridian were closure of Wei-qi and obstruction of Ying-qi,impassability between Wei-qi and Ying-qi,the pathological feature was excess of closure, and was not only the impassability of Taiyang meridian-qi, bu the obstruction of hand-lunar lung qi. （5） Patients with exterior excess of cold, closure of Wei and depression of Ying manifested by sweating was the reason of opening of exterior close and dispersion of depressed Wei-yang qi, for circulation of Wei-qi could make circulation of Ying-qi ; appearing hemorrhinia was the reasen of opening of lung qi and free circulation of depressed Ying-yiin,which could make the opening of Wei,for opening of exterior close could lead circulation of lung qi, circulation of lung qi could make exterior close disperse. Therefore, sweating and hemorrhinia were the signs of elimination of exterior excess of cold syndrome. （6） For the same exterior excess syndrome by cold in Taiyang meridian, hemor- rhinia appearing after taking medicine was first opening of closed Wei-qi, following smoothing of depressed Ying-qi; appearing hemor- rhinia before taking medicine was first opening of depressed Ying-qi, following smoothing of closed Wei-qi ; only appearing hemorrhinia without taking medicine was opening of depressed Ying-qi leading the smoothing of closed Wei-qi. （7） Mahuang Decoction was not only used exterior excess syndrome by cold in Taiyang meridian,it could also be used for exterior syndrome in every meridian caused by in- vasion of external pathogens. （8） Mahuang Decoction which was an effective prescription to bring down fever and relieve exterior syn- drome, was not only confined in the patients with floating and tight pluses. Patients with strong constitution and exothermic exterior cold syndrome could be treated by Mahuang Decoction. Conclusion：Connotation of exterior excess syndrome by cold in Taiyang meridian, syndrome indicated by Mahuang Decoction and hemorrhinia of exterior syndrome need to be further studied.