伤寒论评话 第14章 张仲景并非“群方之祖”,桂枝汤即是“小阳旦汤”——气津两虚证的误治与救治

Discussion of Shanghanlun Zhang Zhongjing Really not “Forefather of Groups of Prescriptions”,Guizhi Decoction Namely “Xiaoyangdan Decoction”——Mistherapy and Treatment of Deficiency of Qi and Fluid Syndrome

目的:探讨气津两虚证的误治与救治机理。方法:对《伤寒论》第29条、第30条进行分析。结果:①《伤寒论》的大多方剂是对汉代以前经方的收集和加减应用,所以说"群方之祖"的说法不够恰切;②桂枝汤就是六神方中的小阳旦汤,桂枝汤证也就是小阳旦汤证;③原文第29条、第30条误治之前是气津两虚证,用桂枝汤加附子误治后出现的厥逆、挛急、谵语为阴阳不相顺接兼有内热证,并非阴阳两虚,而与厥阴病类似,当属厥阴病之轻者;④甘草干姜汤和芍药甘草汤是一对调理阴阳为主的方剂,是针对厥逆、挛急两个症状而设,如同调胃承气汤针对谵语一样;⑤《伤寒杂病论》是张仲景口述和日常诊疗记录,经过别人记录、整理,编纂而成。结论:气津两虚证在治疗时要分步实施,调理阴阳,归复原位。

Objective：To explore mechanisms of mistherapy and treatment for deficiency of qi and fluid syndrome in Shanghanlun. Methods：Article 29 and article 30 in Shanghanlun were analyzed. Results：① Most of the prescriptions in Shanghanlun were the collection and modified application for classical prescriptions before Han dynasty, so the view of ＂Forefather of Groups of Prescriptions＂ was not right ; ② Guizhi Decoction was ＂Xiaoyangdan Decoction＂ of six magical prescriptions, and Guizhi Decoction syndrome was also ＂Xiaoyangdan Decoction＂ syndrome ; ③ Syndromes in article 29 and article 30 of original text were deficiency of qi and fluid syndrome before mistherapy, and cold limbs, tension, and nonsense appeared after mistherapy of Guizhi Decoction addition Aconite were yin and yang couldn＇t mingle smoothly combining the interior heat syndrome, really not yin-yang deficiency syndrome, which was similar to Jue Yin disease, and belonged to mild syndrome of Jue Yin disease ; ④ Licorice and Dried Ginger Decoction and Shaoyao Gancao Decoction were a pair of prescriptions mainly for yin and yang conditioning, which aimed at two symptoms of cold limbs and tension to design, and the same as Tiaoweichengqi Decoction aimed at nonsense. ⑤Shanghanlun was dictations, routine diagnostic words and deeds of Zhang Zhongjing, and was made by record, sorting, compilation of somebody else. Conclusion：Deficiency of qi and fluid syndrome shall be trea- ted by implementing step by step,regulating yin and yang, and restore health.