伤寒论评话 第13章 白虎汤类证未必大汗桂枝汤去桂缘于阴虚———失治误治变证百出 观其脉证随证治之

Discussion of Shanghanlun Baihu Soup Card May Not Big Sweat and Guizhi Soup to Guangxi due to Yin Deficiency——According to Syndrome Differentiation-Treatment

目的:探讨"白虎汤类证未必大汗"及"桂枝汤去桂缘于阴虚"的机理。方法:从《伤寒论》第16条、第26条、第28条入手对白虎汤类证和桂枝汤证进行分析。结果:①"大汗出"不是白虎汤证的必备症状,更不是白虎加参汤证的常规症状。身大热与大汗出同时共存于一个患者身上的可能性很小,因为大汗出的同时散发体表热量,体温自然就不会太高;若体温很高的时候会蒸发大量的体表水分,自然也就不会出现大汗淋漓,所以说白虎汤证大汗出和身大热同时出现的说法是错误的。②桂枝汤中的主药桂枝有"和阳"的功能,而芍药具有"滋阴"的功能。因此,仲景在桂枝汤加减法应用中,既有桂枝汤减芍药,又有桂枝汤加芍药;既有桂枝汤加桂枝,就应该有桂枝汤减桂枝。这种将桂枝和阳、芍药滋阴功能相互对用的规律,符合临床上疾病变化的客观实际。所以桂枝汤化裁就有苓桂术甘汤和苓芍术甘汤,以对应临床所见的脾阳虚水湿停滞和脾阴虚水湿停滞;还有桂枝甘草汤和芍药甘草汤,以对应临床上的阳虚和阴虚,否则就违背了临床实践中阴阳兼顾的治疗特点。结论:白虎汤类证及桂枝汤证若失治误治则变证百出,观其脉证随证治之则可取效。

Objective: To study the mechanism of'white tiger soup card may not big sweat'and'cassia twig soup to guangxi due to Yin deficiency'.Methods: From'treatise on febrile diseases'article 16 and article 26 of article 28 of white tiger soup card and cassia twig decoction syndrome were analyzed.Results: ①Polyhidrosis is not the necessary symptoms of Baihu soup syndrome,but not general signs or symptoms.The possibility of fever heat and sweat out coexist in a patient at the same time is very small,because sweat out sending out body heat as well as a high temperature evaporating a large amount of surface water.So the occurrence of fever heat and sweat out coexist in a patient at the same time is wrong.②Guizhi as the principal agent in Guizhi soup has Heyang function.Shaoyao has nourishing yin function.Therefore,the application of Guizhi soup by Zhongjing has Guizhi soup minus Shaoyao and Guizhi soup plus Shaoyao as well as Guizhi soup plus Guizhi and Guizhi soup minus Guizhi.This regularity of complementary functions conform to the objective reality of clinical disease change.So Guizhi soup has Lingguishugan soup corresponding to water-damp retention of deficiency of spleenYANG and Lingshaoshugan soup corresponding to water-damp retention of asthenic splenoyin as well as Guizhigancao soup and Shaoyaogancao soup corresponding to clinical Yang and Yin deficiency.Otherwise that will violate the consideration of Yin and Yang in clinical practice.Conclusion: Baihutang symptom and Guizhitang symptom have preferable effect according to zheng differentiation-treatment.