伤寒论评话 第19章 汗下留邪动膈扰神 变通应用栀子豉汤——栀子豉汤类证的辨治

Discussion of Shanghanlun Sweat Under Leave Evil Moving Diaphragmatic Interrupting God and Adaptation of Gardenia Soup According to Syndrome Differentiation——Syndrome Differentiation of Gardenia Soup

目的:探讨"汗下留邪动膈扰神"及"变通应用栀子豉汤"的机理。方法:从《伤寒论》第76条、第77条、第78条、第80条、第81条、第221条、第228条及第378条入手,对栀子豉汤证进行分析。结果:①栀子豉汤证病机相同轻重程度不同,临床表现从虚烦不眠—烦热—热不去,是留邪更多,扰神更重,邪热更深;从心中懊憹—胸中窒—心中结痛,是邪郁渐重,气滞更甚,气机不通。②《伤寒论》中具有攻下作用的丸药只有抵挡丸和大陷胸丸,分别治疗蓄血重证和大结胸证,蓄血证血热互结于下焦,大结胸证水热互结于上焦。蓄血下后,瘀血去热独留,其热应在下焦,本证微烦是邪扰心神,其热必在上焦而不可能在下焦,故栀子干姜汤证是大结胸证以大陷胸丸攻下后所致。③栀子汤类方后均有"得吐者,止后服"的注脚,吐只是服药后郁热因势宣泄发越得一种表现形式,而非药效使其必然,临床有服后得吐者,绝大部分不会出现服药后呕吐的情况。但"得吐者,止后服",结论:应用栀子豉汤可能会出现药后反应,提示服用栀子豉汤类药物用量的度,更重要的是提示栀子豉汤类证的主要病位在上焦,凡病位在上的得吐以后就不要再服药。

Objective：To study the mechanism of ＂sweat under leave evil moving diaphragmatic interrupting god＂ and ＂ adaptation of gardenia soup according to syndrome differentiation ＂.Methods： From the 76th,77th,76th article of the gardenia decoction treatise on febrile disease.Results：（1） Gardenia Soup syndrome and pathogenesis same but degree different,clinical manifestation from virtual tired not sleep-bother and hot,leave evil,the one god is heavier,the evil heat deeper;——chests are smothering——pain in the heart,evil depression is increasingly heavy,and qi stagnation,qi activity.（2） There are attack under effect of pills the treatise on febrile disease such as didangwan and dadidang pill,treatment of blood storage heavy card respectively and big chest card,the fact of blood storage in lower heat exchange,the big chest card water heat exchange node in the upper energizer.After the accumulation of blood,blood stasis to heat left,its heat should be lower,this card micro vexed is evil faze mind,its is not possible in hardness,heat will be in the upper energizer reason gardenia dry ginger soup is big knot chest syndrome with after the big chest shot under attack.（3）.Gardenia soup after the parties have served ＂ after＂ have to spit,footnotes,vomit just muggy after taking the drug for potential catharsis hair have a form of performance,rather than the efficacy of the inevitable,have a have to vomit,after the clinical most won＇t appear vomiting after taking the medicine.But ＂ have to vomit,after the check,the conclusion： the application of gardenia fish soup medicine may arise after the reaction,the prompt gardenia fish soup drugs dosage of degrees,more important is the main disease suggests gardenia fish soup in the upper energizer,to spit on every disease in later don＇t take the medicine.