伤寒论评话 第20章 柴胡类证撮其要,病在气机与水道——柴胡类证的辨证治疗

Discussion of Shanghan Lun Chaihu Class Disease in Air Tank and Water Course——Syndrome Treatment of Chaihu Class

目的:探讨《伤寒论》关于柴胡类证的辨证治疗。方法:对《伤寒论》中第98条、第101条、第104条、第147条、第149条进行分析。结果:①根据少阳经的生理功能和病理特点,少阳病大致可分为气郁证、水郁证、气水同郁证。由于气郁程度的不同,还可分为气郁证、气滞证和气结证。②少阳病气机不畅而成气郁者,典型证候就是小柴胡汤证。少阳气郁较重而成气滞者,以大柴胡汤证为代表证候。如果少阳气机郁结日久不解,导致气机结滞而成柴胡加硭硝汤证。邪入少阳,影响水道,即会形成少阳水郁的柴胡桂枝干姜汤证。③少阳气郁证呕而不渴,小便自利,是病在气分,气郁不畅,但气机郁结也会波及水道,兼有水道不利,所以小柴胡汤证间或有小便不利症状;少阳水郁证渴而不呕,小便不利,是病在水分,水郁不化,但水道郁滞也会波及到气机,所以柴胡桂枝干姜汤证亦有胸胁满微结。④少阳气水同郁证与少阳气郁证、少阳水郁证既有联系又有区别,少阳气郁证伴有水郁,是气郁不畅影响了水道的通调;少阳水郁证伴有气郁,即水道郁阻影响了气机的通畅。而少阳气水同郁证是气机与水道共同发生病变,郁滞较深,症状较重,涉及到与少阳相关的经脉和脏腑,是少阳气郁和少阳水郁误治后病变加重的证候。⑤柴胡类证并不全是少阳病,而少阳病中的大多证候属于柴胡类证,这就是柴胡类证与少阳病的关系。结论:《伤寒论》关于柴胡类证辨证治疗的条文对临床有指导意义。

Objective：To investigate the treatise on febrile disease of dialectical treatment of radix bupleuri class certificate. Methods：The treatise on febrile disease in article 98, article 101, article 98, article 147, article 149 is analyzed. Results： （1）According to the physiological functions and pathological characteristics of Yang meridians,less shaoyang disease roughly can be divided into qi depression synrdrome, blue water, gas and water with depressive syndrome. Because of the different degree of qi depression and time, after also can be divided into qi depression syndrome, and qi stagnation syndrome and knot. （2）The shaoyang disease person not free to qi depression, typical syndrome is small bupleurum decoction syndrome. Heavier less sun be the spirit depression and qi stagnation, and major bupleurum decoction syndrome as the representative. If the sun be the spirit machine within less days,long time don＇t understand, cause knot jet lag and radix bupleuri plus the glauber＇s salt soup. Evil in shaoyang, affect channel, which can form shaoyang yu wood Hu Gui water branches ginger soup. （3）Less sun be the spirit yu ou not thirsty, self-interest of urine, is sick in the gas, and poor qi depression, but qi activi- ty stagnation will spread channel constriction, both waterways adverse, so small bupleurum decoction syndrome or have urination symptom ; Yang water depression syndrome less thirsty but not ou, urination, is a disease in the water, water does not turn, but waterway stasis will also spread to angry machine, so the wood Hu Gui branches ginger soup syndrome also have chest side micro all in knots. Sun be the spirit of water with depressive syndrome. （4）Less and less sun be the spirit depression syndrome, yu Yang water less,there are both connection and difference between less sun be the spirit depression, depressive syndrome associated with water is poor qi depression af- fected channel access;Shaoyang faintly water depression syndrome associated with depression, namely channel YuZu affected jet flow. And less sun be the spirit of water with depressive syndrome is a common lesions occur qi activity and waterways, stasis is deeper, symptom heavier, involving related to shaoyang meridians and viscera, sun be the spirit is less depression and little Yang yu disease patholog- ical changes aggravated syndromes after water. （5）Radix bupleuri class certificate is not entirely shaoyang disease, but most of shaoyangdisease syndrome belongs to the radix bupleuri class certificate, this is the radix bupleuri class certificate and relationship of shaoyang disease. Conclusion ： the treatise on febrile disease of radix bupleuri class certificate of provisions as a guidance for clinical diagnosis and treatment.