伤寒论评话 第24章 误吐大多损胃气 水停也可小便利——蓄血证的辨证治疗

Discussion of Shanghan Lun Chapter 24 Harm to Your Stomach Qi Mainly by Mistake for Vomiting Diuresis May be Accompanied with Stagnation of Water——Differentiation and Treatment of Blood Stagnation Syndrome

目的:探讨误吐大多损胃气,水停也可小便利的理论机制。方法:对《伤寒论》第1条、第106条、第120条至第127条原文进行分析。结果:①第121条"不欲近衣"与第11条的"不欲近衣"怕风寒而又不愿衣服挨近皮肤的表现相同,但后者"不欲近衣"是汗出皮肤湿冷,所以不欲近衣;而前者是误吐阳虚而烦,肌肉虚热而不欲近衣。②抵挡汤是以主药水蛭的古别名"至掌"命名衍化而来,从俗名蚂蟥,到通名水蛭,又到古名至掌,再到通假名抵挡,因以水蛭为主药被命名为抵挡汤。③"不可余药""余(其他)药"是指抵挡汤和桃核承气汤二者,两者一是因为药力太猛,一是因为作用太轻,用药太轻而误病,用药太猛而损正,故在条文中予以强调。④"太阳病,小便利者,以饮水多,必心下悸;小便少者,必苦里急也。"提示水饮内停常见小便不利但也有小便自利者;并根据小便不利可以判断水停部位。结论:误吐大多损胃气,水停也可小便利的理论能指导临床疾病的治疗。

Objective：To investigate the theoretical mechanism of harming to your stomach qi mainly by mistake for vomiting, and diure- sis may be accompanied with stagnation of water. Methods：The original articles 106,120 - 127 in Shanghanlun were analyzed. Results： ①Although the same appearance of unthinking wearing clothes in No. 121 and unthinking wearing clothes with fearing cold in No. 11, the later is cold and wet skin by sweating, so the person won＇t wearing the clothes. While the former is restless of yang deficiency by mistake for vomiting and deficiency heat of musle. ②Didang Decoction is formed by Zhizhang, which is Shuizhi. From Mabuang, Shuizhi, to Zhizhang,the interchangeable word is Didang, so it is named Didang Decoction by the main medicine of Shuizhi. ③No sur- plus medicine, which means about Didang Decoction and Taohe Chengqi Decoction, one leads to harm to the healthy qi by the violence, other leads to delay the patient＇s condition by the gentle results. ④One patient who pass water more, drinking more,leads to palpitation; While who pass water less,leads to agony and worried of Great yang disease. Remindering there are both urine more or not of patients with water retention. And judge the position according to dysuria, conclusion：The theory of harming to your stomach qi mainly by mis- take for vomiting, and diuresis may be accompanied with stagnation of water can guide the treatment of clinical disease.