伤寒论评话 第26章 热入血室非邪热 结胸形成有四因——热入血室证治及结胸证成因

Discussion of Shanghan Lun:Heat Invasion of Blood Chamber Really not Evil Heat Blocked-up Chest Syndrome Caused by Four Factors——Syndrome Differentiation and Treatment of Heat Invasion of Blood Chamber Syndrome and the Factors of Blocked-up Chest Syndrom

①"热入血室"与"热入因作结胸"的"热入"似同实不同,"热入因作结胸"是病因病机,热是外来表热;而"热入血室"是证候,热是病人正邪相争时产生的热,不是外来的邪热,也不是风寒所化热,这种热进入血室,与经血相搏,形成"热入血室"证。②"无犯胃气及上二焦",热入血室证病位在下焦胞宫,与胃气及上、中焦无关,胃气包括下焦的大小肠,所以在上二焦的基础上提出胃气加以强调,一则表明重视胃气的一贯思想,二则提示病虽在下焦,但与胃气系统的脏腑无关。③第148条"半在里半在外"指部分表证和阳郁的里证,并非病位;用小柴胡汤是调理枢机,疏通阳郁,而不是和解少阳;本证"可与小柴胡汤"说明不是小柴胡汤的主证,少阳的半表半里之说与本条无关。④大结胸证的形成分别由太阳表热证、少阳热证、太阳少阳并病三者误下,致邪热入里和伤寒日久不解化热入里,与素体停痰留饮搏结而成。⑤女子胞作为奇恒之腑之一,与其他奇恒之腑"藏精而不泻"特点不同,不管是经血还是胎儿,都是要有规律的、有时限的藏泻交替,绝对不是藏而不泻。所以说《素问·五脏别论》关于奇恒之腑特点的归纳是错误的。

＂ Heat invasion＂ of ＂ heat invasion of blood chamber＂ and ＂ heat invasion result in blocked-up chest＂ seems like the same, actually different. ＂Heat invasion result in blocked-up chest＂ is the etiology and pathogenesis ,and heat from external ,while ＂heat invasion of blood chamber＂ is a kind of syndrome,which is formed by heat entering the blood chamber, and struggling with menstrua- tion. The heat is produced by striving for good and evil of patients ,not external evil heat,or cold transformation. ＂ No invading stomach qi,upper jiao and middle jiao＂, the disease location of heat invasion of blood chamber syndrome is lower jiao uterus, which has nothing to do with the stomach qi, upper jiao and middle jiao. Stomach qi including lower jiao intestines, so stomach qi is emphasized on the basis of upper jiao and middle jiao. The one indicates that consistent thought of paying attention to stomach qi, and the second prompts that the disease location is lower jiao, but it has nothing to do with viscera of stomach qi system. @The article of 148 ＂ half inte- rior and half exterior＂ means that partial exterior syndrome, and interior syndrome of stagnation of yang qi, really not disease location. Xiaochaihu decoction is regulating the qi activity, removing the stagnation of yang qi, rather than harmonizing Shaoyang;This syndrome ＂with xiaochaihu decoction＂ explains that it is not the main syndrome of Xiaochaihu decoction, the sayings of half interior and half exterior in Shaoyang has nothing to do with this article. @The formation of big blocked-up chest syndrome is respectively mistreatment of purgation of Taiyang heat-exterior syndrome, Shaoyang heat syndrome, complication of Taiyang and Shaoyang, resulting in pathogenic heat invasion the interior and pathogenic cold not remission for a long time, then heat-transmission into the interior, and struggling with body＇s phlegm and fluid retention. @ Uterus as one of the extraordinary fu organs has different characteristics from other extraordinary fu organs of storing essential substances. Whether menstrual blood or the fetus, both should be alternating with storage and excretion reg- ular and time limit,which is definitely not storage without excretion. So induction about the characteristics of extraordinary fu organs in Suwen Wuzangbielun is wrong.