《伤寒论》阳明病篇有关问题评述

Comment on Yangming Diseases Discussed in Treatise on Febri Diseases

对阳明病篇中有争议的问题进行了点击 ,提出了自己的看法。认为“胃家实”实指肠府燥屎阻结之证 ;阳明病始时之“恶寒”当为太阳病之表现 ,只不过阳明里热偏盛 ,邪气很快化热入里 ,故“二日自罢” ,至于其“万物所归 ,无所复传” ,只是说明六经病证皆可传于阳明 ,但对“无所复传”则当活看 ,关键是视胃气的强弱 ;2 19条白虎汤非治三阳合病之证 ,而是治三阳合病太少之邪统归阳明之证 ,“若自汗出”是其辨证之眼目 ;阳明病篇之用小柴胡汤、桂枝汤、麻黄汤都是建立在合病、并病的基础上 ,是邪虽由太、少传至阳明 ,但太、少之邪未罢 ,是时若阳邪病证不甚 ,则可先从太、少论治 ,此符合表里同病先表后里的治则 ,非为阳明病而用柴、桂、麻黄之剂 ;对于茵陈蒿汤 ,方中之大黄重在伍茵陈、栀子以清利湿热 ,非为通府 。

The author puts forward his opinions on some of the controversies concerning yangming diseases discussed in Treatise on Febrile Diseases . It is the author's opinion that 'excess syndrome of the stomach and intestine' refers to the obstruction in the intestines by dry stools; 'aversion to cold' at the onset of yangming disease should be the manifestation of taiyang diseases, but in a yangming disease the hyperactive heat turns into heat and enters the interior; the 'White Tiger Decoction' is not for treating the diseases of the three yang channels but mainly for yangming diseases; the use of Minor Bupleurum Decoction, Cinnamon Twig Decoction and Ephedra Decoction is based on the fact that the pathogenic factors transmits from the taiyang and shaoyang channels into the yangming channels, not because of the diseases of the yangming channels itself; as far as Oriental Wormwood Decoction is concerned, Radix et Rhizoma Rhei is mainly used in combination with Herba Artemisiae Scopariae and Fructus Gardeniae Jasminoidis is used for clear away damp heat, not for constipation.