伤寒论评话 第32章 客寒包火发阳明,起手三法非本证——阳明经表证和无形邪热的证治

Discussion of Shanghan Lun: External Cold Package Fire Attack of Yangming,Initial Three Methods Not Aiming to Yangming Self-Meridian Syndrome——Syndrome and Treatment of Yangming Meridian Exterior Syndrome and Invisible Evil Heat

①《伤寒论》原文221条所述早期亦属于外寒内热,客寒包火,与大青龙汤证有相似之处,其脉浮紧、身重、烦躁、喘等症状与大青龙汤证类同,而所不同者,大青龙汤证恶寒、无汗,是外寒初袭,表寒较重;本证则是恶热、汗出,是外邪将尽,里热已炽。大青龙汤证是太阳表寒里热证,而本证是阳明表寒里热证;大青龙汤证以表寒重为主,而本证则是表寒将尽,里热已炽。大青龙汤证治疗以辛温解表,发散表寒,本证宜辛凉清里,清宣里热。②阳明病的初期,应以阳明中风和阳明伤寒为多,但由于阳明经多气、多血的生理特点和阳明病多热、多实的病理特征,阳明中风证和阳明伤寒证多为一过性证候。六经在体表都各有分布,都具有感受外邪的可能性,不独太阳经才能够感受外邪,只是太阳经气,也就是卫气布散于表,所分布的面积较大而偏于外侧、背部等阳位,所以太阳经感受外邪的机会也就远远的高于其它五经,太阳经的病证也以表证为多。

（1）The original article 221 in Treatise on Febrile Disease says that the early of disease syndrome belongs to external cold with interior heat, external cold package fire, similar with Daqinglong decoction syndrome which manifests as floating and tense pulse, symp- toms such as heavy body,irritability and asthma, but aversion to cold, adiapneustia in Daqinglong decoction syndrome, it is the beginning of cold outside attack, exterior cold heavier. This syndrome is aversion to heat, sweating. Daqinglong decociton syndrome is exterior cold and interior heat syndrome of Taiyang, but this syndrome is exterior cold and interior heat syndrome of Yangming ; the former is given priority to heavy exterior cold, but the latter is exogenous evil ready to disappear, heat blazing. So the former should be treated by relie- ving exterior with warmth and acridity, dispelling exterior cold, the latter by resolving and clearing internal heat with pungent and cool natured drugs. （2）At the beginning of Yangming disease, should be mainly based on Yangming stroke and Yangming typhoid, but because of pathological feature of abundance in qi and blood in Yangming meridian, and physiological characteristics of multi-heat and multi-excess,Yangming stroke syndrome and Yangming typhoid syndrome were mostly transient syndrome. Six channels have different distribu- tion in body surface, which have the possibility to feel external evils, not only Taiyang meridian, but Taiyang meridian qi spreads out on the body surface, the distribution of the larger area and yang sides such as partial to the outside,back, so the chance of feeling external evils in Taiyang meridian is far higher than the other,Taiyang meridian disease syndrome also mainly base on exterior syndrome.