《伤寒论》麻黄连翘赤小豆汤证探析

On Ephedra-Forsythia-Red Bean Decoction in Treatise on Febrile Diseases

麻黄连翘赤小豆汤证的基本病机为湿热熏蒸于表或湿热兼表,辨证要点为身黄(目黄、皮肤黄)如橘子色,小便不利而色黄,心烦,口渴,身痒,无汗,甚见水肿,或伴恶寒、发热等表证。临床中可见于湿热郁蒸于表或可见表证的湿热证。麻黄连翘赤小豆汤不独用于外有风寒,内有湿热,也可用于湿热外蒸,郁滞于表。若从发黄一证论之,则麻黄连翘赤小豆汤证多见于湿热发黄的早期,由于病邪郁表,腠理闭塞而无汗。水湿郁热不得泄越而蓄积于内,影响三焦气化,水道不通则小便不利,致使邪无出路,与热相合,熏蒸肝胆而导致发黄。还需指出的是,表邪不解,或湿热熏蒸,常见皮肤发痒等症,如湿热不得表解,郁蒸于肺,失于通调水道之职,水气泛滥,还可导致水肿。麻黄连翘赤小豆汤还为临床治疗皮肤痒疾及湿热水肿之有效方剂。

The basic mechanism of Ephedra-Forsythia-Red Bean Decoction is manifested as superficial dampness-heat or dampness-heat complicated with the exterior pattern. The key points in pattern identification are yellow or orange body color （yellow eyes, yellow skin）, dysuria, brown urine, vexation, body itching, absence of sweating, or edema, aversion to cold and fever in severe cases. Clinically, it is effective for superficial dampness-heat or exterior dampness-heat pattern. In other words,this formula is indicated not only for exterior wind-cold and interior dampness-heat, but also for retained superficial dampness-heat, closed striated layer and absence of sweating, resulting in failure of dampness-heat to release, which affects Qi activity of the triple energizer. When the water passage is obstructed, dysuria occurs, and when urine is combined with heat,jaundice occurs as the liver and gallbladder are steamed by it. In terms of jaundice, it is the early pattern of jaundice due to dampness-heat. In addition, it must be pointed out that when the exterior pathogenic factors are not removed, or dampness-heat is going upward, body itching is found. When dampness-heat resides in the body and affects the lung, excessive dampness leads to edema. So, it is why the formula is also effective for body itching and edema due to dampness-heat.