伤寒论评话 第38章 太阳病含肺经病,足太阴病有实证

Discussion of Shanghan Lun:The 38th Chapter—Taiyang Disease Including Lung Channel Disease,Foot Taiyin Disease Having Excessive Syndrome

1太阴病没有肺病的记载,并非六经病只传足经不传手经,而是手太阴肺经的生理和病理特点所决定的。很多肺经的症状是和太阳病同时出现的,《金匮要略》中也分别有专篇论述,所以在太阴篇就不重复列置,详于彼而略于此。2绝大部分方剂是以药物命名、沿袭六神方名称、以方剂的功能命名,而以症状命名方剂的只有所谓"四逆汤";不管何种原因造成的厥逆,都应以救逆、回逆的方法治疗,依照命名原则,应该叫"回逆汤",才能与建中、理中、承气、陷胸等命名法则一致起来;要改变厥逆,就要回复到"顺"的阳气敷布状态,所以要"回逆";回的古体字为"囬",在《伤寒论》流传和转抄中,既有竹简的损蚀朽腐,或者抄写的失误减笔,致使误"囬"为"四",因而囬逆汤、囬逆散就成了四逆汤和四逆散。使用"四逆汤"的原文,没有一条明确提出"四逆"。而用"四逆汤"治疗,就有点名义不顺。所以应该叫"囬逆汤"。3四逆散治疗少阴气机郁而不畅,阴阳之气敷布失常,当然不属于脏有"寒";当归四逆汤所治疗的证候是血虚寒凝,病偏于经脉,也不属于"脏"有寒,排除四逆辈之列。从仅"自利不渴"看,并非戴阳、格阳证,排除白通汤、通脉四逆汤及其加猪胆汁汤数方。太阴虚寒以脾阳不足主,并非阳气、阴液的同时匮乏,茯苓四逆汤、四逆加人参也在排除之列,除此以外剩下的"四逆辈"就只有四逆汤和干姜附子汤。自利不渴也有脾气虚弱为主的,以理中汤、小建中汤、大建中汤以及桂枝人参汤治疗,可见"四逆辈",既不尽是冠有"四逆"名称的四逆汤类,也不排除没有冠以"四逆"的建中、理中等方剂。4"大实痛"是在"时痛"的基础上进一步发展的,"时痛"是邪气停滞,经脉不和,气血聚散所致,在此基础上的"大实痛",就是气血凝滞,经脉不通而成,因此仅以桂枝加芍药汤治疗,其开滞通脉,舒经行气的力量薄弱,所以在此基础上加大黄,增加其除痹、舒挛、止痛的功效。

symptoms and Taiyang disease appeared at the same time,also special writing are respectively discussed in Jinkui Yaolue,so Taiyin dis- ease article no longer discussed repeatedly,that is,detailed in that and briefly on this.②The vast majority of prescriptions are named af- ter drugs,following Liushenfang name,named after the function of the prescription,but named by symptoms only 〝Sini Decoction〝;No matter what the cause of syncope,should be treated with the method of rescuing from collapse by restoring yang,according to the princi- ple of naming,should be called〝Huini Decoction〝,which is consistent with naming rules of Jianzhong,Lizhong,Chengqi,Xianxiong;To change the reverse flow,must return to the state of yang normal spreading,so 〝huini〝;Old style of Hui is different,in the spread and copy of Shanghanlun,both deterioration and rot of bamboo,or copy the error reduction,then miswriting,so result in the appearance of Si- ni Tang and Sini San. The use of〝Sini Tang〝 in the original,there is not a clearly putting forward the〝Sini〝. Using〝Sini Tang〝 in the treatment of the disease makes name disagree with the meaning.③Sini San treatment of Shaoyin Qi depression,Yin-yang qi abnormal spreading,certainly not belonging to〝cold〝 of viscera;Danggui sini tang treatment of blood-insufficiency and cold accumulation,partial to the meridians,so excluding Sini-like. From 〝diarrhea but not thirsty〝,not Dai Yang,Ge Yang syndrome,eliminates Baitong Tang, Tongmai Sini Tang,etc. . Taiyin deficiency-cold mainly with spleen-Yang deficiency,not lack of both Yang and Yin,Fuling Sini Tang, Sini Jia Renshen Tang are excluded from the list,then Sini Tang and Ganjiang Fuzi Tang remained. Diarrhea but not thirsty also mainly with spleen-Qi deficiency,treatment with Lizhong Tang,Xiaojianzhong Tang,Dajianzhong Tang,Guizhi Renshen Tang,it is clearly that Sini-like neither fully named by〝Sini〝,also not eliminating prescriptions such as Jianzhong,Lizhong,ect. .④〝Intense pain〝is the fur- ther development based on〝pain〝,and〝pain〝is caused by evil stagnation,discord of meridians,Qi and blood harmony,and on the ba- sis of〝pain〝,〝intense pain〝is stagnation of Qi and blood,meridian barrier,therefore treatment only by Guizhi Shaoyao Tang,its role of promoting stagnation and coronary circulation is weak,so additionally Daihuang（ Rhubarb）can increase its effect of relieving Rheuma- tism and pain.