《伤寒论》“躁烦”辨析

Analysis of “Agitated Vexation”in Treatise on Cold Damage

躁烦的出现提示表闭阳郁、里热炽盛、水热互结、热扰于心、阳虚阴盛和传变及转归等。表闭阳郁之躁烦源于发汗不彻,表邪未尽,然病邪并不内传,始终羁留于太阳之表,形成邪微而正虚之表郁轻证。宜选用辛温发散之剂,得小汗即安,服桂枝二麻黄一汤,取其微发汗。里热炽盛之躁烦源于太阳病误火后的变证。太阳病二日不应有躁而现躁,故曰反躁,既然有躁,表明表邪未解而里热已盛,当解散表邪,清里透热,切勿用辛温或火攻发汗。水热互结,热扰于心之躁烦源于误下后胃中空虚,邪气乘虚而犯胸膈,致心神不安,甚至懊恼不安。此时宜泻热逐水,方用大陷胸汤。阳虚阴盛之躁烦源于少阳阳气脱绝,残阳外扰,神不守舍。临床需观其脉证,知犯何递,随证治之。

The appearance of ＂agitated vexation＂indicates the closing of the exterior and yang depression,exuberant internal heat,binding of water and heat,heat disturbing the heart,yang deficiency and yin excess,the transformation and prognosis. The closing of the exterior and yang depression originates from unthorough perspiration,incomplete elimination of the exogenous pathogens. The pathogenic factors don＇t transform to the interior but stay at the exterior of Taiyang,forming the light depressive external syndrome. Guizhier Mahuangyi Tang with the effect of pungent warming and dispersing is applied to induce slight perspiration. Agitated vexation due to exuberant internal heat is derived from the deteriorated syndrome after Taiyang disease is wrongly treated with heat medicine. After two days attacked by Taiyang disease,the vexation appears as reverse vexation,which indicates the uneliminated external pathogenic factors but the exuberance of internal heat. The therapeutic principle should be eliminating the external factors,clearing the interior and heat and avoid the use of pungent warm and hot drugs to induce diaphoresis. Agitated vexation due to binding of water and heat,heat disturbing the heart comes from empty stomach after erroneous purgation;the attacking of pathogenic factors into the chest and diaphragm causes malaise,even upset. In this case,Major Chest Draining Decoction should be used to purge heat and drain water retention. Agitated vexation due to yang deficiency and yin excess comes from yang qi collapse of Shaoyang,external disturbance of residual yang,thus causing absent mind. In clinic,the pulse and symptoms should be checked and the treatment should be applied according to the syndrome.