从历代医案探太阳伤寒挟虚证的论治

Treatment of Taiyang Cold Damage Complicated with Deficiency Syndrome Based on the Medical Cases of Past Dynasties

诸家医案所载诸虚有气虚,有阳虚,有阴虚,有营血虚,有胃气虚,有久病体虚后感伤寒等情况;从治法上看有先解表,后扶正;有先扶正,后解表;有解表为主,有扶正为主;有只解表,不扶正;也有只扶正,不解表;还有小其制等法。但究竟采用何法,还是看具体病情,其中脉象强弱非常重要,若伤寒脉浮紧,按之有力,纵兼夹虚证,可一汗而解;若脉迟细弱无力,即使伤寒证非常典型,亦不可峻用汗法。若虚实兼杂,分清主次,予以扶正解表,做到解表不伤正,扶正不恋邪。诸家医案中还有假虚伤寒,须仔细鉴别,治病求本,当汗则汗。如虽年衰岁高,得太阳伤寒证,如脉证合,当用麻黄汤时亦不可犹豫,若用荆防等发汗不力亦错失时机而变证多出。

In the medical cases of past dynasties on deficiency syndromes,there are records of qi deficiency,yang deficiency,yin deficiency,nutrient blood deficiency,stomach qi deficiency and cold damage of patients with weak constitution after prolonged disease. For the treatment,some relieve the exterior first and then strengthen the body resistance while some reverse the order; some stress the relieving of the exterior while some value strengthening the body resistance; some merely relieve the exterior but not strengthen the body resistance while some merely strengthen the body resistance but not relieve the exterior. The choice of the therapeutic method should be based on the specific disease condition and the strength of the pulse plays a key role. If the pulse is floating and tense and forceful when pressed,it means the cold damage is complicated with deficiency syndrome and sweating can relieve the condition. If the pulse is retarded,thin,weak and forceless,drastic sweating cannot be applied even though the cold damage syndrome is very typical. If it is deficiency complicated with excess syndrome,the therapeutic principle should be strengthening the body resistance and relieving the exterior,and draw a clear distinction between the primary and the secondary of them to achieve the purpose of relieving the exterior without impairing healthy qi and reinforcing healthy qi without retaining pathogenic factors. Among the medical cases of past dynasties,there are some pseudo-cold-damage which needs distinguishing. Search for the primary cause during the treatment of the disease and sweating should be applied when needed. If an aged patient suffers from cold damage syndrome with corresponding pulse syndrome,Mahuang Decoction should be used without hesitation. If Jinfang Decoction is used,it fails to induce sweating effectively and thus complications may appear.