《伤寒论》第148条雏议

Discussion About No. 148 Item of Treatise on Cold-Damaged Diseases

《伤寒论》第148条患者症状不典型且和少阴之证非常类似,唯一的区别点就是“头汗出”,所以“脉细”“脉沉紧”都不能辨证为少阴证,特别是“脉沉紧”不能作为少阴病的辨证点,因为脉搏可以出现和中医证型不符合之处,《伤寒论》第148条也说的很明白:“脉虽沉紧,不得为少阴病,所以然者,阴不得有汗,今头汗出,故知非少阴也。”所以《伤寒论》第148条本意是指的患者太阳病表证未除,阳气微结涉及阳明证而出现“大便硬”的一种特殊情况,为“半在里半在外也”,未涉及下焦,仲景用小柴胡汤解表且疏通郁结之阳气,正是因为此证不典型,仲景才说“可与小柴胡汤”而并非“小柴胡汤主之”。

Accnrding to No. 148 item of Treatise on Cold-Damaged Diseases,if a patient＇s symptoms are not typical but similar to shaoyin syndrome, but he has sweating over the head. Therefore, thready pulse, deep and tense pulse can not be regarded as shaoy- in syndrome,especially the latter. Because pulse condition may not comply with the characteristics of TCM syndrome types,which is also stated clearly in No. 148 item of Treatise on Cold-Darmged Diseases ： Deep and tense pulse can not be regarded as shaoyin syndrome,because yin syndrome should not have sweating symptom. Sweating over the head should not belong to shaoyin syn- drome. The statement originally means that the patient＇s superficial symlrome of taiyang disease has not been completely removed, leading to slightly stagnated yang qi affecting yangming syndrome, and hard stool. This is called meso-exterior-interior syndrome without influencing the lower energizer. ZHANG Zhong-jing uses Minor Bupleurum Decoction to relieve the superficies and un- block stagnated yang qi according to its non-typical syndrome. That＇s why he says Minor Bupleurum Decoction may be used rather than is mainly used. In this item, slight aversion to cold shows that the superficial syndrome still exists. At the same time, hard stool and deep pulse belongs to interior syndrome of the lower energizer,which is stated in Ihe No. 148 item. Both interior and ex- terior are diseased,which is called meso-exterior-interior syndromeby ZHANG Zhong-jing.