张仲景辨识潮热症

Study on symptom identification of tidal fever by ZHANG Zhong-jing

潮热作为一种特殊的发热类型,在《伤寒论》《金匮要略》中多次出现。主要见于阳明病大、小承气汤证。故普遍认为,张仲景所述潮热症状,可作为阳明腑实证的典型特征,可代表阳明腑实证。但笔者通过梳理相关条文发现,潮热症状也可见于小柴胡汤证、大陷胸汤证、麻黄杏仁薏苡甘草汤证。因此,若临证一见潮热,便草率断定为阳明腑实证,滥用攻下燥结之法,极易偾事。同时,也提醒我们,临证要全局把握,综合分析,不可主观臆断。

The symptom of tidal fever, as a special type of fever, has often appeared in Shanghan Lun and Jinkui Yaolue. It primarily comes from the description of Dachengqi Decoction syndrome and Xiaochengqi Decoction syndrome. It is generally believed that the tidal fever, discussed by ZHANG Zhong-jing, would be the typical characteristic of excess of Yangming fuviscera syndrome. However, some other concerned original text showed that the symptom of tidal fever also met the syndrome of Xiaochaihu Decoction, Daxianxiong Decoction and Mahuang Xingren Yiyi Gancao Decoction. It prompts us that we can't abuse purgation when treating tidal fever. On the other hands, it also reminds us that we should make comprehensive analysis on all of symptoms with the patient to avoid subjective assumptions.