《金匮要略》痰饮水气辨析

Discrimination on the Phlegm Retention and Hydrosphere of Jingui Yaolue

《金匮要略》中的痰饮与水气病均属于津液代谢障碍之病,二者之间有很大的相似之处,对于二者的异同,尚未形成统一观点,笔者通过反复研读条文,将自己对二者异同的认识进行探讨如下:痰饮与水气病均属于水液代谢障碍,并无本质区别,二者鉴别的关键点为是否存在水肿。按照部位来分类,痰饮可分为:在表之溢饮,在里偏上之支饮,在里偏下之痰饮,在里位于两胁之悬饮;水气病可分为:在表之风水、皮水,在里偏上之正水,在里偏下之石水,水阻气机兼有表虚之黄汗。痰饮病的治疗重在温化水饮,使邪气转化为正常津液;水气病的治疗重在祛除水邪,水去则正自安。同时也不应该拘泥,痰饮病与水气病可相兼存在,"病痰饮者,当以温药和之""诸有水者,腰以下肿,当利小便,腰以上肿,当发汗乃愈"可为二者共同的治疗原则,只不过有所侧重。

Phlegm retention and hydrosphere disease in Jingui Yaolue belong to body fluid metabolism disorders, the two are very similar, and the relationship between the two has not been unified. After repeated study of the original text, the relationship between the two is as follows： phlegm retention and hydrosphere are no difference in essence, and the key points of the identification of the two are ＂ edema＂. According to body position, phlegm retention can be divided into： Yiyin on body surface, Zhiyin the upper part of the inside body, Tanyin the Lower part of the body, Xuanyin on both sides of the chest and flank. Hydrosphere disease can be divided into： Fengshui and Pishui on body surface, Zhengshui the upper part of the inside body, Shishui the lower part of the body,yellowsweat belongs to qi and water mixture and also deficiency of superficies. Focus on the treatment of phlegm retention disease is use of warm medicine to eliminate the phlegm retention, let the evil into the normal fluid. The focus of treatment of hydrosphere disease is to clear water, destroy the destruction of the human body into a normal factor. To be flexible, two kinds of the diseases can exist at the same time, ＂ Disease with phlegm retention, when taking drugs warm＂ and ＂ The water belowthe waist, swollen, when diuresis, above the waist is more swollen, when sweating＂ is the common treatment principle of the two diseases which had different focus.