猪苓汤临证运用发微

Discussion About Clinical Application of Polyporus Decoction

猪苓汤证病位应在下焦,猪苓汤是通利小便之剂,制方根据因势利导原则创立。辨猪苓汤证主症时,需注意以下几点。1辨脉浮、发热。猪苓汤证病机为阴虚水热互结,阴虚必是发热的一个因素,阴虚致阴不敛阳,阳气浮越于外,则见脉浮。如果是阳明病误治发展成为此证,笔者认为其发热、脉浮也可能兼是阳明余热所致。2辨口渴。水热互结,津不上承才是猪苓汤证口渴的关键所在。其渴多表现为:渴不欲饮或欲饮而饮水不多。3辨小便不利。小便不利是猪苓汤证的必见症状,可以作为猪苓汤证的辨证眼目。4辨下利。下利是《伤寒论》第319条首先出现的症状,又是猪苓汤证进一步发展的因素。水热互结于下焦,则下利;"下利六七日"又可使阴津亏损更甚,进一步加剧肾阴亏虚而形成恶性循环。但"下利"并不能作为猪苓汤证的必有证,若出现表示病情严重。目前,猪苓汤被广泛运用于临床各科,尤其是泌尿系统疾病。临证中,无论何种肾脏疾病,只要抓住水热互结兼有阴伤的病机关键,皆可用此方加减治疗。

The disease location of of Polyporus Decoction syndrome lies in the lower energizer. Polyporns Decoction is mainly used for promoting urination,and established based on the principle of guiding a matter along its caurse of development. In clinical practice, the following points should be paid attention to： （1）Differentiation of floating pulse and fever. The pathogenesis of Polypurus Decoction syndrome is intermingled yin deficiency and fluid retention and fever. Yin deficiency is the key factor for tever, because it may lead yin failing to astringe yang qi floating outside giving rise to floating pulse. If yangming disease is mistreated and develops into Polyporus Decoction syndrome,the authors think fever and floating pulse may also be caused by residual heal of yangming meridian. （2）Differentiation of thirst. Intermingled fluid retention and fever, fluid failing to reach upward is the key factor for thirst of Polyporus Decoction syndrome. Its thirst is manifested as：thirst without desire for drink or with desire 1or drink but nol much. （3）Differentiation of dysuria. Dysuria is a most commonly-seen symptom of Polyporus Decoction syndrome, so il can be a necessary index. （4）Differentiation of dysentet7 and diarrhea. Dysentery and dian-hea is the first symptom appearing in No. 319, and a factor for further development of Polyporus Decoction syndrome. Intermingled water retention and fever in tire lower energizer leads to dysentery and dianhea,but dysentery and diarrhea for 6 or 7 days may even damage yin fluid,anti further aggravate the kidney yin deficiency and form a vicious spiral. Dysentel7 and diarrhea cannot be regarded as the necessary symptom of this syndrome, if dysentery and diarrhea appears,it means disease aggravated. At present, Polyporus Decoc.tion is widely used in clinic, especially urinary system diseases. No matter what kind of kidney disease,grasping pathogenesis key is irrtcrmingled water retention and te, ver and yin damage, Modified Polyporus Decoction can be adopted.