《伤寒论》发热证治

Syndromes and Treatment of Fever in Treatise on Cold Damage

《伤寒论》对发热的证治对后世发热证治奠定了理论基础。如三阳病发热多为外感发热,三阴病发热多为内伤发热。太阳病发热者,可用汗法解表散热;阳明病发热者可用清、下两法,辨明在经在腑,用清法解毒清热或者用下法泻下里热;少阳病发热者,用和法和解退热;太阴病发热者,可用温法甘温除热;少阴病发热者,辨明寒化热化,寒化者用温法破阴回阳除热,热化者用补法滋阴清热;厥阴病发热者,可用寒热平调法除热。另外,合病并病者,可根据病情选择适当的一种或多种治法;兼有水湿瘀血者,可兼以利水、化湿、化瘀之法;有兼证者,可对证添加相应药物治疗。在针对发热一症的治疗上,太阳以汗法为主,代表方为麻黄汤和桂枝汤。阳明以清、下两法为主,代表方为白虎汤和承气汤(调胃承气汤、小承气汤和大承气汤)。少阳以和法为主,代表方为小柴胡汤。太阴以温法为主,可用小建中汤甘温除热。少阴以回阳救逆为主,甚者可反佐凉药引经,方用四逆汤类。少阴热化以滋阴清热为主,以黄连阿胶汤为代表。厥阴以寒温并用为主,或用乌梅丸、或用干姜黄芩黄连人参汤、或用麻黄升麻汤,热证者用白头翁汤。

The syndromes and treatment of fever described in Treatise on Cold Damage have laid theoretic basis for the treatment of fever among later generations. For instance, fever of three yang diseases is mostly exogenous fever; fever of three yin diseases is mostly fever by internal injury. Fever of taiyang disease can be relieved by sweating, exterior-relieving to disprove; fever of yangming disease can be relieved by clearing and purging methods, and the location of meridians or viscera should be distinguish- ed, then clearing method can be applied to eliminate loxicity and clear heat or purging method can be applied to purge the interior heat; fever of shaoyang disease can be abated by harmonizing method; fever of taiyin disease can be eliminated by warimg method with warm and sweet drugs; fever of shaoyin disease should be differentiated cold pattern or heat pattern, and the former can be treated by warming to break yin, rescue yang and eliminate fever while the latter can be treated by tonifying, nourishing yin and cieing heat; fever of jueyin disease can be dispelled by regulating cold and heat. Besides, for co-existent diseases and compli- cations, one or multiple methods can be chosen according to the disease condition. For complicated with water dampness and blood stasis, promoting diuresis and resolving dampness and l）lood stasis can be applied. For complicated with other syndromes, corresponding drugs can be added for the treatment.