仲景解表攻里法证治探讨

The Discussion About Zhang Zhong-jing's Methods of Relieving Exterior Syndrome and Endopurgation

《伤寒论》中对解表攻里的认识非常全面深刻,解表攻里有一定的治疗原则但也有其规律性和灵活性,一般情况下有表证先解表,里急者先治里,表里同重则表里双解。在临床上有相当一部分病人,表证长期未解,此时要先解表,表解而内自和,若兼有其他杂症,需再辨其内证,依次治疗。对于表里同病的治疗原则可以分为先表后里、先里后表、表里同治;但是先后并不能根据表证里证的多少而决定先解表还是攻里,关键在于抓住病机,根据"急则治其标"的原则进行治疗。在临床上可以结合对疾病的病位病势分析,以病机作为主要依据,准确把握疾病的部位深浅和病情轻重、表里变化,采取正确的治疗方法来指导临床。

Regardless of the duration of the disease,in general,if there is exterior syndrome,it should be relieved first. In clinical practice,there are quite a number of patients whose exterior syndrome has not been relieved for a long time, so in such cases,exte- rior syndrome should be relieved to lead to spontaneous internal harmony. If the patient also has other symptoms,interior syndrome should also be identified and treated according to order. The routine treatment is aimed at Yangming abdominal distention syn- drome also ealled syndrome of Sanchengqi Decoction. Simple Yangming M）dominal distention can be treated with purgation only when there is no Taiyang exterior syndrome,stomach fluid is damaged and dryness-heat is stagnated inside the body;if purgation is used early, many deteriorated cases will appear. The purgation method of treating three-yin-meridian diseases is mainly aimed at Shaoyin three-urgent purgation, because the syndrome is dangerous marked by dry shit retention, withered stomach fluid, acute contraction of genital organ,so dry shit should be removed as soon as possible to save yin and fluid. The treatment principle for disease involving both exterior and interior should be first divided into first exterior then interior greatment ,first interior then exte- rior treatment, treatment both exterior and interior at the same time. But the order should not be based on the degree of exterior and interior,the key is to grasp the pathogenesis. The treatment should be based on the principle of ＂immediate treatment of sec- ondary aspects for urgent syndrome＂. Zhang Zhong-jing has a ve~＇ complete and deep understanding of method of relieving exteri- or syndrome and endopnrgation in Treatise on Cold Damage Diseases. The method has certain treatment principle, but also rules and flexibility. Generally speaking,if there is exterior syndrome, it should be relieved first. For urgent interior syndrnme ,endopur- gation is used. For the same severity of disease in both exterior and interior, relieving both of them is necessary. In clinical prac- tice, disease areas and conditions can be analyzed,and the pathogenesis should be regarded as the major base to accurately grasp the disease severity,depth and position changes for choosing better therapies and clinical guidance.