《伤寒论》第374条浅析

Reveal of the 374^(th) Clause of Treatise on Febrile Disease

[目的]阐述《伤寒论》第374条的具体含义,探究其临床意义。[方法]以《伤寒论思维与辨析》一书中所总结的《伤寒论》动态思维为基础,结合《伤寒论》原文当中与燥屎证、小承气汤、栀子豉汤以及下利有关的条文,以仲景本身的理论来分析并解释第374条原文的真正意义。[结果]第374条并非独立的一条,而是当与第375条结合,阐述了在治疗阳明病实热兼夹证时先使用大剂量的小承气汤攻下燥屎,后使用栀子豉汤清除余热的治疗思路。同时第374条在理解时也应与第368条至375条相参,以对比的方式阐述了寒性下利、湿热下利、实热兼夹利、虚热下利的区别和治法。[结论]《伤寒论》第374条创立了治疗阳明病实热兼夹证时的先下后清之法,并通过和其它与之并列条文的结合,完善了治利的理论体系。同时此两方合用的范例,对临床治疗各种兼夹证有极大的借鉴意义。

[bjective] This paper is about to expound the true meaning of the 374^（th） clause of Treatise on Febrile Diseases. [Methods] Under the guidance of dynamic thinking of Treatise on Febrile Diseases, with the help of other clauses about Zaoshi syndrome, Small Decoction for Ordering the Qi, Gardenia and Prepared Soybean Decoction, to understand the 374^（th） clause.[Results] The 374^（th） clause is not alone, it should be combined with the 375^（th） clause, they tell us when we treat the combination of Shi and Re syndrome of Yangming disease, we should use Small Decoction for Ordering the Qi first, then use Gardenia and Prepared Soybean Decoction. At the same time if we want to understand the 374^（th） clause, we should combine it with the 368^（th） clause to 375^（th） clause, it tells us the treatment and difference between the diarrhea of cold, wet heat, Shi and Re, deficient heat etc. [Conclusion]This clause institutes the principle of the treatment for Shi and Re syndrome of Yangming disease, completing the system of treating diarrhea. It also tells us how to combine two decoctions.