《伤寒论》第318条浅识

Understanding of Item 318 in Treatise on Cold Damage

虽然《伤寒论》少阴病篇同厥阴病篇中均有"四逆"一症的论述,但《伤寒论》第318条将"少阴病"置于"四逆"之前,旨在界定条文所论述者属少阴病。而由本条所述之主症仅见"四逆",其余诸症皆为或然症,可知其寒象不甚,故不宜将之归属于阴盛阳虚之候,本条所述之"四逆",为少阴枢转不利,影响太阴之开、厥阴之阖,致阳气内郁,其温煦之功不能外达所致,其治法为温脾和胃,运转枢机。观四逆散之组方,虽无四逆汤辈中所取桂附之属峻剂温阳,但针对条文证机,以补益太阴脾土为主,兼以调和三阴经之气,藉补土以益元阳,调气以助枢机,使少阴枢转,而三阴之阴阳气调畅,阳气敷布则逆冷自去。复观其加减用药,均能紧扣证机,并结合兼症,灵活用药,由是则仲景所示之辨证论治亦充分体现。

Even though the discussion of the symptom of ＂ frigid extremities＂ appears in both the chapter of Shaoyin disease and the chapter of Jueyin disease,Shaoyin disease is put before ＂ frigid extremities＂,in item 318 of Treatise on Cold Damage,which means that the contents of this item belongs to Shaoyin disease. The main symptoms in this item only with ＂ frigid extremities＂,the rest of the this item are all possible symptoms,so the cold manifestations are not obvious and therefore it is not advisable to classify the ＂ frigid extremities＂ into yin exuberance and yang deficiency. ＂ Frigid extremities＂ discussed in this item is due to dysfunction of Shaoyin influencing the opening of Taiyin and closing of Jueyin,leading to internal depression of yang qi which fails to reach outside. The treatment should be warming the spleen and stomach,and unblocking the Jueyin. In terms of the composition of Frigid Extremities Powder,there is no violent drugs to warm yang,but it is mainly to tonify spleen,simultaneously harmonize qi of three yin meridians,tonify earth to benefit primordial yang,regulate qi to promote the function of Shaoyin,thus making yin,yang and qi of three yin smooth,yang qi dispersing and frigidness disappearing. The modification of the drugs is closely based on the pathogenesis of the syndrome and combines the complicated symptoms to apply drugs flexibly,which is the full reflection of Zhang Zhongjing＇s syndrome differentiation and treatment.