论《伤寒论》之“痞”(上)

"Pi"in Treatise on Cold Damage(Part One)

在张仲景的书中"痞""痞硬(硬满)""结胸"三症状是不同的,仲景定义"痞"为"不痛",典型的方证如第154条、第164条的小泻心汤方;"结胸"定义为"按之痛",典型方证如第135条、第137条的大陷胸汤证;而在临床中还有很多时候,患者症状介于"痞"和"结胸"之间,有疼痛但是比较轻微,既不属于完全不痛的"心下痞、气痞",又不属于疼痛明显的"结胸",张仲景将其称为"痞硬"或"硬满",两者意义相同,方证如第96条、第230条、第266条的柴胡汤证,第157条、第158条的生姜泻心汤证和甘草泻心汤证,第160条的旋复代赭汤证,第163条的桂枝人参汤证,第165条的大柴胡汤证,第166条的瓜蒂散证,第124条的抵当汤证。从仲景的行文可以看出三者关系为:痞→痞硬(硬满)→痞硬痛(结胸),由"但满不痛"到"痛不可近"是一个由轻到重的过程。由此推断半夏泻心汤当有疼痛。

In Zhang Zhongjing＇s Classics,the symptoms of ＂Pi＂, ＂Piman＂and ＂Jiexiong＂are different. ＂Pi＂is without pain according to Zhang Zhongjing,and the typical prescriptions are item 154 and item 164 Minor Heart-Draining Decoction; ＂Jiexiong＂is defined as ＂aversion to pressure＂,and the typical prescriptions are item 135 and item 137 Major Chest Draining Decoction.However,clinically the symptoms of many patients were between ＂Pi＂and ＂Jiexiong＂,with slight pain,neither ＂epigastric fullness,qi fullness＂nor ＂Jiexiong＂with obvious pain,which is called as ＂hard fullness＂,with syndromes of the Bupleurum Decoction syndrome in item 96,item 230 and item 266; Fresh Ginger Heart-Draining Decoction syndrome and Licorice Heart-Draining Decoction syndrome in item 157 and item 158; Inula and Hematite Decoction syndrome in item 160; Cinnamon Twig and Ginseng Decoction syndrome in item 163; Major Bupleurum Decoction syndrome in item 165; Melon Stalk Powder syndrome in item 166;Resistance Decoction syndrome in item 124. The relationship among the three can be seen in the Zhang Zhongjing＇s classic： fullness→hard fullness→ hard and painful fullness（Jiexiong）,and ＂fullness but not pain to pain aversion to pressure＂is a process from the moderate to severe. It can been seen that Pinellia Heart-Draining Decoction syndrome include the symptom of pain.