《伤寒论》六经辨治“胸满”方证探析

Syndrome-differentiation of the six meridians on ‘chest oppression' in Shanghan Lun

《伤寒论》之胸满,有寒、热、虚、实之分,以其发病,则有传经、合病、本经自发等多途,所以有病在太阳、少阳、阳明、少阴以及两经合病之不同;但从病机而论,又多责之于胸阳不振、气机郁滞两端。胸阳不振,主以桂枝去芍药汤,若进而胸阳不足,则加附子;气机郁滞者,当辨因何而郁,如因肺气不宣而郁者,治以麻黄汤;因热扰胸膈而郁者,治以栀子豉汤;因少阳枢机不利而郁者,治以柴胡剂;亦有因少阴虚火上炎而郁者,可与猪肤汤治之。

The chest oppression in Shanghan Lun, can be divided into cold, heat, deficiency and excess. In the case of the disease, there are multiple ways to develop the illness, for example, transmission from one channel to another, combination of disease, originate in channel and so on. So, there is a difference in taiyang, shaoyang, yangming, shaoyin meridian and combination of two channels disease. But from the pathogenesis, it also relates to both of the hypofunction of yang qi in chest and depression and qi stagnation. The hypofunction of yang qi in chest, mostly be treated with Guizhi Qu Shaoyao Decoction. And if it had developed further to deficiency of yang qi in chest, Fuzi can be added. Depression and qi stagnation, it should be identified which place had stagnated. If it happened because of the lung qi failing in dispersion, Mahuang Decoction was used to treat; if it was because of the chest and diaphragm disturbed by heat, Zhizi Chi Decoction was used to treat; if it caused by dysfunction of Shaoyang, Chaihu Decoction was used to treat; also if it was caused by flaring up of deficient fire, Zhufu Decoction was used to treat.