《金匮要略》中痰饮所致背恶寒探微

A Probe into Aversion to Cold in Back Caused by Phlegm Retention in Essentials from the Golden Cabinet

背恶寒病机与阳气有关,阳气不通或阳弱而致寒,而痰饮致背恶寒,或因脾胃虚弱,或因气化不利,或因实邪痰饮阻滞,导致胃有痰饮,阳气不能转经于背,背部恶寒,范围手掌之大,因于痰饮,所以治疗应以温药和之,药性以温为主,方法以和为宜。痰饮致背恶寒具体可分土不制水,气化不利,新饮停留等三个证型,其治法可分利水行气,温阳化气,攻逐水饮三法,分别选用苓桂术甘汤或小半夏茯苓汤,肾气丸或五苓散,甘遂半夏汤或己椒苈黄丸。痰饮所致背恶寒的治疗必须是以治本为主,治标为辅,同时也要注意缓则治本,急则治标。

The pathogenesis of aversion to cold in back is related to yang qi.It belongs to the narrow sense of phlegm retention leading to aversion to cold in back due to obstruction or weak yang.Because of the weakness of the spleen and stomach,or because of the disadvantage of gasification,or the blockade of phlegm due to excessive pathogens,the stomach has phlegm retention.Then yang qi can not be transferred to the back,the back has aversion to cold,the scope is as large as the palm.Therefore,the treatment should focus on harmonizing with drugs with warm nature.According to cold,there are three types:earth failing to control water,unfavorable gasification,and new fluid retention,and the treatment is promoting,resolving and attacking respectively.The chosen prescriptions are the following respectively:Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction,or Minor Pinellia and Poria Decoction;Kidney Qi Pill or Five Substances Powder with Poria;Radix Kansui and Pinellia Decoction or Capsicum and Amaranth Pills.The treatment of c aversion to cold in back caused by phlegm retention must be based on the treatment of the root causes,supplemented by the treatment of symptoms.At the same time,attention should be paid to the treatment of the root causes if the disease is mild,while the secondary symptoms if the disease is serious.