从肝体阴用阳解析《伤寒论》厥阴病篇

An Analysis of Jueyin Diseases Based on Liver Blood and Liver Yang in Treatise on Cold Damage Diseases

根据六经是基于脏腑经络的理论,肝脏为厥阴的脏腑基础,厥阴病病机为:病至厥阴,体阴(肝血)亏损,引起用阳(肝阳)的不足,而用阳的亏虚,又引起体阴的病变。厥阴病阳虚的特点为:体阴不足,用阳不及致肝经虚寒,阳气不通。而厥阴阴虚主要涉及肝脏,临床表现为肝筋及经络失于濡养的肝系症状,使用乌梅、当归、白芍等入肝养血之品养肝柔肝,补养肝体。厥阴病体阴不足,用阳不及,阳气不能疏泄,故郁而化热,厥阴病之热的来源可总结为:体阴不足→用阳亏虚→阳气疏泄不及→郁而化热,热像并非厥阴病必见症状,如果无郁而化热之证,只需补肝体,助肝用。《伤寒论·辨厥阴病脉证》提纲证中所提到的脾胃症状病机为厥阴肝木之气不能疏泄,引起脾土运化不及,故出现不能运化津液的"消渴",不能运化水谷的"饥而不欲食",用黄芩、黄连清解肝经郁热,干姜、人参补中焦虚寒。

According to the theory that six meridians are based on viscera and meridians,liver is the viscera basis of Jueyin meridian.The pathogenesis of Jueyin diseases is as follows:When the disease reaches Jueyin meridian,the deficiency of body yin(liver blood)causes the deficiency of liver yang,and the deficiency of liver yang causes the pathological changes of body yin.The characteristics of deficiency of yang in Jueyin diseases are:deficiency of body yin and deficiency of liver yang lead to deficient cold of the liver meridian and obstruction of yang qi.Jueyin yin deficiency is mainly related to the liver,and its clinical manifestations are liver system symptoms of liver muscle and meridians lost in nourishing.So the mecicinals for nourishing liver blood such as Wumei(Fructus Mume),Danggui(Radix Angelicae Sinensis),Baishao(Radix Paeoniae Alba),etc.can be used to nourish the liver.The deficiency of liver blood and liver yang makes yang qi fail to disperse,and stagnated into heat.The source of heat of Jueyin diseases can be summarized as follows:deficiency of body yin→deficiency of liver yang→yang qi failing to disperse→stagnated heat.The heat is not necessarily a symptom of Jueyin diseases.If there is no syndrome of stagnated heat,it only needs to supplement the liver body and help the liver function properly.In Treatise on Cold Damage Diseases,the pathogenesis of spleen and stomach symptoms is that the liver qi of Jueyin meridian fails to disperse,which causes the spleen to fail to be transported,so there is"thirst"that can’t transport body fluid and food and drinks manifested as hunger without appetite,so Huangqin(Radix Scutellariae)and Huanglian(Rhizoma Coptidis)can be used to remove the stagnated heat of liver meridian;Ganjiang(Rhizoma Zingiberis)and Renshen(Ginseng)can be used to supplement the deficiency cold of middle jiao.