《伤寒论》第28条争议探析

Controversy of Line 28 in Treatise on Febrile Diseases

《伤寒论》第28条是张仲景著作中存在争议的条文之一,历代医家对该条所用方剂中桂枝和芍药的去留,主要有4种不同意见:①认为原文当是“桂枝去桂”。②认为原文应该“桂枝去芍”。③认为原文应“桂枝减量”。④认为“既不去桂亦不去芍”。参照《伤寒论》第28条前后条文,并从病机角度解析,认为原文应为“桂枝去桂”,因该条方证病机为水饮内停致太阳经气不利,而无表证存在,表证表现实为水饮郁遏太阳经气所致,证治宜攻其所得,不需再用桂枝解表,故该条所用方剂应为桂枝去桂加茯苓白术汤。

Line 28 in Treatise on Febrile Diseases is one of the most controversial lines.There are four different opinions on the removal and retention of Guizhi(Ramulus Cinnamomi)and Shaoyao(Radix Paeoniae Alba seu Rubra)in the prescription used in this article.There are mainly 4 kinds of interpretations.Firstly,the original text means the removal of Guizhi.Secondly,the original text means removal of Shaoyao.Thirdly,the original text means reduction of Guizhi.Finally,the original text means both are reserved.With reference to the provisions before and after Line 28,and from the perspective of pathogenesis,this article holds that the original text should be“removal of Guizhi”,due to the inhibited Taiyang meridians,which is caused by fluid retention.The exterior syndrome is actually caused by the inhibited Taiyang meridians and treatment should not be retention of the fluid.So,there is no need to use Guizhi to relieve the exterior.Therefore,the prescription used in this article should be removal of Guizhi plus Fuling Baizhu decoction.