《伤寒论》第195条病机考

Research on Pathogenesis of 195th Clause in Shang Han Lun

《伤寒论》第195条的释义存在两种观点。其一从脉象推论,认为本条为阳明寒湿成疸,或重胃寒;其二认为本条为阳明胃虚,合并寒湿。多数学者对本条的研究受黄疸“湿邪内郁”的基本病机影响,囿于“脉迟属寒”的思维。考《伤寒论》中脉迟,亦见于邪热结聚。故《伤寒论》第195条“脉迟”的内涵应为中焦虚弱、胃气虚馁、脾失健运;《伤寒论》第195条病机应为阳明中虚郁热,此条的治疗绝非温化寒湿,而应在健脾益气的基础上,清其郁热,升阳助运。

Two views exist on the interpretation of the 195 th clause in Shang Han Lun.The first view was deduced from the pulse manifestation,which believes that this clause is the accumulation of Cold-Dampness of Yangming meridians resulting in jaundice or severe Stomach cold.The other view holds that this clause discusses the Stomach deficiency of Yangming meridians combining with Cold-dampness.Most scholars′researches on this clause are affected by the basic jaundice pathogenesis of"internal retention of dampness"and constrained by the idea that"slow pulse being induced by Coldness".However,the slow pulse in Shang Han Lun also happens in case of the accumulation of Evil Heat.Therefore,in the 195 th clause in Shang Han Lun,the connotation of"slow pulse"should be the weakness in the Middle Jiao,Stomach Qi deficiency,and dysfunction in transportation of the Spleen.Its pathogenesis should be Middle Qi deficiency and Heat depression in Yangming meridians,and the treatment should not warm the Cold-Dampness but clear the stagnated Heat as well as raising Yang to help transport based on strengthening the Spleen and replenishing Qi.