论桂枝汤之应用

Study on Application of"Cinnamon Twig Decoction"

康平本《伤寒论》在桂枝汤证“阳浮而阴弱”前加了一个“脉”字,《脉经》认为,“弱则无血,弱则有热”“弱则为悸”“弱为虚,为悸”“弱则血不足,必弱为虚”“寸口脉弱,阳气虚,自汗出而短气。”可知弱脉的病机为无血、有热、血不足、阳气不足,故桂枝汤证隐藏症状还有“短气、悸、项强头眩”。桂枝汤证有汗与否,当看外感内伤。外感之桂枝汤证出现弱脉,为外感风邪,津液开泄,使脉道中的津血减少所致。内伤之桂枝汤证病机为脾胃气弱,生化无力,津液虚少,故可能出现由于津液不足、汗源不充所导致的无汗。因此,桂枝汤证也可以无汗。《伤寒论》认为:“若其人脉浮紧……不可与之也。”“此里虚,须表里实,津液自和,便自汗出愈。”小便数为肾与膀胱虚,有客热扰之,为桂枝汤的禁忌证。故桂枝汤的禁忌证有“脉浮紧”“下焦精血不足”与“小便数”。

In Kangping′s version of Treatise on Cold Damage Diseases,the word"pulse"is added before the syndrome of Cinnamon Twig Decoction of"floating yang and weak yin".According to Pulse Classic,"weakness means no blood,and no heat";"weakness leads to palpitations"and"weakness leads to blood deficiency and palpitations";"weak wrist pulse and yang deficiency lead to spontaneous sweating and shortness of breath".It can be seen that the pathogenesis of weak pulse is no blood,has heat,insufficient blood and yang.The hidden symptoms of Cinnamon Twig Decoction also include"shortness of breath,palpitations,rigidity of the neck and dizziness".Whether Cinnamon Twig Decoction has sweating or not depends on external contraction and internal injuries.The weak pulse of Cinnamon Twig Decoction syndrome caused by external contraction is due to apoplexy caused by exogenous infection,released body fluid,which reduces the fluid and blood in the pulse channels.Therefore,the weak pulse of Cinnamon Twig Decoction syndrome is related to sweating.The pathogenesis of Cinnamon Twig Decoction syndrome of internal injury is weak spleen and stomach qi,weakness in generating,and deficient body fluid.Therefore,there may be no sweating due to insufficient body fluid and sweat source.Therefore,among internal injuries and miscellaneous diseases,Cinnamon Twig Decoction syndrome can have no sweating.According to Treatise on Cold Damage Diseases,"If the patient has floating and tight pulse....Cinnamon Twig Decoction cannot be used.""For deficient exterior,interior and exterior have to be both sufficient.Only when the body fluid itself is at peace with the relatively strong qi phase,can it sweat automatically.Then the patient will recover from the disease."The high frequency of urination is due to deficiency of the kidney and bladder,and there is also guest heat disturbance,which is the contraindication of Cinnamon Twig Decoction.Therefore,the contraindications of Cinnamon Twig Decoction include"tight pulse","insufficient blood essence in lower energizer",and"high frequency of urination".