“火郁发之”在《伤寒论》寒热错杂方证中的应用

Application of“Fire Stagnation Requiring Dissipation”in Cold Mixed with Heat Syndrome Discussed in Treatise on Febrile Diseases

“火郁”是以热邪内结不能外达宣泄为主要矛盾,以气机升降失常为根本病机的病证,故治宜因势利导,散而发之。凡使气机畅达,无论是发汗、升散、疏导,皆可谓之“发”。用药上有解郁和除热两端,以温药开郁散结,以寒药清火降泄。《伤寒论》首创寒热错杂方,“火郁发之”的思想在其中多有体现。烦躁、心下痞、四肢厥逆为典型表现,代表方剂大青龙汤表寒热闭,治以解表清热;栀子干姜汤热郁胸膈,治以宣泄并举;半夏泻心汤中虚热结,治以辛开苦降;柴胡桂枝干姜汤饮结阳郁,治以透达郁阳;麻黄升麻汤阳郁下陷,治以发越郁阳。治疗上寒热并用,升降气机,调和阴阳。煎法上,使用麻沸汤渍,轻泄拂郁。服法上,中病即止,以和为度。

“Fire Stagnation”is a disease in which the internal heat cannot be vented externally,and the qi functions abnormally.Therefore,it is advisable to cure it according to its trend.As long as the qi is flowing,whether sweating,lifting,or dissipating,it can be described as“Fa”.Drugs can be used for depressing relief and removing heat at the same time.Warm traditional Chinese medicine is used to open depression while cold medicine is used to clear the fire and discharge.Treatise on Febrile Diseases pioneered the mixtures of cold and heat,and the theory of“Fire Stagnation Requiring Dissipation”is reflected in many areas.The symptoms are manifested as irritability,abdominal distension,and cold limbs.Prescriptions include Daqinglong Decoction for surface cold and closed heat,which treats the surface heat;Zhizi Ganjiang Decoction for heat and depressing in the breast,which helps to vent and drain;Banxia Xiexin Decoction for internal weakness and heat accumulation,which offers pungent drugs for opening and bitter drug for decrease;Chaihu Guizhi Ganjiang Decoction for fluid retention and yang stagnation,which cures the retention and stagnation;Mahuang Shengma Decoction for yang stagnation and depression,which cures stagnation and depression.The treatment combines the application of cold and warm natured drugs,realizes unobstructed qi,and reconciles yin and yang.As for decoction,fry Chinese medicine in hot water.And in usage,the decoctions should be stopped once it is effective,and harmony is the key.