再辨《伤寒论》第29条

Reanalysis of the 29th Clause in Shang Han Lun

《伤寒论》第29条因方证模糊,治法特殊,诸家对此条争议较大。该条为太阳中风兼阴阳两虚证,本应扶正解表,却用桂枝增桂加附子汤发汗太过,伤阳损阴,进一步导致了阴阳两虚更盛的变证。临证时应先用甘草干姜汤温复阳气,再用芍药甘草汤益阴缓急。该法体现了张仲景临证区分轻重缓急的原则,同时也表明了张仲景重视阳气的思想,以及在变证治疗过程中出现了阳复太过或发汗伤阳的情况,及时以调胃承气汤或四逆汤设法御变,堪称“观其脉证,知犯何逆,随证治之”的典范。

The 29th clause in Shang Han Lun is controversial because of its vague prescription and special treatment method.This clause is about the syndrome of Taiyang Zhongfeng combined with the deficiency of both Yin and Yang.It can be treated by strengthening Zheng Qi to relieve superficies syndrome,however,Guizhi Zenggui Jiafuzi Decoction used in clinic causes excessive sweating,which injures Yang and damages Yin,and further leads to the deterioration of deficiency of both Yin and Yang.Therefore,in clinical practice,Gancao Ginger Decoction should be used first to warm and restore Yang Qi,and then Shaoyao Gancao Decoction can be used to benefit Yin and relax tensions.This method not only embodies Zhang Zhongjing′s principle of distinguishing priorities in clinical trials but also shows his thought of attaching importance to Yang Qi.Besides,in the process of deteriorated case treatment,if there is a situation of excessive Yang Fu or sweating that hurts Yang,timely use of Tiaowei Chengqi Decoction or Sini Decoction to prevent the deterioration is necessary.It can be called a good example of"observing the pulse and syndrome,knowing what′s the problem,and treating with syndrome differentiation".