《伤寒论》大青龙汤证属半表半里证之探究

Study on Daqinglong Decoction as a half-exterior and half-interior syndrome in Shanghan Lun

《伤寒论》第38条所述之大青龙汤证,病机并非表里同病、太阳与阳明合病,而是半表半里证。因人禀赋体质、感邪轻重不同,可出现不同的疾病转归,大青龙汤当属和解半表半里之剂,而非解表清里之表里双解剂。“半表半里”之说,并非张仲景在《伤寒论》中明确提出,而是后世医家在解读《伤寒论》的过程中所创立,多用来阐释少阳病的病位及病机。但经仔细推敲,若将半表半里与少阳病论为相等概念,则与张仲景本意相去甚远,半表半里概念更当与临床疾病动态发展情况相结合。半表半里证又当与合病、并病、表里同病等概念相区别,扩大理论研究范围,以期指导临床应用。

The pathogenesis of Daqinglong Decoction mentioned in Article 38 of Shanghan Lun is not‘exterior and interior diseases’or‘Taiyang and Yangming combined diseases’,but‘half exterior and half interior syndrome’.The prognoses are different in the various constitutions of traditional Chinese medicine and the severity of pathogenic factors.Daqinglong Decoction should be the medicine for reconciliation of half exterior and half interior,rather than diaphoresis relieving superficies union kiyosato.The theory of‘half exterior and half interior’haven’t been proposed explicitly by ZHANG Zhong-jing in Shanghan Lun,but created by later physicians in the interpretation of Shanghan Lun,which was used to explain the location and pathogenesis of Shaoyang disease.However,after careful scrutiny,if the concept of‘half exterior and half interior’is equal to Shaoyang disease,it is far from the original meaning of ZHANG Zhong-jing.The concept of‘half exterior and half interior’should be combined with the dynamic development of clinical diseases.Additionally,‘half exterior and half interior syndrome’should be distinguished from the concepts of comorbidity,complication,exterior and interior diseases,so as to expand the scope of‘half exterior and half interior syndrome’theoretical research and guide clinical application.