《伤寒论》脏结辨治解析

Analysis of differentiation and treatment of dirty knot in Shanghan Lun

基于《伤寒论》相关原文分析提出,脏结的脉症表现具有胸腹局部硬痛、有形包块产生、长期胃肠功能失调、脉小细沉紧的特点,以阳虚寒凝,阴寒结聚于内,脏腑气血涩滞不通为辨证要点,相较于胃肠道内宿食糟粕积聚而成的腑结,脏结乃邪附结于脏器血络间,难以攻下法除邪;原文虽未明言,但《伤寒论》三阴病篇有适用于脏结的治法,分别为:太阴虚在气分实在血分的治以温阳散寒活血通络法;少阴阳虚寒凝血络治以温阳通脉加入血分破阴结;厥阴血虚寒凝的治以温阳养血通络。由外感六淫营卫郁滞、实邪结滞腑气不通的邪在气分到阳虚邪气入里向血分转移,再到正气亏虚邪气内结于血络,体现了脏结形成发展的动态性,其辨治思路方法对恶性肿瘤具有指导意义:恶性肿瘤依据阳气的盛衰判断其发病阶段,邪结在腑者以破积消结为主驱邪外出,截断病程;在脏者温阳、通络、养血为基本治法;已形成肿瘤的患者在手术及放化疗治疗前应用脏结不可攻的辨治依据进行病情评估,促进攻邪手段的准确应用,避免过度治疗,提高患者生活质量。

Based on the original analysis of the relevant original text in Shanghan Lun,it is proposed that the pulse symptoms of dirty knot are characterized by local hard pain in chest and abdomen,tangible mass,long-term gastrointestinal dysfunction,and small,thin and tight pulse.The key points of syndrome differentiation are yang deficiency and cold coagulation,yin and cold accumulation in the interior,and stagnation of qi and blood in viscera.Compared with the fu-organ knot accumulated by eating dregs in the gastrointestinal tract,dirty knot is an evil attached to the blood collaterals of organs,which is difficult to attack and remove evil.Although the original text is not explicit,Shanghan Lun has the treatment methods suitable for dirty knot,which are as follows:Taiyin deficiency is treated by warming yang,dispelling cold,promoting blood circulation and dredging collaterals;The treatment of deficiency of yin and yang,deficiency of cold and coagulation of collaterals is to warm yang and dredge veins and add blood to break the yin knot;The treatment of jue yin blood deficiency and cold coagulation is warming yang,nourishing blood and dredging collaterals.From exogenous six evils to stagnation of health and stagnation of excess pathogens to stagnation of fu-qi,the pathogens with stagnation of fu-qi are transferred from qi to yang deficiency and then to blood,and then to deficiency of vital qi and stagnation of blood in collaterals,which reflects the dynamic formation and development of dirty knots.Its thinking and methods of diagnosis and treatment are of guiding significance to malignant tumors:malignant tumors judge their onset stage according to the rise and fall of yang,and those with stagnation in fu-organs mainly drive away evil spirits and cut off the course of disease;warming yang,dredging collaterals and nourishing blood are the basic treatments for dirty people;Before surgery and radiotherapy and chemotherapy,patients who have formed tumors should be evaluated on the basis of syndrome differentiation and treatment,so as to promote the accurate application of pathogenic means,avoid overtreatment and improve the qualityof life of patients.