论仲景疑难条文议癫痫、虚狂可从外感辨治

Analysis of Zhang Zhongjing's difficult articles in Synopsis of Golden Chamber on the differential treatment of epilepsy and insanity from external causes

《金匮要略》“阴气衰者为癫,阳气衰者为狂”及其所在条文令人费解,许多医家依据金元以来的理论和语言习惯,从癫病和阳狂的角度注解,有违张仲景的本意。文章首先基于“哭”“客”在汉代读音相近等原因,提出条文中“邪哭”表示“邪客”,即表示邪气入侵;其次考证出汉唐医者认为风邪是精神疾病的病因,主要从外感病的角度论治癫、狂。最终得出结论:条文中阴阳若指代表里,则“癫”为痫病,“狂”为阴狂(本虚标实);阴阳若指代血、气,则“癫”“狂”均泛指心神失常。

The article"Dian when Yin Qi fails,and Kuang when Yang Qi fails"in Synopsis of the Golden Chamber is beyond comprehension,and many medical scholars annotate it from the perspectives of depressive psychosis and yang manic psychosis according to the theories and language habits since the Jin and Yuan Dynasties,which goes against the original intention of Zhang Zhongjing.To solve this problem,firstly,based on the similar pronunciation of"Ku"and"Ke"in the Han Dynasty,the article proposes that"Xie Ku"means"Xie Ke",which means the invasion of evil Qi.Secondly,it is verified that physicians during the Han and Tang dynasties believed that wind pathogen was the cause of mental illnesses,so these doctors treated epilepsy and insanity mainly from the perspective of exogenous diseases.Finally,the conclusion is that in this article,if"Yin"and"Yang"refer to the interior,"Dian"is epilepsy and"Kuang"is yin manic psychosis(deficiency in origin and excess in superficislity);if"Yin"and"Yang"refer to blood and Qi,"Dian"and"Kuang"both refer to mental disorders in general.