《伤寒论》喘与汗关系浅探

An analysis of the relationship between dyspnea and sweating in Shanghan Lun

《伤寒论》对喘证有详细的阐述,许多提及喘证的条文中都有关于“有汗”“无汗”的论述,包括“太阳病麻黄汤证和小青龙汤证的无汗而喘、桂枝加厚朴杏子汤证的汗出而喘、阳明病承气汤证的喘而汗出、太阳与阳明合病葛根芩连汤证的喘而汗出”,其在对喘的症状进行描述时,汗的特点显得尤为重要,如麻黄汤证无汗而喘、麻杏石甘汤证的喘伴汗出黏腻不畅、阳明病的腹满而喘伴汗出连续量多、厥阴证的微喘不休伴绝汗。文章通过对麻黄汤证、麻杏石甘汤证、桂枝加厚朴杏子汤证、大承气汤证、葛根芩连汤证中的喘证及所伴随的不同汗出特点的论述总结出喘与汗的关系在肺和气与津之间,肺失宣降既能出现气机逆乱的喘,又可以表现出汗出异常。当气的运行出现障碍时,体内津液的输布排泄也会出现问题,喘是气机运行障碍的外在表现,汗出异常是津液排泄出现问题的外在表现,总的来说喘与汗是相互联系的,其内在的病机是相同的,只是表现形式不同,这是中医整体观念的体现,也同样给临床诊疗带来启发,当无法通过主症判断其病机时,可以通过有特点的兼症辅助判断。喘证是一种急性发作的病证,但其病机却是复杂多样的,观察是否汗出以及汗出特点可以帮助我们尽快判断喘之病机,从而给予及时有效的治疗。

Shanghan Lun(《伤寒论》)has a detailed description of dyspnea syndrome.There are discussions on sweating and no sweating in the relevant provisions of dyspnea syndrome,including dyspnea without sweating in the Mahuang decoction syndrome(麻黄汤证)of Taiyang disease(太阳病)and the Xiaoqinglong decoction syndrome(小青龙汤证),dyspnea with sweating in the Guizhi Houpo Xingzi decoction syndrome(桂枝加厚朴杏子汤证),dyspnea with fullness sensation in the Chengqi decoction syndromeS(承气汤证)of Yangming disease(阳明病),dyspnea with fullness sensation in the Gegen Qinlian decoction syndrome(葛根芩连汤证)of Taiyang and Yangming disease.When describing the symptoms of dyspnea,the characteristics of sweating are particularly important.There are dyspnea without sweating of the Mahuang decoction syndrome,dyspnea with sticky sweating of the Maxing Shigan decoction syndrome(麻杏石甘汤证),dyspnea with fullness sensation in the stomach with a lot of continuous sweating of Yangming disease,and continuously slight dyspnea without sweating of the Jueyin syndrome(厥阴证).In this article,the discussion of dyspnea syndromes and its accompanying sweating characteristics in the Mahuang decoction syndrome,the Maxing Shigan decoction syndrome,the Guizhi Houpo Xingzi decoction syndrome,the Dachengqi decoction syndrome,the Gegen Qinlian decoction syndrome are summarized.The conclusion is drawn that the relationship between dyspnea and sweating is between lung and Qi(气)and fluid.Impairment of dispersing and descending function of the lung can cause both dyspnea of Qi disorder and abnormal sweating.When there is an obstacle to the operation of Qi,the transfusion of body fluid will also have problems.Dyspnea is the external manifestation of Qi dysfunction,and abnormal sweating is the external manifestation of body fluid problems.Dyspnea and sweating are related to each other,and their inherent pathogenesis is the same,but their manifestations are different,which is not only the embodiment of the overall concept of TCM,but also brings inspiration to clinical diagnosis and treatment.When it is impossible to judge the pathogenesis by the main symptoms,it can be judged by the characteristic concurrent symptoms.Dyspnea syndrome is a kind of acute attack syndrome,but its pathogenesis is complex and diverse,and observing whether sweating and sweating characteristics can help us to judge the pathogenesis of dyspnea as soon as possible,so as to make timely and effective treatment.