仲景攻泻救急思想初探--从少阴三急下证谈起

ZHANG Ji’s thought of using catharsis method in urgent condition--discussing from the Shaoyin San Jixia symptoms

《伤寒论》少阴三急下证所描述的病证,相当于当今肝肾功能衰竭的表现。而古人面对此危重病证,常用攻泻法以改善保全。攻泻法是古人拯危救急的必要手段,而历来学者以为少阴三急下证运用大承气汤,则此证必以阳明腑实为主导。文章力驳其非,证实其是少阴病证自然发展的危重阶段,病本在肾,而与阳明燥热结实无关,并阐释其中机制及选方用药的依据等。攻泻救急之法运用于诸如肝肾功能衰竭的危重病证是古代常用的治疗措施,类似于现代的“透析”,对保护剩余肝肾单位有良好疗效。文章总结张机(字仲景)选方用药有两大基准点:一是根据正气状态,二是根据病势缓急。而惟于患者弥留之际,后者当为主导外,其他情况甚至急危重症下,前者应成为选方用药的根本出发点。攻泻救急之法虽不能完全治愈疾病,但可以缓解病情,挽留生命,更为重要的是,需要看清事情的本质,打破传统观念的束缚,拓宽临床诊疗思路。

The Shaoyin San Jixia symptoms(少阴三急下证)were described in Shanghan Lun(《伤寒论》),are equivalent to the manifestations of liver and kidney failure today.In the face of this critical illness,the ancients often used the method of catharsis to improve preservation.The method of catharsis was a necessary means for the ancients to save the crisis,and scholarsT have always believed that if the Shaoyin San Jixia symptoms ware treated with the Dachengqi decoction(大承气汤),this symptom must be dominated by Yangming(阳明)viscera deficiency as the guide.This paper refutes the wrongdoing,confirms that it is a critical stage of the natural development of oligo-negative disease,the root of the disease is in the kidney,and has nothing to do with Yangming dry heat and solidity,and explains the mechanism and the basis for drug selection.The application of the method of using catharsis method in urgent condition to critical diseases such as liver and kidney failure is a commonly used treatment measure in ancient times,similar to modern dialysis,which has a good effect on protecting the remaining liver and nephrons.The author concludes that there are two benchmark points for ZHANG Ji’s prescription medication:one is based on the state of healthy Qi(气),and the other is based on the urgency of the disease.However,when the patient will die,the latter should be the leader,and in other situations and even acute and critical diseases,the former should become the fundamental starting point for the selection of medications.Although the method of using catharsis method in urgent condition cannot completely cure the disease,to alleviate the disease and save life,more importantly,we must see the essence of the matter,break the shackles of traditional concepts,and broaden the clinical diagnosis and treatment ideas.