从兵法角度探析《伤寒杂病论》“重攻”治疾思想

An Analysis of the"Severe Elimination"Disease Treatment Thought in Treatise on Cold Damage and Miscellaneous Diseases from the Angle of Military Art

兵法万变不离其宗,皆以攻击与打败敌人为目标、守护己方安全为前提,治病救人也与之相似,遣方用药意在祛除病邪,同时也要顾护正气,从而使病人恢复健康。兵法中的攻守与中医的攻法、补法有相通之处。张仲景受时代影响,较为注重“攻”法,即以祛邪为主。对于邪实之证,如阳明腑实证、痞证、结胸、水气等,有邪必攻。感受外邪,速攻速决,如治疗外感的方剂随着病邪由太阳到阳明的深入而变换,由表及里依次为麻黄汤、大青龙汤、麻杏石甘汤、白虎汤。此外,进攻重速,收兵也需及时,中病即止,张仲景多次提到“停后服”“止后服”,即体现了该思想。在治疗虚实夹杂证时,张仲景多以祛除病邪为主,扶正补虚为辅,且补虚目的并非补其不足,而是为了使机体能承受药物的攻伐之力,补虚多是在病邪祛除后进行,如十枣汤服后需“糜粥自养”。当正气犹存,可耐受药力时,更是纯攻无守,如抵当汤。纯攻非长久之计,当中病即止。兵法思想与中医学有互通之处,可借兵法理解历代中医学说的理、法、方、药,但二者也存在差异,应有所取舍地学习与借鉴。

All changes in military art are based on the premise of attacking and defeating the enemy and protecting their own security.Treating diseases and saving people is also similar to it,and the purpose of adopting drugs and formulas is not only to remove pathogenic factors,but also to protect the healthy qi,so as to restore the patient to health.There are some similarities between attack and defense in the military art and elimination and tonifying methods in TCM.Influenced by the times,Zhang Zhongjing paid more attention to the"elimination"method,that is,to remove pathogens.For the syndromes of pathogenic excess,such as yang brightness fu-organ excess syndrome,stuffiness syndrome,chest bind,water qi,etc.,which are all removed by using elimination.For exogenous pathogens,quick elimination method is used.For example,the formulas for the treatment of exogenous diseases are Ephedra Decoction,Major Green Drag-on Decoction,Ephedra and Apricot Kernel and Gypsum and Licorice Decoction,and White Tiger Decoction in turn with the pathogens from the greater yang meridian in the exterior to the yang brightness meridian in the interior.In addition,the troops also need to be called off timely.As long as the disease is improved,the treatment should stop,which Zhang Zhongjing repeatedly mentioned and reflects the idea.For syndrome of deficiency and excess in combination,Zhang Zhongjing mainly used elimination method supplemented with de-fense,that is,to remove the pathogenic factors mainly,supplemented with tonifying deficiency.The purpose is not to supplement its defi-ciency,but to make the body withstand the power of the drug,and tonifying deficiency is carried out after the removal of the pathogenic factors.For example,after taking Ten Jujubes Decoction,"deeply-cooked porridge is needed for self-nourishing".When healthy qi still exists which can prevent the stomach qi from drug damage,pure elimination method is used,for example,Resistance Decoction can be a-dopted.Pure elimination is not a long-term solution,as long as the disease is improved,treatment should stop as quickly as possible.There are some similarities between the thought of military art and TCM.We can understand the theory,law,formula and medicine of TCM through military art,but there are also differences between them,so we should learn from it selectively.