《伤寒论》身重病因病机

Study on the Etiology and Pathogenesis of Heavy Body in Treatise on Cold Damage Diseases

《伤寒论》中的身重病机有风寒外束,里热炽盛,气机郁滞,水湿不化,阳气受损,精气亏虚等,其最后转归均为经脉受邪,失于濡养。风寒外束,阳气闭塞,寒性收引,表闭不开,阳郁不伸,四肢经脉失养,则发为身重,用大青龙汤解表清热;阳明里热炽盛,伤津耗气,周身经脉失于濡养则身重,用大承气汤破实攻满,或用白虎汤清阳明之热;少阳枢机不利,气机失于条达,运行不畅,经脉失养,发为身重,用柴胡加龙骨牡蛎汤疏通三焦气机,驱阳达表;少阴病肾阳虚损,水湿不化,浸于四肢,导致四肢沉重疼痛,用真武汤温阳利水;表邪不解误用灸法,表闭阳郁,火性炎上,上实下虚,故见下肢沉重麻木,用肉桂、附子等温通下焦阳气,龙骨、牡蛎等潜镇在上之浮阳,表邪不解误用下法,阳气受损,经脉失养,可见身体困重,治疗当以补益扶正为主,方用小建中汤或补中益气汤;伤寒后正气亏虚,行房事更耗伤精气,四肢失于濡养,形气两伤,故身重,治疗应以扶正为主,方用烧裩散。

In Treatise on Cold Damage Diseases,the pathogeneses of heavy body include wind-cold external restraint,excessive internal heat,qi movement stagnation,water dampness failing to transform,damaged yang,and deficient essential qi.All the final outcomes will be towards meridians attacked by pathogens,with loss of nutrients.For wind-cold external restraint,yang qi blockage,coldness absorption,closed exterior,yang stagnation,limb meridians with loss in nourishment,leading to heavy body,Major Green Dragon Decoction is used to release the exterior and clear heat.For excessive inner heat in the yang brightness meridian,fluid injury and qi consumption,body meridians with loss of nutrients in meridians,leading to heavy body,Major Purgative Decoction is used to remove excess and fullness;or White Tiger Decoction is used to clear heat in the yang brightness meridian.For unfavorable lesser yang axis,qi movement failing to flow,body meridians with loss of nutrients,leading to heavy body,Bupleurum plus Os Draconis and Oyster Shell Decoction is used to dredge triple energizer qi movement,drive yang to the exterior.For lesser yin disease with kidney yang deficiency,water dampness immersed in the limbs,resulting in limbs heavy pain,True Warrior Decoction is used to warm yang and induce diuresis.For exterior pathogens mistreated with moxibustion method,closed exterior,yang depression,fire inflammation,upper excess,lower deficiency,leading to lower limbs′ heavy numbness,Rougui(Cortex Cinnamomi),Fuzi(Radix Aconiti Lateralis Preparata),etc.can be used to warm and dredge yang qi in the lower energizer;Longgu(Os Draconis),Muli(Concha Ostreae),etc.can be used to settle floating yang.For exterior pathogens mistreated with purgative method,damaged yang,loss of nutrients in meridians,leading to heavy body,the treatment should focus on tonifying and strengthening healthy qi,so Minor Center-Fortifying Decoction or Center-Supplementing and Qi-Boosting Decoction can be used.After being attacked by wind and cold,deficient healthy qi,more healthy qi consumption after the sexual intercourse,causing shape and qi damage,leading to heavy body,the treatment should focus on strengthening healthy qi.