从阳明病理法探讨竹叶石膏汤证

Study on the Syndrome of Lophatherum and Gypsum Decoction from Treating Principle and Methods of Yang Brightness Diseases

竹叶石膏汤方载于《伤寒论·辨阴阳易差后劳复病脉证并治》中,但其并非“伤寒差后劳复”的专方,而为阳明病类方。其证可以看作是白虎汤证由经入腑,由实转虚的中间阶段,此时,阳明经腑同病,既有阳明经无形邪热,又有阳明胃腑阴伤气逆。在此阶段,随着阴液的不断损伤,疾病可能发生两类转归:若邪热鸱张,进一步损伤阳明肠腑津液,化燥成实,则可转为承气汤类证;若邪热持续耗损胃阴,则会进展为大气上逆之麦门冬汤证,甚至进一步由实转虚,发展为沙参麦冬汤证、益胃汤证。临床上,对于各种外感发热类疾病,凡属阳明热盛兼气阴两虚者,不必拘于是否为“差后劳复”,均可使用竹叶石膏汤化裁治疗;同时,对于各类内伤杂病,如糖尿病、甲状腺功能亢进、睡眠障碍、更年期综合征、热射病等疾病,亦可根据病机使用竹叶石膏汤化裁治疗。

Lophatherum and Gypsum Decoction can be found in Treatise on Cold Damage Diseases,but it is not a specialized formula for "disease relapse due to overstrain".In fact,it is a formula for yang brightness diseases,which can be seen as the intermediate stage of the syndrome of White Tiger Decoction from the meridian to the viscera,from excess to deficiency.At this stage,the yang brightness meridian and viscera are all affected by the same disease.There are both intangible pathogenic heat in the yang brightness meridian and yin damage and qi counterflow in the yang brightness stomach.With the continuous damage of yin fluid,the disease may undergo two types of outcomes:if the pathogenic heat spreads and further damages the yang brightness intestinal and body fluids,transforming dryness into excess,it can be transformed into the syndrome of Major Purgative Decoction.If the pathogenic heat continues to consume stomach yin,it may further develop into the syndrome of Ophiopogon Decoction with qi counterflow,and even further develop from excess to deficiency into the syndrome of Radix Adenophorae seu Glehniae and Ophiopogon Decoction,or the syndrome of Stomach-Replenishing Decoction.In clinical practice,for various external febrile diseases,those who belong to the syndrome of excessive yang brightness heat and deficiency of both qi and yin do not need to be restricted to "relapse due to overstrain",and can be treated with Lophatherum and Gypsum Decoction.At the same time,for various internal injuries and miscellaneous diseases,such as diabetes,hyperthyroidism,sleep disorders,climacteric syndrome,heat stroke and other diseases,Lophatherum and Gypsum Decoction can also be used flexibly according to the exact pathogenesis.