论《伤寒论》第29条、第30条
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摘要
《伤寒论》第29条言:"……少与调胃承气汤",《伤寒论》第213条言:"阳明病,其人多汗,以津液外出,胃中燥,大便必硬,硬则谵语,小承气汤主之。若一服谵语止,更莫复服。"所以第30条中"阳明内结,谵语,烦乱"无论是从仲景原文看还是临床上看都应是承气汤。根据第30条的变化,29条中的"咽中干,烦躁"症状和"胃气不和,谵语"之证是不能分开的,所以《伤寒论》第29条应该为"伤寒脉浮,自汗出,小便数,心烦,微恶寒,脚挛急,反与桂枝汤,欲攻其表,此误也,得之便厥。若胃气不和,咽中干,烦躁,谵语者,少与调胃承气汤。吐逆者,作甘草干姜汤与之,以复其阳。若厥愈足温者,更作芍药甘草汤与之,其脚即伸。若重发汗,复加烧针者,四逆汤主之。"
In Treatise on Cold Damage Diseases,No. 29 article reads, " ——a small dose of Stomach-Regulating and Purgative Decoction can be used". No. 213 article reads, " Yangming disease is characterized by perspiration,body fluid going out of body,dry stomach,hard stool,delirium. Minor Bupleurum Decoction should be used. If delirium stops,the patient should not take it again. " Therefore,in No. 30 Article, " Yangming disease marked by delirium,and irritability" should use Purgative Decoction based on both in the original text of Zhang Zhong-jing and in clinical practice. According to changes in No. 30 article,in No.29 article,the symptoms of dry throat and irritation and " discordant stomach and delirium" in No. 29 article can not be separated. So No. 29 Article in Treatise on Cold Damage Diseases should be stated as follows: Cold damage leads to floating pulse,self-sweating,frequent urination,irritability,slightly aversive cold,foot contracture. If Cinnamon Twig Decoction is used to relieve exterior symptoms,it will be a mistake. If the patient takes it,he will lose consciousness. For vomiting,Licorice and Rhizoma Zingiber Decoction should be used to nourish yang qi. If convulsion is healed and foot temperature is warmed,Peony and Licorice Decoction should be used,then the patient' s feet can stretch out. If the patient has serious sweating and high fever,Frigid Extremities Decoction can be used.
In Treatise on Cold Damage Diseases,No. 29 article reads, " ——a small dose of Stomach-Regulating and Purgative Decoction can be used". No. 213 article reads, " Yangming disease is characterized by perspiration,body fluid going out of body,dry stomach,hard stool,delirium. Minor Bupleurum Decoction should be used. If delirium stops,the patient should not take it again. " Therefore,in No. 30 Article, " Yangming disease marked by delirium,and irritability" should use Purgative Decoction based on both in the original text of Zhang Zhong-jing and in clinical practice. According to changes in No. 30 article,in No.29 article,the symptoms of dry throat and irritation and " discordant stomach and delirium" in No. 29 article can not be separated. So No. 29 Article in Treatise on Cold Damage Diseases should be stated as follows: Cold damage leads to floating pulse,self-sweating,frequent urination,irritability,slightly aversive cold,foot contracture. If Cinnamon Twig Decoction is used to relieve exterior symptoms,it will be a mistake. If the patient takes it,he will lose consciousness. For vomiting,Licorice and Rhizoma Zingiber Decoction should be used to nourish yang qi. If convulsion is healed and foot temperature is warmed,Peony and Licorice Decoction should be used,then the patient' s feet can stretch out. If the patient has serious sweating and high fever,Frigid Extremities Decoction can be used.
引文
[1]李宇铭.论《伤寒论》第29条与第30条方证原意[J].河南中医,2012,32(5):531-532.
[2]熊曼琪.伤寒学[M].北京:中国中医药出版社,2007:39.
[3]成无己.伤寒论辑义[M].北京:学苑出版社,2011:65.
[4]尤怡.伤寒贯珠集[M].北京:中医古籍出版社,1998:29-30.
[5]许慎.说文解字[M].郑州:中原农民出版社,2008:165.
[6]左丘明.春秋左传[M].南昌:江西美术出版社,2013:86.
[7]王焘.外台秘要[M].北京:华夏出版社,2009:142.
[8]李宇铭.《伤寒论》第29条初见证研究[J].河南中医,2012,32(7):793.
[2]熊曼琪.伤寒学[M].北京:中国中医药出版社,2007:39.
[3]成无己.伤寒论辑义[M].北京:学苑出版社,2011:65.
[4]尤怡.伤寒贯珠集[M].北京:中医古籍出版社,1998:29-30.
[5]许慎.说文解字[M].郑州:中原农民出版社,2008:165.
[6]左丘明.春秋左传[M].南昌:江西美术出版社,2013:86.
[7]王焘.外台秘要[M].北京:华夏出版社,2009:142.
[8]李宇铭.《伤寒论》第29条初见证研究[J].河南中医,2012,32(7):793.
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