《金匮要略·痰饮咳嗽病》第35条-第40条证治
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摘要
支饮病机为胸阳不足,饮留膈间(及胃),上凌心肺,肺失宣降。小青龙汤方证属太阳表实证,内有寒饮,证候病机与方证病机相宜,投小青龙汤以散外寒,逐内饮;小青龙汤服后,表证去,因患体素虚而引发里饮冲逆,遂以桂苓五味甘草汤,敛气平冲,降逆缓急;服桂苓五味甘草汤后,冲气平,匿伏在肺的寒饮复现,于上方去桂枝,加干姜、细辛散寒化饮、止咳泻满;服苓甘五味姜辛汤后,咳满即止,饮消未尽而犯胃致呕吐、不渴、苦眩冒,于上方加半夏降逆止呕;服苓甘五味姜辛夏汤后,水去呕止,水饮行散外溢见身体浮肿,于上方加杏仁宣肺利水;五诊过后,因连续服用温药或者病久饮邪郁而化热,见面热如醉状,又饮消未尽,在上方基础上加大黄清泻胃热。经过六次诊治,里邪渐出表,由(太)阴渐转阳(明),是向愈之候。从《金匮要略·痰饮咳嗽病》第35条-第40条可见仲景运用辨证论治的原则性与灵活性,既治病求本,又要照顾其标,证变法变,药随证转,随机应变。
The pathogenesis of fluid retention in the thorax is that deficient yang in the chest makes water retention stay in the thorax(involving the stomach) attacking the heart and lung failing to dissipate and descend. The syndrome in Minor Green Dragon Decoction belongs to taiyang exterior excess syndrome with cold retention inside the body,pathogenesis of syndrome and syndrome pathogenesis in the formula are the same,so Minor Green Dragon Decoction can be used to remove external cold and internal fluid retention. After taking Minor Green Dragon Decoction,exterior syndrome is removed. If the patient is constantly weak,interior retention ascends adversely,Decoction of Cinnamon Twig and Poria and Fructus Schisandrae Chinensis and Licorice can be used to astringe qi,descend adversity and relieve emergency. After taking Decoction of Cinnamon Twig and Poria and Fructus Schisandrae Chinensis and Licorice,ascending qi can be descended,if latent cold retention in the chest reoccurs,Guizhi(Cinnamon Twig) in the above formula should be removed,while Ganjiang(Rhizoma Zingiberis) and Xixin(Radix et Rhizoma Asari) can be added to disperse cold and resolve retention,arrest cough and purge fullness. After taking Decoction of Poria and Licorice and Fructus Schisandrae Chinensis and Rhizoma Zingiberis and Radix et Rhizoma Asari,cough and fullness will be removed,if the left retention attacks the stomach and leads to vomiting,no thirst,bitter mouth,dizziness and vertigo,Banxia(Rhizoma Pinelliae) can be added into the above formula to lower the adverse flow of qi and stop vomiting. After taking Decoctionof Poria and Licorice and Fructus Schisandrae Chinensis and Rhizoma Zingiberis and Radix et Rhizoma Asari and Rhizoma Pinelliae,if edema appears,Xingren(Semen Armeniacae Amarum) can be added into the above formula to disperse lung-qi and promote dieresis.After receiving the above treatment of five stages,if stagnated heat due to taking warm medicine continuously or long-time disease leading to stagnation appears manifested as hot face like being drunk,it shows that there is still some left fluid retention,so Dahuang(Radix et Rhizoma Rhei) can be added into the above formula to purge stomach heat. After six times' diagnosis and treatment,interior pathogenic factor reaches to the surface step by step from taiyin meridian to yangming meridian,which is the sign to recover. According to articles from No. 35 to No. 40 in Essentials from the Golden Cabinet,it can be seen that Zhang Zhong-jing's principle and flexibility of using treatment based on syndrome differentiation. He not only considers the primary aspect to treat the disease,but also takes cares of the second aspect. His therapy changes with the syndrome,and medicine changes with the syndrome. He really adjusts everything to changing circumstances.
The pathogenesis of fluid retention in the thorax is that deficient yang in the chest makes water retention stay in the thorax(involving the stomach) attacking the heart and lung failing to dissipate and descend. The syndrome in Minor Green Dragon Decoction belongs to taiyang exterior excess syndrome with cold retention inside the body,pathogenesis of syndrome and syndrome pathogenesis in the formula are the same,so Minor Green Dragon Decoction can be used to remove external cold and internal fluid retention. After taking Minor Green Dragon Decoction,exterior syndrome is removed. If the patient is constantly weak,interior retention ascends adversely,Decoction of Cinnamon Twig and Poria and Fructus Schisandrae Chinensis and Licorice can be used to astringe qi,descend adversity and relieve emergency. After taking Decoction of Cinnamon Twig and Poria and Fructus Schisandrae Chinensis and Licorice,ascending qi can be descended,if latent cold retention in the chest reoccurs,Guizhi(Cinnamon Twig) in the above formula should be removed,while Ganjiang(Rhizoma Zingiberis) and Xixin(Radix et Rhizoma Asari) can be added to disperse cold and resolve retention,arrest cough and purge fullness. After taking Decoction of Poria and Licorice and Fructus Schisandrae Chinensis and Rhizoma Zingiberis and Radix et Rhizoma Asari,cough and fullness will be removed,if the left retention attacks the stomach and leads to vomiting,no thirst,bitter mouth,dizziness and vertigo,Banxia(Rhizoma Pinelliae) can be added into the above formula to lower the adverse flow of qi and stop vomiting. After taking Decoctionof Poria and Licorice and Fructus Schisandrae Chinensis and Rhizoma Zingiberis and Radix et Rhizoma Asari and Rhizoma Pinelliae,if edema appears,Xingren(Semen Armeniacae Amarum) can be added into the above formula to disperse lung-qi and promote dieresis.After receiving the above treatment of five stages,if stagnated heat due to taking warm medicine continuously or long-time disease leading to stagnation appears manifested as hot face like being drunk,it shows that there is still some left fluid retention,so Dahuang(Radix et Rhizoma Rhei) can be added into the above formula to purge stomach heat. After six times' diagnosis and treatment,interior pathogenic factor reaches to the surface step by step from taiyin meridian to yangming meridian,which is the sign to recover. According to articles from No. 35 to No. 40 in Essentials from the Golden Cabinet,it can be seen that Zhang Zhong-jing's principle and flexibility of using treatment based on syndrome differentiation. He not only considers the primary aspect to treat the disease,but also takes cares of the second aspect. His therapy changes with the syndrome,and medicine changes with the syndrome. He really adjusts everything to changing circumstances.
引文
[1]吕志杰.仲景方药古今应用[M].2版.北京:中国医药科技出版社,2016:8.
[2]中国中医科学院研究生班.《金匮要略》注评[M].北京:中国中医药出版社,2011:1.
[3]何任.金匮要略校注[M].北京:人民卫生出版社,2013:114.
[4]王玉兴.金匮要略三家注[M].北京:中国中医药出版社,2013:10.
[5]李克光.金匮要略译释[M].2版.上海:上海科学技术出版社,2010:2.
[6]毛进军.思考经方:《伤寒论》六经方证病机辨治心悟[M].北京:中国中医药出版社,2014:7,146.
[7]郑振达.学习《金匮要略·痰饮咳嗽篇》28-33条的体会[J].陕西中医函授,1989,8(1):28-31.
[8]沈凌波.何任教授论痰饮[J].浙江中医药大学学报,2009,33(2):238-239.
[9]景选龙,李龙山,王茂锦,等.仲景方应用姜辛味探析[J].亚太传统医药,2016,12(22):73-74.
[10]唐容川.金匮要略浅注补正[M].太原:山西科学技术出版社,2013:5.
[2]中国中医科学院研究生班.《金匮要略》注评[M].北京:中国中医药出版社,2011:1.
[3]何任.金匮要略校注[M].北京:人民卫生出版社,2013:114.
[4]王玉兴.金匮要略三家注[M].北京:中国中医药出版社,2013:10.
[5]李克光.金匮要略译释[M].2版.上海:上海科学技术出版社,2010:2.
[6]毛进军.思考经方:《伤寒论》六经方证病机辨治心悟[M].北京:中国中医药出版社,2014:7,146.
[7]郑振达.学习《金匮要略·痰饮咳嗽篇》28-33条的体会[J].陕西中医函授,1989,8(1):28-31.
[8]沈凌波.何任教授论痰饮[J].浙江中医药大学学报,2009,33(2):238-239.
[9]景选龙,李龙山,王茂锦,等.仲景方应用姜辛味探析[J].亚太传统医药,2016,12(22):73-74.
[10]唐容川.金匮要略浅注补正[M].太原:山西科学技术出版社,2013:5.