以病案案例观解读《伤寒论》第28条的思考
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摘要
[目的]研究《伤寒论》第28条所述病证的病因、病机与证候,推演张仲景诊疗过程,探讨桂枝去桂加茯苓白术汤的组方机理。[方法]通过分析相关伤寒条文及后世注家注释,结合临床湿病致病过程和治疗原则及相关药物的药性与功效分析仲景《伤寒论》第28条处方立意。[结果]《伤寒论》第28条所述病证的病因病机为素有内湿,感受外湿伤及太阳;后因汗法不当及误用下法使内外之湿相合,湿阻于中,壅遏阳气。治疗上则按照"通阳不在温,而在利小便"之理而选方及加减用药。[结论]《伤寒论》第28条所述病证是对太阳中湿证误诊所致的变证,而非太阳中风证变证或太阳病类似证。
[Objective] To study the etiology, pathogenesis and syndromes of the disease mentioned in Article 28 of Treatise on Febrile Diseases, deduce the process of ZHANG Zhongjing's diagnosis and treatment, and explore the mechanism of Guizhi Qugui Jia Fuling Baizhu Decoction. [Method] By analyzing the relevant provisions of typhoid fever and the annotations of later annotators, and combining with the pathogenic process and treatment principle of clinical wet disease and the medicinal properties and efficacy of related drugs, the prescription intention of Article 28 of Zhongjing's Treatise on Febrile Diseases was analyzed. [Result] The etiology and pathogenesis of the disease mentioned in Article 28 of Treatise on Febrile Diseases are internal dampness, feeling traumatic dampness involving. Later, due to improper sweating and misuse of the method, the internal and external dampness is combined, dampness is blocked in the middle, and the Yang is blocked. In the treatment, according to the principle of "Tongyang is not to warm, but piss", the prescription is selected and the medication is added or subtracted. [Conclusion] The symptoms mentioned in Article 28 of Treatise on Febrile Diseases are alterations caused by mistaken diagnosis of dampness syndrome of Taiyang, rather than Taiyang apoplexy syndrome or similar syndrome of Taiyang disease.
[Objective] To study the etiology, pathogenesis and syndromes of the disease mentioned in Article 28 of Treatise on Febrile Diseases, deduce the process of ZHANG Zhongjing's diagnosis and treatment, and explore the mechanism of Guizhi Qugui Jia Fuling Baizhu Decoction. [Method] By analyzing the relevant provisions of typhoid fever and the annotations of later annotators, and combining with the pathogenic process and treatment principle of clinical wet disease and the medicinal properties and efficacy of related drugs, the prescription intention of Article 28 of Zhongjing's Treatise on Febrile Diseases was analyzed. [Result] The etiology and pathogenesis of the disease mentioned in Article 28 of Treatise on Febrile Diseases are internal dampness, feeling traumatic dampness involving. Later, due to improper sweating and misuse of the method, the internal and external dampness is combined, dampness is blocked in the middle, and the Yang is blocked. In the treatment, according to the principle of "Tongyang is not to warm, but piss", the prescription is selected and the medication is added or subtracted. [Conclusion] The symptoms mentioned in Article 28 of Treatise on Febrile Diseases are alterations caused by mistaken diagnosis of dampness syndrome of Taiyang, rather than Taiyang apoplexy syndrome or similar syndrome of Taiyang disease.
引文
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