伤寒论评话 第22章 桂枝建中治表里,随经过经属传变——新传变方式—“经传”的提出  

Discussion of Shanghanlun Chapter 22 Guizhi Decoction and Xiaojianzhong Decoction Treatment of Exterior Syndrome and Interior Syndrome, "Tranmission with the Channel" and "Tranmission through the Channel" Belonging to the Transmission——Proposition of the

作　　者：梁华龙[1] 

机构地区：[1]河南中医学院,河南郑州450046

出　　处：《中医学报》2013年第10期1468-1471,共4页Acta Chinese Medicine

基　　金：国家中医药管理局专项课题(编号:2009-0001);河南省科技厅基金项目(编号:496060303)

摘　　要：目的:通过对桂枝建中治表里,随经过经属传变机制的研究,提出新传变方式—"经传"。方法:对《伤寒论》第100条-第109条原文进行分析。结果:①桂枝汤和小建中汤都具备表里同治的功能,但其侧重点有所不同,桂枝汤解表散风寒为主,兼有建中和阴阳的作用,侧重于表;而小建中汤以健补中气为主,兼有解肌散风寒的功能,侧重于里。两者补中解表的药理基本相同。所以中焦虚弱,外感风寒的表里同病,初期感邪,以表证为主者,用桂枝汤治疗,譬如太阴中风;中虚较重,又感外邪,以里证为主者,治疗用小建中汤,譬如小建中汤证。②历代医家和历版教材,对于《伤寒论》传经方式,比如循经传、越经传、表里传、首尾传等,从一经病传为另一经病的情况,研究和介绍的比较清楚,而忽略了"随经"和"过经"这两种本经从经到腑的经传方式,"随经"是太阳经邪气由经到腑的传变,而"过经"则是阳明经邪气由经到腑的传变,由于二者都属于本经邪气由经到腑的传递,为区别与两经之间的传递,所以笔者不妨称之为"经传",传经和经传都属于伤寒的传变方式。③肝乘脾称之为"纵",肝乘肺称之为"横","纵"即是顺从,"横"即横逆。"肝乘脾"是顺从相克的次序,只是相克太过,所以称之为"纵";"肝乘肺"是与五行相克的次序相反,是一种反克,也就是"侮",属于反乘,所以称之为"横"。结论:新传变方式—"经传"的提出对临床疾病的治疗有重要指导意义。Objective ：To put forward the new transmission way-＂ channel transmission＂ through the mechanism researches on Guizhi De- coction and Xiaojianzhong Decoction treatment of exterior syndrome and interior syndrome, and ＂ tranmission with the channel＂ and ＂ tranmission through the channel＂ belonging to the transmission way. Methods：The original articles 100 - 109 in Shanghanlun were ana- lyzed. Results：①Guizhi Decoction and Xiaojianzhong Decoction both have the function of together treatment of exterior syndrome and interior syndrome, but the focus is different. Guizhi Decoction is given priority to relieve exterior syndrome, and dispel wind and cold, and also the function of tonifying middle-jiao and balance yin-yang, emphasis on exterior syndrome; While Xiaojianzhong Decoction is given priority to tonify middle qi, and also the function of dispelling and removing wind and cold, emphasis on interior syndrome. Phar- macological function of tonifying middle-jiao and relieving exterior syndrome of the two prescriptions were basically the same. So exterior syndrome and interior syndrome of weak middle-jiao and exogenous cold-winter exist at the same time,invasion of exogenous pathogen at the early stage, mainly with exterior syndrome,treatment with Guizhi Decoction, such as Taiyang stroke;Heavier weak middle-jiao, and as well exogenous cold-winter, mainly with interior syndrome, treatment with Xiaojianzhong Decoction, such as Xiaojianzhong Decoction syndrome.②Physicians and edition teaching material over the ages have studied and introduced more clearly on transmission ways in Shanghanlun, such as follow the channel transmission, beyond the channel transmission, exterior-interior channel transmission, begin- ning-end channel transmission, namely, the situation of one channel disease to another channel disease, while ignore the transmission channel ways of the own channel from the channel to viscera, such as ＂ tranmission with the channel＂ and ＂ tranmission through thechannel＂.＂ Tranmissio

关 键 词：伤寒论 柴胡类证 少阳病 小柴胡汤证 大柴胡汤证 柴胡桂枝干姜汤证 柴胡加龙骨牡蛎汤 柴胡加芒硝汤 ＂经传＂ 

分 类 号：R222.2[医药卫生—中医基础理论]