伤寒论评话 第34章 当下与否看失气,临床细辨三承气——阳明腑实证的辨证施治(二)  

Discussion of Shanghan Lun: Whether Using Purgation Method Depending on Flatus,Clinical Carefully Differentiation Three Chengqi——Syndrome Differentiation of Yangming Fushi Syndrome( Second)

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》2014年第10期1425-1428,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：1小承气汤使用的3个特点:一是以小承气汤"微和胃气";二是以小承气汤测试转失气与否;三是一服谵语止者,更莫复服。提示3个问题:一是小承气汤证不一定是燥屎内结,很可能是大承气汤证的前奏;二是小承气汤的攻下力量比大承气汤要弱得多;三是小承气汤不在于泻实而是偏重于行气。2调胃承气汤证多是误治后出现的一些变证,属于邪热在胃,并非有燥屎结滞在大肠。所以关于"燥、实、坚"的说法,"燥""实"尚可,"坚"则无从解释,绝不能因方中使用了芒硝,就断定证中有燥屎结滞。3关于承气汤的命名,"承气",即帮助阳明大肠承接阳明胃的下降之气,与"亢则害,承乃制"没有关系。4调胃承气汤证是邪热还在阳明胃之际,唯恐大肠不能承顺胃气而正常通降,尤须清除胃热以防邪热下传,所以方名叫"调胃承气汤"。"调胃"二字已经明确显示,病在阳明胃而非在阳明大肠,之所以"承气",仍是秉承既病防变,提前截断的治疗思想。5三承气汤证,是阳明胃家邪热亢盛到阳明大肠燥屎内结的一个系统过程。阳明邪热在胃,如不及时清除热邪,就会使邪热进一步加重而耗伤津液,而成阳明大肠燥结,所以尽快用调胃承气汤清泻胃热,截断病情发展。阳明燥屎在肠,潮热、谵语、腹痛,甚则喘冒直视、循衣摸床,说明燥屎已成,所以可用大承气汤攻下燥屎。而从阳明胃家邪热到阳明大肠燥屎过程中,虽见有潮热、谵语、腹满,但尚不能确定腑实燥屎的形成,所以用小承气汤进行试探性治疗。①The three characteristics of using xiaochengqi decoction：the first is the xiaochengqi Decoction ＂ regulating stomach qi＂; The second is xiaoehengqi Decoction testing flatus whether or not ;The third is once delirious speech stopped, no more taken. Tip three questions：The first is xiaochengqi decoction not always dry stool within the body, which is likely to be the prelude to daehengqi decoction ; The second is purgative strengtia of xiaochengqi decoction weaker than that of dachengqi decoction ; The third is xiaochengqi decoction not aiming reducing excess but promoting the circulation of qi. ②Tiaowei chengqi decoction syndrome is mostly some variable syndrome after mistreatment, which belongs to the pathogenic heat in the stomach, not dry stool accumulation in the large intestine. So a ＂dryness, solid ,hard＂ argument, but ＂hard＂ can not explain,which can＇t because of the use of Glauber＇s salt and permit that the syndrome containing dry stool accumulated. ③The naming of chengqi decoction,＂ Cheng Qi＂ , help Yangming large intestine taking decending qi from Yangming stomach,which has no relationship with the ＂ excess is harmful, and resisting for balance＂. ④ Tiaowei chengqi decoction syndrome is at the time of evil heat in Yangming stomach,lest large intestine can＇t taking decending qi from Yangming stomach, especially removing stomach-heat to prevent pathogenic heat transfer, so called ＂tiaowei chengqi decoction＂. ＂Tiao wei ＂ two words have clearly shown that disease location in Yangming stomach rather than in Yangming large intestine, and ＂cheng qi＂ , still uphold the treatment thought of preventive treatment of disease. ⑤The three chengqi decoction syndrome, a system of Yangming stomach evil heat excessive to large intestine dry stool accumulation in the body. Yangming heat in the stomach,if not promptly remove the heat evil, will make the evil heat further aggravating and damage the fluids, and Yangming large intestine dryness, so as soon as possible clearing

关 键 词：小承气汤证 调胃承气汤证 大承气汤证 阳明腑实证 

分 类 号：R222.2[医药卫生—中医基础理论]