谈《伤寒论》之渴(上)  

Discussion About Thirst in Treatise on Cold Damage Diseases (Ⅰ)

作　　者：王明炯[1] 王文华[1] 余钰[2] WANG Ming-jiong;WANG Wen-hua;YU Yu(School of TCM of Changsha Medical College,Changsha,Hunan,China,410219;Xiangya School of Public Health of Central South University,Changsha,Hunan,China,410008)

机构地区：[1]长沙医学院中医学院,湖南长沙410219 [2]中南大学湘雅公共卫生学院,湖南长沙410008

出　　处：《河南中医》2019年第9期1297-1300,共4页Henan Traditional Chinese Medicine

基　　金：国家自然科学基金项目(71804197)

摘　　要：阳明病多口渴,阳明胃家有热是导致口渴的直接原因。小柴胡汤证患者如果阳明热重津液被伤,则口渴,张仲景去半夏之辛燥,加人参、栝蒌根生津液;如果患者风重,则不渴,仲景去人参之甘寒,加桂枝祛风。脾约丸证患者,胃气虚乏而生热,此热乃虚热,其病机以脾虚寒为主,所以患者口不渴。阳明经阳气的来复是疾病向愈之兆,阳气来复的表现为口渴,此时病人少量饮水,阴阳自和则痊愈;如果饮水过多则"不能消之",表现为"其腹必满,小便不利";对于"太阳有寒,阳明有热",加上饮水过多的患者,当阳气恢复必定"大汗出,小便利",阳明之热和太阳之寒随汗而解,体内蓄积之水随小便而解。Yangming disease often has thirsty. Some yangming gastrologists believe that heat is the direct cause of thirst. For patients with syndrome of Minor Bupleurum Decoction, if yingming heat is excessive, fluid will be hurt and thirst will appear. So Zhang Zhong-jing removes pungent and dry nature of Banxia(Rhizoma Pinelliae), makes good use of Renshen(Radix et Rhizoma Ginseng) and Kuolougen(Radix Trichosanthis) in order to generate fluid. For patients with serious wind syndrome, thirst will not appear. So Zhang Zhong-jing removes sweet and cold nature of Renshen(Radix et Rhizoma Ginseng), adds Guizhi(Ramulus Cinnamomi) in order to remove wind. For patients with syndrome of Pill for Constipation of Splenic Origin, deficient stomach qi generates heat which belongs to heat of deficiency type, the syndrome is mainly manifested as deficiency and cold of spleen, so the patients have no feeling of thirst. The return again of yang-qi in yangming meridian is a sign of disease healing;the manifestation of yang-qi return again is thirst. If patients drink a small amount of water, yin and yang will harmonize and the disease will heal;if they drink too much water, they cannot digest it, which is manifested as abdomen fullness and dysuria. For patients who have cold syndrome in taiyang meridian and heat in yangming meridian and drink too much water, when yang returns again, they must have sweating too much and smooth urination. Then cold syndrome in taiyang meridian and heat in yangming meridian will be removed by sweating, and water accumulation inside the body will be removed with urine.

关 键 词：渴 阳明病 《伤寒论》 张仲景 小柴胡汤证 麻子仁丸证 猪苓汤证 肝乘脾 肝乘肺 

分 类 号：R222.2[医药卫生—中医基础理论]