《伤寒论》大陷胸汤证  

Discussion About Syndrome of Major Chest Draining Decoction in Treatise on Cold Damage Diseases

作　　者：王明炯[1] 于洁 欧阳峰松[1] WANG Ming-jiong;YU Jie;OUYANG Feng-song(College of Traditional Chinese Medicine of Changsha Medical University,Changsha,Hunan,China,410219)

机构地区：[1]长沙医学院中医学院,湖南长沙410219

出　　处：《河南中医》2022年第5期649-652,共4页Henan Traditional Chinese Medicine

基　　金：长沙医学院《中医学》校级重点学科科研项目{长医研[2016]3号}。

摘　　要：与大陷胸汤证类似的证候有大柴胡汤证、桂枝去桂加茯苓白术汤证、栀子豉汤证、十枣汤证。大柴胡汤证与大陷胸汤证主要鉴别点是“往来寒热”,而“往来寒热”是邪入少阳的典型症状。大陷胸汤证与桂枝去桂加茯苓白术汤证临床表现类似,大陷胸汤证有“胃中空虚,客气动膈”这一过程,而桂枝去桂加茯苓白术汤证则无。栀子豉汤证主症有“心中懊[忄农]”“心中结痛”,大陷胸汤证主症有“膈内拒痛,心中懊[忄农],按之痛”,栀子豉汤证既有结胸证症状,又有痞证症状。十枣汤所治乃水热互结之证,但热势较轻微,水停部位为胸中、心下、胁下,大陷胸汤所治水热互结之证,热势明显,水停部位在心下。综上,大陷胸汤证为“形象中风”证误下而成,若患者下焦不虚,被误下后则形成桂枝去桂加茯苓白术汤证;阳明证若下之过早,不会形成大陷胸汤证,而是形成类似结胸的栀子豉汤证;大陷胸汤证病位不在少阳,而是涉及阳明,病机为上焦有热,水热结于胸中、心下,热势明显。The syndromes similar to syndrome of Major Chest Draining Decoction include syndrome of Major Bupleurum Decoction,syndrome of Cinnamon Twig Decoction Plus Cinnamon combined with Poria and White Atractylodes Decoction,syndrome of Gardenia and Semen Sojae Praeparatum Decoction,and syndrome of Ten Jujubes Decoction.The most important distinguishing point between syndrome of Major Bupleurum Decoction and syndrome of Major Chest Draining Decoction is "alternating chills and fever",which is a typical symptom of pathogen entering lesser yang.The clinical manifestation of syndrome of Major Chest Draining Decoction is similar to that of syndrome of Cinnamon Twig Decoction Plus Cinnamon combined with Poria and White Atractylodes Decoction.The former has the process of "stomach emptiness and pathogenic qi attacking diaphragm," while the later one has no such process.The main symptoms of syndrome of Gardenia and Semen Sojae Praeparatum Decoction have "heart annoyance" and "heart knot pain",while the main symptoms of syndrome of Major Chest Draining Decoction have "refusal pain in diaphragm,heart annoyance,and pain when being pressed",so syndrome of Gardenia and Semen Sojae Praeparatum Decoction has symptoms of both thoracic accumulation syndrome and fullness syndrome.Ten Jujubes Decoction is mainly used to treat the syndrome of combined water and heat,but the heat tendency is slight,and the water retention lies in the middle of the chest,under the heart and under the flank.Major Chest Draining Decoction is also mainly used to treat the syndrome of combined water and heat,but the heat tendency is obvious,and the water retention lies under the heart.To sum up,the syndrome of Major Chest Draining Decoction is caused by "image stroke" treated wrongly with purgative drugs.If the patient′s lower energizer is not deficient,the syndrome of Cinnamon Twig Decoction Plus Cinnamon combined with Poria and White Atractylodes Decoction will be formed.If yang brightness meridian syndrome is treated too early with purgative drugs,it will n

关 键 词：《伤寒论》 大陷胸汤证 大柴胡汤证 桂枝去桂加茯苓白术汤证 栀子豉汤证 十枣汤证 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]