《伤寒论》白虎汤“热结在里”考辨  

Textual Research on "Re Jie Zai Li" About Baihu Decoction in Shang Han Lun

作　　者：庄文元 杨东方[1] ZHUANG Wenyuan;YANG Dongfang(Beijing University of Chinese Medicine,Beijing China 100029)

机构地区：[1]北京中医药大学,北京100029

出　　处：《中医学报》2022年第8期1593-1596,共4页Acta Chinese Medicine

基　　金：北京中医药大学科研创新团队项目(2019-JYB-TD017)。

摘　　要：白虎汤在《伤寒论》中用以治疗病后余热或阳明气分热证。但是,宋本《伤寒论》白虎汤中“热结在里”,不仅用于白虎汤证,也用于阳明燥屎内结证,而阳明燥屎内结证与白虎汤证的症状、病程、病机、治法、用药均不相同。经对照发现,除《伤寒论》外,宋以前相关医籍中,白虎汤条文原有两种文本。二者之间最重要的区别是,唐本《伤寒论》《外台秘要》作“热结在里”,《诸病源候论》《千金方》等医籍中均作“结热在里”。宋以后,虽然白虎汤证“热结在里”流传较为广泛,但医家对于白虎汤证“热结在里”的注释多强调与阳明燥屎无关。结合文献与医理分析,现通行本《伤寒论》白虎汤条文存在错讹,“热结在里”当作“结热在里”。In Shang Han Lun,Baihu Decoction is used to treat residual Heat after illness or Yangming Qi Fen Heat syndrome.However,in the Song Dynasty version of Shang Han Lun,the wording of " Re Jie Zai Li" about Baihu Decoction is not only used for the syndrome of Baihu Decoction,but also for the syndrome of Yangming dry feces accumulation inside.However,the symptoms,course,pathogenesis,treatment,and medication of Yangming dry feces accumulation inside syndrome and Baihu Decoction syndrome are all different.After comparison,it was found that,except for Shang Han Lun,there were two original texts of Baihu Decoction in relevant medical books before the Song Dynasty.The most important difference between the two is that in the Tang version Shang Han Lun and Wai Tai Mi Yao,it was stated as "Re Jie Zai Li",while in Zhu Bing Yuan Hou Lun and Qian Jin Fan,and other medical books it was all described as "Jie Re Zai Li".After the Song Dynasty,although Baihu Decoction syndrome "Re Jie Zai Li" was widely spread,physicians′ comments on Baihu Decoction syndrome "Re Jie Zai Li" emphasized that it had nothing to do with Yangming dry feces.Combined with the analysis of literature and medical theory,there should be an error in the provisions of Baihu Decoction in the current version of Shang Han Lun:"Re Jie Zai Li" should be "Jie Re Zai Li".

关 键 词：白虎汤 白虎汤证 “热结在里” “结热在里” 《伤寒论》 

分 类 号：R222.16[医药卫生—中医基础理论]