基于六经气化学说的张志聪三阳阳明病浅析  

Analysis of ZHANG Zhicong's Three-Yang Yangming Diseases Based on the Theory of Six-meridian Qi-transformation

作　　者：郝亚非 徐光星[1] HAO Yafei;XU Guangxing(Zhejiang Chinese Medical University,Hangzhou(310053),China)

机构地区：[1]浙江中医药大学基础医学院,杭州310053

出　　处：《浙江中医药大学学报》2023年第5期479-482,489,共5页Journal of Zhejiang Chinese Medical University

基　　金：浙江省中医药科技计划中医药现代化专项项目(2020ZX002)。

摘　　要：[目的]浅析张志聪基于六经气化学说的《伤寒论》三阳阳明病相关论述,为更好地理解及临证运用伤寒阳明病相关理论提供参考。[方法]通过研读张志聪《伤寒论集注》《伤寒论宗印》《黄帝内经素问集注》等著作,旁参其他医家关于《伤寒论》及六经气化学说的相关研究文献,简要解析张志聪六经气化学说,并从症候表现、病机本质、方药选用等方面阐释其对三阳阳明病的分析论述。[结果]六经气化学说为张志聪依照运气学知识,将六气气化和伤寒三阴三阳病脉证并治体系具体结合的学说思想。三阳阳明病症候表现,在不更衣、内实、大便难等“胃家实”症状的基础上各有不同侧重,太阳阳明病兼有小便数,正阳阳明病强调腑实,少阳阳明病兼有心烦。太阳阳明病病机为太阳阳热之气入于太阴脾土,脾阴受损不能为胃行其津液;正阳阳明病病机为阳明燥金之气及悍热之气侵袭阳明本腑经所致液少津亏;少阳阳明病病机为三焦受邪,少阳枢转不利,误治失津而阳明液损。太阳阳明病方选助脾输津、通腑行便的麻子仁丸;正阳阳明病方选推陈置新、荡涤攻邪的大承气汤,少阳阳明病方选承热畅中的调胃承气汤或疏导气机、交通阴阳的小柴胡汤。[结论]基于六经气化学说对三阳阳明病机的分析探究,揭示了人体无形之气与有形之质的紧密联系,二者共同决定了脏腑经络的生理机制及病理反应。[Objective]To explore the connotation of epidemic eruption in modern Chinese medicine.[Methods]Based on the relevant literature concerning ancient and modern epidemic eruption,this paper analyzed the controversies and deficiencies in the traditional understanding of the concept of epidemic eruption while referring to the domestic and foreign clinical reports of skin lesions of Coronavirus Disease 2019(COVID-19),and proposed a relatively new definition of epidemic eruption in modern Chinese medicine.Meanwhile,this paper differentiated the characterization and nature of traditional epidemic eruption and COVID-19,and analyzed the skin lesions and disease attributions.[Results]Epidemic eruption has broken through the traditional concept clinically in modern Chinese medicine;Instead,it is a general term for a class of contagious diseases caused by the epidemic pathogen,which could damage skin and mucous membranes.The“eruption”of epidemic eruption is not limited to“spots”and“rashes”,but should be expanded to include sores,pox,sha,blisters,ulcers,scabs,pulp,pus,fester,and other Chinese medicine skin lesions,as well as modern medicine skin lesions such as plaques,herpes,nodules,cysts,scales,hyperpigmentation and lichenification.For instance,COVID-19 includes complex skin lesions such as pseudo-chilblain,urticaria,vesicles and purpura.What‘s more,the disease is not necessarily accompanied by fever,which indicates the nature of epidemic eruption are not absolutely hot,but also is cold,damp and dry.[Conclusion]The characterization and nature of epidemic eruption are essentially the external image and apparent reflection of the body‘s feeling of the epidemic pathogen.By means of re-examining the connotation of epidemic eruption and using the multi-disciplinary cross fusion research,it is helpful to construct a modern syndrome differentiation and treatment system full of traditional Chinese medicine characteristics,so as to further guide clinical and scientific research.

关 键 词：三阳阳明病 伤寒论 阳明病 六经气化 张志聪 伤寒论集注 黄帝内经 五运六气 

分 类 号：R221[医药卫生—中医基础理论]