从“沉潜水滀”探讨《伤寒杂病论》水病脉证  

Cold Damage Diseases Based on"Deep Pulse in Charge of Interior Syndromes and Fluid Retention"

作　　者：卢宣君 郝征[1] LU Xuanjun;HAO Zheng(Tianjin University of Traditional Chinese Medicine,Tianjin,China,301617)

机构地区：[1]天津中医药大学,天津301617

出　　处：《河南中医》2023年第9期1302-1306,共5页Henan Traditional Chinese Medicine

基　　金：国家中医药管理局2020年度中医药古籍文献和特色技术传承专项项目(GZY-KJS-2020-037)。

摘　　要：水邪即病理之水,一源而四歧,包括“水、湿、痰、饮”。水病即水邪致病,为停蓄之水所引发的疾病,包括结胸、湿痹、痰饮、水气。水病脉多沉,“寸脉浮,关脉沉”为结胸的主要脉象;湿痹里湿偏盛,脉多沉细;痰饮病虽多见弦脉,但若脾阳虚,脉气鼓动无力,亦可见沉脉;水气病多为沉脉。沉脉主水蓄在里、水蓄久留、水蓄下焦,风水、皮水本为脉浮,若脉象转为沉脉,则提示病势加剧,且脉愈沉则水病愈甚。湿病、痰饮、水气等病证也可出现浮脉、弦脉等其他脉象,故沉脉并不尽为水病,水病亦非皆为脉沉。一因一病当有一致的主脉,体现了病证的一般规律;亦可见他脉,原因或为感邪路径不同,或为病位深浅不同,或为病证变化不同,故临床辨证,当脉证合参。Water pathogens mean the pathological water,which has one source and four diferent types,including"water,dampness,phlegm,fluid retention".Water diseases are caused by accumulated water pathogens.In terms of water diseases,the patient's pulse is usually deep."Floating cun pulse and deep guan pulse"are the main pulse images of thoracic accumulation.Dampness rheumatism has excessive dampness in the interior,the pulse is usually deep and thin.Although the phlegm-retention disease often has wiry pulse,if the spleen yang deficiency syndrome leads to pulse qi failing to incite,deep pulse may appear.Deep pulse is often seen in fluid retention.Deep pulse is in charge of water accumulated in the interior and in the lower energizer.Wind edema and skin edema originally have floating pulse.If the pulse image changes to deep pulse,it indicates that the disease is worsening,and if the deep pulse is heavy,the fluid retention will be very severe.Floating pulse,wiry pulse and other pulse images may appear in dampness disease,phlegm retention and fluid retention,so deep pulse does not mean water diseases,and water diseases do not mean having deep pulse.One cause and one disease should have the same main pulse,reflecting the general law of disease;It can also have other pulse images,which reflects the different path of inductive pathogens,or the different depth of disease,or the diferent changes of disease syndrome,so in clinical practice comprehensive analysis of pulse and syndromes should be adopted.

关 键 词：水病 沉脉 脉沉 《伤寒论》 《金匮要略》 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]