“病者痿黄,躁而不渴,胸中寒实,而利不止者,死”考  

Textual Research on"Sallow Complexion,Restlessness Without Thirsty,Cold Excess Chest and Lasting Diarrhea Leading to Death"

作　　者：赵京博 徐爽 赵沛涵 钟相根[1,2] ZHAO Jingbo;XU Shuang;ZHAO Peihan;ZHONG Xianggen(Beijing University of Chinese Medicine,Beijing China 100029;State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs,Beijng China 100700)

机构地区：[1]北京中医药大学,北京100029 [2]道地药材品质保障与资源持续利用全国重点实验室,北京100700

出　　处：《中医学报》2024年第3期671-674,共4页Acta Chinese Medicine

基　　金：中央本级重大增减支项目“名贵中药资源可持续利用能力建设项目”(2060302-2301-16);全国中医临床优秀人才研修项目{国中医药人教函〔2022〕239号};北京中医药大学教育科学研究课题项目(XJZX2019)。

摘　　要：“病者痿黄,躁而不渴,胸中寒实,而利不止者,死”为《金匮要略》第10篇第4条,本条的篇目归属及记载在《金匮要略》《脉经》《备急千金要方》《医心方》中不尽相同。本文运用版本学、校勘学、文字学等方法,结合仲景字词使用习惯、历代注家解读以及中医医理,详细考察了本条的篇目归属及更可能的原文样貌,结果如下:本条应归属于《金匮要略·呕吐哕下利病脉证并治第十七》;本条第一句当作“病者痿黄”;第二句当作“躁而不渴”;第三句当作“胃中寒实”;第四句当作“而下利不止者”。本考证的价值:其一,有文献价值,有助于还原仲景先师的原文原意;其二,有临床价值,该考证确定了本条归属于下利病篇,且“胸中寒实”当作“胃中寒实”,当遇到此类患者时,不宜救其胸阳,而应救其胃阳,可选择附子理中丸等温胃还阳的方药。The theory that"Sallow complexion,restlessness without thirsty,cold escess chest and lasting diarrhea leading to death"is the fourth article of the tenth chapter of Jin Gui Yao Lue.The attribution and record of this article are not the same in the Jin Gui Yao Lue,Mai Jing,Bei Ji Qian Jin Yao Fang,Yi Xin Fang,and there are many disputes in the past dynasties,so further research is needed.This article,by using methods such as bibliology,textual criticism,philology,being combined with Zhongjing's wording habit,interpretations of annotations in various dynasties,and traditional Chinese medicine theories,is to examine in details the attribution of the article and the exact original text.The results are as follows:This article should be attributed to the 17th chapter of Jin Gui Yao Lue:Retching,vomiting,hiccup and diarrhea disease:pulses,syndromes/patterns and treatment;The first sentence of this article is regarded as"Sallow complexion",The second sentence is regarded as"restlessness without thirsty",The third sentence is regarded as"cold escess chest";The fourth sentence is regarded as"lasting diarrhea".The value of this research:First,it has literature value,which helps to restore the original text and original meaning of Zhongjing.Second,it has clinical value.This research confirms that this article belongs to the chapter of diarrhea disease,and"cold escess chest"is regarded as"cold escess stomach".When encountering such patients,it is not appropriate to save their chest yang,but to save their stomach yang.Prescriptions such as Fuzi Lizhong Pills can be selected to warm stomach yang.

关 键 词：“病者痿黄 躁而不渴 胸中寒实 而利不止者 死” 胃中寒实 《金匮要略》 条文考证 张仲景 

分 类 号：R222.3[医药卫生—中医基础理论]