《金匮要略》黄汗及其转归  

Yellow Sweat and its Transformation of Synopsis of the Golden Chamber

作　　者：王明炯 王润鹏 戴瑜娉 颜童旭 WANG Mingjiong;WANG Runpeng;DAI Yuping;YAN Tongxu(Hunan Aerospace Hospital,Changsha,Hunan,China,410205;Hunan University of Chinese Medicine,Changsha,Hunan,China,410208)

机构地区：[1]湖南航天医院,湖南长沙410205 [2]湖南中医药大学,湖南长沙410208

出　　处：《河南中医》2024年第7期989-992,共4页Henan Traditional Chinese Medicine

摘　　要：《金匮要略·水气病脉证并治》中对黄汗症状的记载有“脉浮”与“脉沉”、“小便通利”与“小便不利”、“渴”与“不渴”等,看似矛盾,实为黄汗病机的动态描述,“脉浮”与“脉沉”为表里之别、“小便通利”与“小便不利”为寒热之变、“渴”与“不渴”亦为寒热之变。当黄汗还处于表证阶段,小便通利,汗出不黄,用桂枝加黄芪汤祛风解表;病邪深入,入里化热,用黄芪芍药桂枝苦酒汤发散蕴热。黄汗日久,寒郁化热,积腐成脓,则转为痈脓;若黄汗患者平素肝肾阴虚,日久寒邪深入,则转为历节。临证常需考虑寒热关系与病机演变。黄汗包括了大部分风水的典型症状,二者皆起于感受风寒,皆存在由表入里、由寒化热的动态变化过程,但病机的侧重点不同,治疗亦不同。The record of symptoms of yellow sweat in Synopsis of the Golden Chamber includes:"pulse floating" and "pulse sinking","smooth urination" and "unfavorable urination","thirst" and "non thirst",which seem contradictory but actually describe the dynamic mechanism of yellow sweat."Pulse floating" and "pulse sinking" are the differences between the exterior and the interior;"smooth urination" and "unfavorable urination",etc.are the changes of cold and heat;and "thirst" and "non thirst" are also the changes of cold and heat.When yellow sweat is still in the exterior syndrome stage,if urination is smooth and sweat is not yellow,Cinnamon Twig Decoction Plus Astragalus Wind-Eliminating Decoction can be used to dispel wind and release the exterior.When the disease pathogen deepens and enters the body,transforms heat,Astragalus and Peony and Cinnamon Twig and Bitter Wine Decoction can be used to disperse accumulated heat.If yellow sweat is accumulated for a long time,cold stagnation transforms into heat,pus will appear.If patients with yellow sweat usually suffer from liver and kidney yin deficiency,and the cold pathogen deepens over time,multiple arthralgia will appear.In clinical practice,it is often necessary to consider the relationship between cold and heat and the evolution of the disease mechanism.Yellow sweat includes most typical symptoms of wind edema,both of which arise from the infection of wind and cold,both of which undergo dynamic changes from the exterior to the interior and from cold to heat.However,the focus of the pathogenesis is different,and the treatment should be also different.

关 键 词：黄汗 桂枝加黄芪汤 黄芪芍药桂枝苦酒汤 历节 痈脓 风水 《金匮要略》 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]