基于太阳病误下变证论“膈病”  

Study on"Diaphragmatic Disease"Based on Deteriorated Syndrome of Greater Yang Disease Treated with Purgative Method

作　　者：张克克[1] 王祥麒[2] ZHANG Keke;WANG Xiangqi(The Second Affiliated Hospital of Henan University of Chinese Medicine,Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou,Henan,China,450002;Third Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,China,450008)

机构地区：[1]河南中医药大学第二附属医院,河南省中医院,河南郑州450002 [2]河南中医药大学第三附属医院,河南郑州450008

出　　处：《河南中医》2024年第8期1140-1144,共5页Henan Traditional Chinese Medicine

基　　金：河南省中医药科学研究专项课题项目(2021JDZX2130);李鲜全国名老中医药专家传承工作室建设项目{豫卫中医函[2022]3号};河南省中医药传承与创新人才工程(仲景工程)中医药青苗人才培养项目{豫卫中医函[2021]6号}。

摘　　要：太阳病涵盖了伤寒由表到里的整个演变过程,由于患者禀赋强弱、感邪轻重、就诊是否及时等原因,在此阶段可能出现表里证,所以太阳病可用到下法,但由于对表里先后顺序及整体病势把握不准确而误下产生变证者不少。太阳病下之后结局有两种:(1)下之愈。(2)下之不愈,而不愈者又可分为三种情况:一是误治后邪气仍在表者,当以汗解之;二是有表里证者,表解乃可攻里,否则引邪入里,为逆;三是误下影响了太阳病自然发展轨迹,导致表证几无,而邪气入膈,从而产生变证。无论太阳病正常转归还是误下发为变证,“膈”均是邪气入里之“首站”。膈病主要是邪气侵扰使其失去阻隔、分界作用,导致清浊易位,上下隔拒,典型特点为清浊不分,“上逆”与“下趋”症状并见,治疗首当察其在膈上、膈下,遵循“病在膈上必吐,在膈下必利”的治疗原则,观其脉证,随证治之。Greater yang disease covers the entire evolution process of cold damage from exterior to interior.Due to factors such as the patient's natural endowment,the severity of pathogenic factors,and timely medical treatment,exterior to interior syndrome may occur at this stage.Therefore,greater yang disease can be treated with the purgative method.However,there are many cases of deteriorated syndrome due to inaccurate understanding of the order of exterior to interior and the overall condition of the disease.There are two outcomes of treating greater yang disease with the purgative method of:(1)being cured.(2)not being cured,which includes three types:Firstly,if the pathogenic qi still exists in the exterior,it should be relieved by sweating;Secondly,for those who have both exterior and interior syndromes,attacking the interior syndrome can be used after releasing the exterior;Otherwise,inducing pathogens into the body can lead to adverse transmission.The third is that the purgative affects the natural development course of greater yang disease,resulting in almost no exterior syndrome,but the entry of pathogenic qi into the diaphragm,leading to deteriorated syndromes.Regardless of whether greater yang disease progresses normally or develops into deteriorated syndromes,"diaphragm"is the"frst stop"for pathogenic qi to enter.Diaphragm disease is mainly caused by the invasion of pathogenic qi,which leads to the loss of its barrier and boundary function,resulting in the translocation of clear and turbid fluids,and the rejection of the upper and lower septa.The typical characteristic is that clear and turbid fluids are not separated,and the symptoms of"upward reversal"and"downward trend"of the rejection of the upper and lower septa are observed simultaneously.The first step in treatment is to observe its presence above and below the diaphragm,following the treatment principle:"the disease must have vomit above the diaphragm,and it must have diarrhea below the diaphragm",so it is necessary to observe pulse condition and syndro

关 键 词：“膈病” 太阳病 误下变证 下法 《伤寒论》 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]