《伤寒杂病论》“饮食如故”涵义浅析  

An analysis of the meaning of "diet as usual" in Treatise on Cold Pathogenic and Miscellaneous Diseases

作　　者：成佳琳 李长香 任梓林 兰芯 郑雨晓 韩金华 王雪茜 CHENG Jialin;LI Changxiang;REN Zilin;LAN Xin;ZHENG Yuxiao;HAN Jinhua;WANG Xueqian(School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学中医学院,北京100029

出　　处：《北京中医药大学学报》2024年第7期934-938,共5页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家中医药管理局中医学术流派传承工作室(燕京刘氏伤寒流派传承工作室)建设项目(No.1190062620029)。

摘　　要：《伤寒杂病论》中共有5条涉及“饮食如故”的条文。医家们对此类条文进行注解时,多将“饮食如故”解释为饮食正常或胃气未受疾病影响,忽略“饮食如故”的真实意义及其在临床鉴别诊断中的作用。本文通过整理归纳“饮食如故”相关条文,结合《说文解字》及古今医家对“饮食如故”条文的注解,探究其背后的涵义。笔者认为“饮食如故”作为兼症,当理解为“饮食同之前一样”,因其存在于多种疾病中,故不可一味引申为“饮食正常”。“饮食如故”在临床鉴别诊断中发挥两种作用:一方面为提示病邪性质,胃里空虚,无实无饮阻滞气机,或胃肠积滞化热,但尚未形成燥屎;另一方面,当中焦成为疾病的致病因素之一时,“饮食如故”可提示胃气尚存,排除中焦影响。In Treatise on Cold Pathogenic and Miscellaneous Diseases,there are five articles concerning "diet as usual".When many doctors annotate such articles,they mostly interpret "diet as usual" as normal diet or because of stomach qi not affected by disease,ignoring the true significance of "diet as usual" and its role in clinical differential diagnosis.Through sorting out and summarizing the relevant provisions of "diet as usual",combining with the comments of Shuowen Jiezi and various ancient and modern doctors on the relevant provisions of "diet as usual" to explore the meaning behind it,the author believes that "diet as usual" can only be understood as "diet as before".Because it exists in a variety of diseases,it cannot be blindly extended to "normal diet"."Diet as usual" has two functions in clinical differential diagnosis:on the one hand,the stomach is empty,and no solid no drink blocks the qi movement,or there is stagnant heat in the stomach and intestines,but has not yet formed dry feces;on the other hand,when the middle jiao becomes one of the pathogenic factors of the disease,"diet as usual" can exclude the influence of the middle jiao.

关 键 词：伤寒杂病论 饮食如故 病邪 病位 

分 类 号：R222.19[医药卫生—中医基础理论]