浅析《金匮要略》“历节黄汗”  

Brief analysis on"Lijie and yellowish sweating"in Synopsis of Golden Chamber

作　　者：兰芯 任梓林 邵奇 郑雨晓 李长香 程发峰 王雪茜 王庆国 LAN Xin;REN Zilin;SHAO Qi;ZHENG Yuxiao;LI Changxiang;CHENG Fafeng;WANG Xueqian;WANG Qingguo(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》2025年第2期161-165,共5页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(No.82104560,No.U21A20400)。

摘　　要：“历节黄汗”出自《金匮要略》中风历节病篇,后世对其释义通常为关节疼痛处溢出黄水,是历节的一种特征性表现。历节在西医学中可对应痛风性关节炎,其临床主要表现为关节处红、肿、热、痛,多无黄水流出。因此,“历节黄汗”的释义与本病常观察到的临床表现相悖。对此疑议点,本文从“汗出入水中,如水伤心”的病机出发,结合历代医家观点,对“历节黄汗”进行重新诠释,认为确定“黄汗”在此处的含义对理解历节病机、明晰历节与“黄汗”的关系至关重要。张仲景将历节与“黄汗”并提,并非为了区分两病,而是强调两者共有的病机,即寒湿伤及心和血脉。本文提出“历节黄汗”新解,认为汗非局限于关节,可遍及全身。“历节黄汗”的病机为肝肾不足、外感水湿,导致营卫不和、阴阳失调。治疗上,应以调和营卫、补益肝肾为主,临床选方用药可考虑桂枝汤类方加减。“历节黄汗”病机复杂,临床治疗需综合考虑,以期达到最佳疗效。"Lijie and yellowish sweating"originates from the chapter on stroke and arthralgia diseases in Synopsis of Golden Chamber.Later generations typically interpret it as yellow fluid oozing from painful joints,a characteristic manifestation of arthralgia.In Western medicine,Lijie corresponds to diseases such as gouty arthritis,with its primary clinical manifestations being redness,swelling,heat,and painful joints,most often without yellow fluid discharge.Therefore,the interpretation of"Lijie and yellowish sweating"contradicts the clinical manifestations often observed in this disease.Thus,this article reinterprets the meaning of"Lijie and yellowish sweating"from the pathogenesis of"sweat exposure to water,as if water harms the heart",combined with the viewpoints of other medical practitioners.Determining the meaning of"yellowish sweating"is crucial for understanding the pathogenesis of arthralgia and clarifying the relationship between arthralgia and yellowish sweating.ZHANG Zhongjing mentioned arthralgia and"yellowish sweating"together,not to differentiate between the two diseases but to emphasize the common pathogenesis of the two,namely,the cold and dampness injuring the heart,blood,and vessels.This paper proposes a new explanation of"Lijie and yellowish sweating",which suggests that"yellowish sweating"is not confined to the joints but can be found all over the body.The pathogenesis of"Lijie and yellowish sweating"lies in the insufficiency of the liver and kidney and exogenous water dampness,leading to disharmony between nutrient qi and defensive qi and between yin and yang.Primary treatment should harmonize yingfen and weifen,as well as tonify and replenish the liver and kidney.The clinical selection of medicines can be considered Guizhi Decotion,a type of formula.The pathogenesis of"Lijie and yellowish sweating"is complex,and clinical treatment should be comprehensively considered to achieve the best therapeutic effect.

关 键 词：金匮要略 历节黄汗 如水伤心 病机 

分 类 号：R222.3[医药卫生—中医基础理论]