基于《伤寒杂病论》“不得卧”论重症的辨识与救治  

Discussion on identification and treatment of critical cases based on the theory of‘unable to lie'in Treatise on Typhoid and Miscellaneous Diseases

作　　者：张传龙 李奕 恩格尔 庞博[3] 花宝金[2] ZHANG Chuanlong;LI Yi;EN Geer;PANG Bo;HUA Baojin(Department of Traditional Chinese Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;International Medical Department of Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京友谊医院中医科,北京100050 [2]中国中医科学院广安门医院,北京100053 [3]中国中医科学院广安门医院国际医疗部,北京100053

出　　处：《中华中医药杂志》2025年第3期1356-1359,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：北京市自然科学基金面上项目(No.7222296);中国中医科学院科技创新工程(No.CI2021A01805)。

摘　　要：《伤寒杂病论》中多次提到“不得卧”一证,诸家多以此等同于“不得眠”而释。然“卧”与“眠”二字本义不同,“不得卧”对于重症的临床启示值得进一步辨析。从《伤寒杂病论》“不得卧”相关条文人手,结合现代医学认知,总结“不得卧”的根本原因或为胸腔、腹腔、盆腔等部位压力过大,或感染性休克、低血容量性休克等导致的缺血缺氧。水气本为一体,“不得卧”病性本质分为“水(气)多”与“水(气)少”两端。张仲景辨治“不得卧”之方与法对重症的辨识与救治具有重要意义,“水(气)多”指导辨定病位,可伍利水降气之品以减压;“水(气)少”指导辨别病势,可配养血清火之属以救水。综合辨析,为临床提供新的思路与方法。The certificate of‘unable to lie'is mentioned many times in the Treatise on Typhoid and Miscellaneous Diseases,which is often equated with‘sleeplessness'.However,the original meaning of the word‘lie'is different from that of‘sleep',and the clinical enlightenment of‘unable to lie'to critical cases is worthy of further discrimination.Starting with the relevant provisions of‘unable to lie'in the Treatise on Typhoid and Miscellaneous Diseases,combined with the cognition of modern medicine,it is concluded that the root cause of‘unable to lie'perhaps is excessive pressure in the chest,abdominal cavity,pelvis and so on,or ischemia and hypoxia caused by septic shock,hypovolemic shock and so on.Water and qi are originally one,and the nature of the disease can be divided into‘more water(qi)'and‘less water(qi)'.ZHANG Zhongjing's prescription and method of differentiation and treatment of unable to lie'is of great significance to the identification and treatment of critical cases.‘More water(qi)'guides the identification of disease location,and the products of reducing qi and water are needed to reduce pressure,and ‘less water(qi)'guides the identification of disease situation,matching nourishing blood and clearing fire to save water.Comprehensive discrimination provides new ideas and methods for clinical practice.

关 键 词：《伤寒杂病论》 不得卧 重症 辨识 救治 体位 

分 类 号：R222.2[医药卫生—中医基础理论]