文章摘要
陈寅清,韩世盛,王怡.从《伤寒论》少阴篇讨论阳虚阴盛证辨治规律[J].浙江中医药大学学报,2024,48(3):324-327, 331.
从《伤寒论》少阴篇讨论阳虚阴盛证辨治规律
Discussion on the Rules of Differentiation and Treatment of Deficiency of Yang with Hyperactivity of Yin Syndrome from the Shaoyin Chapter of Treatise on Febrile Diseases
DOI:10.16466/j.issn1005-5509.2024.03.013
中文关键词: 阳虚阴盛证  少阴  辨治规律  伤寒论  浙派中医  经方  各家学说
英文关键词: deficiency of Yang with hyperactivity of Yin syndrome  Shaoyin  rules of differentiation and treatment  Treatise on Febrile Diseases  Zhejiang school of TCM  classical prescription  theories of various schools
基金项目:国家自然科学基金项目(82274391)
作者单位
陈寅清 上海中医药大学 上海 201203 
韩世盛 上海中医药大学附属岳阳中西医结合医院 
王怡 上海中医药大学附属岳阳中西医结合医院 
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中文摘要:
      [目的] 讨论《伤寒论》中阳虚阴盛证的病势、层次、治法及用药规律,探究并扩充阳虚阴盛证的辨治规律及临床意义。[方法] 结合后世医家的医论,明确阳虚阴盛证的病机及证候;从病理生理学角度,阐释阳虚阴盛证的机制;分析少阴篇中各版本条文的差异,论述病位、邪气性质、胃气、津液的不同,治法、主方、配伍的变化,归纳在少阴篇中隐含的辨治规律。[结果] 阳虚阴盛证的辨治原则是“保胃气、存津液”,可将其细分为太阴湿土病、少阴君火病、厥阴风木病。细致的望闻问切,并结合现代医学的病理生理基础能精确辨阳虚阴盛证。少阴为三阴枢机,少阴篇结构完整,能动态反映少阴发病、两阴合病或并病、三阴合病的相互变化过程。由条文可发现,病位由表入里,治法有灸焫、温经、温阳、通阳之别;病情由轻而重、痰饮有无,治法有散寒、散饮、利水之别;津液损伤程度不同,治法有救逆、救阴之别。[结论] 从病理生理角度,能阐释中医主症的变化机制。辨治阳虚阴盛证时,应根据病位、邪气性质、胃气、津液择取方药,阳虚阴盛证的辨治规律对于其他证候的辨治同样具有指导意义。
英文摘要:
      [Objective] To discuss the pathogenesis, hierarchy, treatment and medication rules of deficiency of Yang with hyperactivity of Yin syndrome in Treatise on Febrile Diseases. [Methods] Combining with the medical theory of later physicians, this paper clarifies the pathogenesis and syndrome of deficiency of Yang with hyperactivity of Yin syndrome, explains the mechanism of Yang deficiency and Yin excess syndrome from the perspective of pathophysiology. This paper also analyzes the differences among the various versions of the text of the Shaoyin Chapter including the variations in disease location, the pathogen nature, stomach Qi and body fluid, and inducts the implicit therapeutic principles in the Shaoyin Chapter. [Results] The principle of differentiation and treatment for deficiency of Yang with hyperactivity of Yin syndrome is “protecting stomach Qi and preserving body fluids”, which can be subdivided into Taiyin damp earth disease, Shaoyin monarch fire disease, and Jueyin wind wood disease. Through careful observation, questioning, smelling and palpation, combined with the pathological and physiological basis of modern medicine, it can accurately diagnose deficiency of Yang with hyperactivity of Yin syndrome. Shaoyin plays a crucial role in Treatise on Febrile Diseases. The structure of the Shaoyin Chapter is well-organized and can dynamically reflect the changes in the pathogenesis of Shaoyin syndrome, the combination of Shaoyin and Taiyin or Jueyin, or the tri-coordination syndrome of these location. From the text, it can be inferred that the location of the disease begins on the surface and gradually extends to the interior. The treatment methods will include moxibustion, warming the meridians, warming Yang and dredging Yang. The severity of the illness and the presence of phlegm-fluid determine the treatment, which may involve dispersing cold, dispersing fluids, and promoting urination. The degree of exhaustion of bodily fluids may require either reviving Yang for resuscitation or nourishing Yin. [Conclusion] From a pathological and physiological perspective, the mechanisms behind the changes in the primary symptoms of traditional Chinese medicine can be explained. When treating deficiency of Yang with hyperactivity of Yin syndrome, the selection of herbal prescriptions should be based on factors such as the disease location, the pathogen nature, stomach Qi and body fluids. The treatment principles for deficiency of Yang with hyperactivity of Yin syndrome have instructive significance for the treatment of other syndromes as well.
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