3 Cold-Damp Blockage of the Spleen

(3) Cold-Damp Blockage of the Spleen Headaches with chills and heat, abdominal distension and discomfort, nausea and vomiting, intestinal rumbling and diarrhea, a slippery, moist pulse—treatment focuses on releasing exterior cold, dispersing dampness, and using Huo Xiang Zheng Qi San (from "Ju Fang"). The spleen is inherently weak, once it encounters wind-cold, internal dampness combines with external cold, giving rise to this condition; therefore, this syndrome consists of two parts: ① Headaches with chills and heat, a slippery, moist pulse (external cold); ② Abdominal distension, nausea and vomiting, intestinal rumbling and abdominal pain (internal dampness). (4) Spleen-Damp Heat When dampness and heat combine and become trapped in the spleen, this condition arises. When heat outweighs dampness, high fever, thirst, burning diarrhea, a yellow, greasy coating on the tongue, and a slippery, rapid pulse may occur—treatment focuses on clearing heat and drying dampness, using Ge Gen Qin Lian Tang from "Wen Bing Tiao Bian." When dampness outweighs heat, the condition begins with a sense of heaviness, a body temperature that does not rise, abdominal distension, intestinal rumbling and diarrhea, nausea and vomiting—treatment focuses on clearing heat and eliminating dampness, promoting qi circulation and resolving turbidity, using San Ren Tang from "Wen Bing Tiao Bian," and Huo Pu Xia Ling Tang from "Yi Yuan." When heat outweighs dampness, the condition is acute (acute congestion and obstruction are both due to heat); when dampness outweighs heat, the condition is mild (dampness is sticky and difficult to eliminate quickly)—the former is characterized by heat rushing alongside dampness, while the latter is characterized by dampness lingering and taking time to dissipate. (5) Stomach Fire Excess Dry mouth, bad breath, oral ulcers, toothache and gum swelling, bleeding gums, burning pain in the stomach, a red tongue coated in yellow, and a rapid pulse—treatment focuses on clearing the stomach and reducing fire, using Qing Wei San (Li).

The characteristic of this condition lies in the oral cavity, as the mouth is the gateway of the spleen and stomach, located at the upper part; when fire rises upward, it directly impacts the oral cavity, thus giving rise to this condition.

(6) Stomach Yin Deficiency

Burning pain in the stomach, dry mouth and lack of drinking, a red tongue with little coating, and a fine, rapid pulse. At the same time, there is bone marrow heat and hot flashes, restlessness and heat in the five centers, and spontaneous sweating—treatment focuses on nourishing yin and nourishing the stomach, using Nourishing Stomach Tang (Ye Tian Shi) and Sha Shen Mai Men Dong Tang (Zhang Zhongjing). This condition consists of two parts: ① Yin deficiency syndrome: bone marrow heat, hot flashes, restlessness, spontaneous sweating, dry mouth and lack of drinking, a red tongue with little coating, and a fine, rapid pulse. The first three symptoms are basic signs of Yin deficiency; the last three are general signs of Yin deficiency; ② Stomach heat syndrome: burning pain in the stomach. Although there is stomach heat, it is different from stomach fire excess—while the former damages yin due to heat, the latter experiences fire that becomes rampant, and fire rising upward leads to various oral symptoms.

II. Heart Disease Diagnosis (1) Heart Qi Deficiency, Heart Yang Deficiency, Loss of Yang

Palpitations, shortness of breath, a fine, irregular pulse—these are the basic symptoms of heart qi deficiency; if accompanied by coldness, chills, and spontaneous sweating, it is considered heart yang deficiency. As heart yang deficiency progresses, symptoms such as pale complexion, cold sweat, cold extremities, and a fine, weak pulse may appear—this is loss of Yang. Heart qi deficiency, heart yang deficiency, and loss of Yang are three progressively deepening pathological stages. When qi deficiency reaches its extreme, it leads to yang deficiency; when yang deficiency reaches its extreme, it leads to loss of Yang—this is a fundamental concept in traditional Chinese medicine. Treatment for heart qi deficiency and heart yang deficiency focuses on replenishing qi and calming the heart, using Nourishing Heart Tang (Wang Ken Tang); for loss of Yang, emergency resuscitation to restore yang is needed, using Shen Fu Tang and Si Ni Tang (Zhang Zhongjing).

(2) Heart Blood Deficiency, Heart Yin Deficiency, Loss of Yin

Palpitations, forgetfulness, insomnia, and frequent dreams—these are the basic symptoms of heart blood deficiency. If accompanied by hot flashes and bone marrow heat, restlessness and heat in the five centers, and spontaneous sweating, it is considered heart yin deficiency; as heart yin deficiency progresses, symptoms such as irritability, labored breathing, dry skin, and warm hands and feet may appear—this is loss of Yin. Heart blood deficiency, heart yin deficiency, and loss of Yin are also three progressive pathological stages. When blood deficiency reaches its extreme, it leads to yin deficiency; when yin deficiency reaches its extreme, it leads to loss of Yin—this is one of the fundamental concepts in traditional Chinese medicine. Treatment for heart blood deficiency and heart yin deficiency focuses on nourishing blood and calming the mind, using Tian Wang Bu Xin Dan (Wei Yilin); for loss of Yin, it is necessary to replenish qi and nourish yin, using Sheng Mai San (from "Qian Jin Fang").

(3) Heart Fire Overactive

Burning heat in the chest, restlessness and difficulty sleeping, a red tip of the tongue, and a fine, rapid pulse—these are the basic symptoms of heart fire overactivity. If accompanied by oral ulcers and a short, painful urination, it is considered heart fire shifting heat to the small intestine (organ heat shifting to the viscera). Heart fire resides in the chest; when it rises upward, it causes restlessness and difficulty sleeping, a red tongue; since the heart and small intestine are interconnected through the meridians, although fire rises upward, it can also descend along the meridians to the small intestine—"the small intestine is the organ responsible for storing and transforming substances, playing a role in separating clean from impure," and it has the function of filtering and distinguishing between clean and impure. When the small intestine is heated, urination becomes red and painful. Oral ulcers are caused by the small intestine’s dampness, which is carried upward by fire. Treatment for heart fire overactivity focuses on clearing fire and calming the mind, using Huang Lian A Jiao Tang (Zhang Zhongjing); when heart fire shifts heat to the small intestine, it is necessary to guide the heat downward, using Dao Chi San (from "Xiao Er Yao Zheng Zhi Jue").

(4) Phlegm Blocking the Heart’s Channels

Confusion of consciousness (restlessness, mania, laughter, speech), a slippery pulse, and a greasy tongue—these are the basic symptoms of this condition; treatment focuses on guiding phlegm, opening the channels, and calming the mind, using Sheng Tie Luo Yin (from "Yi Xue Xin Wu"). The heart governs consciousness; since the heart’s channels are blocked, consciousness becomes confused; a slippery pulse and a greasy tongue are signs of phlegm, because the cause of channel blockage is phlegm.

(5) Blood Stagnation in the Heart

Pain in the chest, pain radiating to the arms, palpitations and shortness of breath, a dark purple tongue, and a rough, slow pulse—these are the basic symptoms of this condition; treatment focuses on activating blood circulation, resolving stasis, and promoting yang flow, using Coronary I No. (a collaborative formula from Beijing), or Gua Lou Xie Bai Ban Xia Tang (Zhang Zhongjing). A rough pulse and a dark purple tongue indicate blood stasis; chest pain and palpitations indicate that blood stasis is concentrated in the heart.

III. Liver Disease Diagnosis (1) Liver Qi Stagnation

Bitter taste in the mouth, dry throat, irritability and quick temper, chest and flank discomfort, a tense pulse—these are the basic symptoms of liver qi stagnation. If accompanied by abdominal distension and poor appetite, it is considered liver-stomach disharmony; if there is something stuck in the throat, unable to be expelled or swallowed, it is considered liver qi rising upward (mei he qi). Liver qi stagnation requires soothing the liver and resolving stagnation—using Chai Hu Shu Gan San (from "Jing Yue Quan Shu"); for liver-stomach disharmony, it is necessary to soothe the liver and harmonize the stomach—using Xiao Yaoshan (from "Ju Fang"); for liver qi rising upward, it is necessary to soothe the liver and lower qi—using Ban Xia Hou Po Tang (Zhang Zhongjing). When liver qi flows smoothly, stagnation can lead to cross-currents that affect the stomach (liver-stomach disharmony) —this is the first manifestation; when stagnation rises upward and hits the throat (mei he qi), it is the second manifestation. Both...

Chinese-English Translation:

Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Correct diagnosis is essential for providing reliable basis for treatment. Among the Eight Principles, the Yin-Yang principle is particularly important as it serves as the overarching framework for the other six principles. Yin can govern the interior, and deficiency, cold; Yang can govern the exterior, excess, heat. The manifestations of any clinical disease are the result of an imbalance between Yin and Yang. Only by grounding our understanding on the foundation of the Yin-Yang principles can we gain a deeper insight into cold-heat, deficiency-excess, and exterior-interior patterns.

I. Yin and Yang

Yin and Yang serve as the primary framework of the Eight Principles. The nature of all diseases can be broadly categorized into two major types: Yin-type conditions and Yang-type conditions. Despite the intricate and ever-changing clinical presentations, these conditions can ultimately be summarized into two extremes: Yin excess and Yang excess. When diagnosing a condition, one must first distinguish between Yin and Yang, then further differentiate between exterior and interior, cold and heat, deficiency and excess—only in this way can we achieve clear distinctions and accurate diagnoses. As stated in "Suwen · Yin-Yang Yingxiang Da Lun," "Yin and Yang are the Way of Heaven and Earth, the fundamental framework of all things, the parents of change, the origin of life and death, and the realm of divine wisdom. In treating illness, we must always start with the root cause." The "Suwen" also says, "A skilled physician should first discern Yin and Yang through observing color and palpating pulse." Zhang Jingyue further noted, "In all cases of pulse diagnosis and treatment, one must first examine Yin and Yang before distinguishing between them—this is the core principle of medical practice. Without neglecting Yin and Yang, there can be no proper treatment. Though medical practice may be complex, it can be summed up in a single phrase: Yin and Yang." From this, we can see just how crucial Yin and Yang are in both diagnostic reasoning and therapeutic approaches.

(1) Basic Manifestations of Yin-Type Conditions

<!-- translated-chunk:9/261 -->

Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: 口苦咽干，急躁易怒，胸胁苦满，头晕头痛，耳鸣目眩，面红目赤，心悸气急，小便短赤，脉弦而数

治宜清肝泻火用龙胆泻肝汤(《医宗金鉴》)。此证多因郁久化火所致，其基本症群由两部分组成：①

苦咽干，急躁易怒，胸胁苦满（肝气郁结）；②头晕头痛，面红目赤，小便短赤，脉数（火性上炎）。 (三)肝阴不足 头晕目眩，腰酸耳鸣，骨蒸潮热，五心烦热，盗汗，手足麻木，震颤，舌红少苔，脉弦细数，治宜滋水 涵木，用杞菊地黄丸（《医级》）。肝肾同源，肝阴借肾阴以滋之，因此肝阴虚之表现由三部分组成：①头 晕目眩，腰酸耳鸣（肾虚症群）；②骨蒸潮热，五心烦热，盗汗（阴虚症群）；③手足麻木、震颤（阴不养 筋）。 (四)肝风内动 临床上通常表现为三种情况：①热极生风（风火相煽）：证见高烧，伴惊悸、抽风、厥逆、脉弦数，治 宜泻火镇惊，用羚角钩藤汤《通俗伤寒论》）；②阳亢生风（诸暴强直皆属于风）：主要表现头痛耳鸣，偏 瘫失语，口眼喝斜，抽风昏迷，治宜镇肝熄风，方用镇肝熄风汤（《衷中参西录》）；③血虚生风（血不养 筋）：主要临床表现是震颤、麻木、抽搐、肌肉胸动等，治宜养血熄风，方用大定风珠（《温病条辨》）。 (五)寒滞肝经 少腹冷痛，阴囊回缩，睾丸重坠，宜暖肝散寒，方用暖肝煎（《景岳全书》）。少腹、阴囊、睾丸均为足 厥阴肝经循行之地。 四、肺病辨证 (一)肺寒咳嗽 证见头痛，发热恶寒，咳喘痰多，痰涎清稀，脉浮紧，治宜解表散寒，止咳祛痰，方用麻黄汤（《伤寒 论》），此证是风寒表证兼咳嗽。 (二)肺热咳嗽 证见头痛、发热恶寒（热多寒少），口渴、多饮、烦躁、咳喘、舌红，脉数，治宜清热、宣肺、止咳，用麻 杏石甘汤（《伤寒论》），此证是风热表证兼咳嗽。 (三)肺燥咳嗽 口干、咽干、鼻干，咳嗽吐痰，痰黏不利，舌红少津，宜清燥救肺，方用清燥救肺汤（《医门法律》）。中 医“大凡燥证必有三干”即口干、咽干、鼻干，此证即由三干与咳嗽痰黏组成。 (四)痰浊阻肺 痰涎壅塞，咳逆倚息不得卧，治宜导痰宣肺，方用苏子降气汤（《局方》）、葶苈大枣泻肺汤（张仲 景）。 (五)肺气虚

颜面苍白，少气懒言，自汗乏力，咳喘痰涎，舌淡胖，脉濡细，治宜益气补肺，方用补中益气汤（李东 垣），该方为培土生金之正剂。

(六)肺阴虚

咳嗽吐痰，痰黏不利，痰中带血，骨蒸潮热，五心烦热，盗汗，治宜滋阴清肺，方用百合固金汤（《医 方集解》）。此证由阴虚症候与肺咳症群所组成。

五、肾病辨证

头晕耳鸣，腰酸腿困，尺脉弱是肾虚症候群。如伴骨蒸潮热、五心烦热、盗汗者为肾阴虚；如伴形寒 怯冷、自汗者为肾阳虚。肾阴虚治宜滋阴补肾，方用六味地黄汤（《小儿药证直诀》）；肾阳虚则可分成下

列四个类型，分别论治： (一)肾不藏精 肾阳虚基本症群伴遗精、阳痿者，治宜壮肾固精，方用补肾丸（《银海精微》）。 (二)肾不纳气 肾阳虚基本症群伴气急喘息者，宜温肾纳气，方用都气丸（《医宗已任编》）。 (三)命门火衰 肾阳虚基本症群伴五更泄，治宜温肾止泻，方用四神丸（《内科摘要》）。 (四)阳虚水泛 肾阳虚基本症群伴全身或区域性浮肿者，治宜温阳化水，用真武汤（张仲景）。 附 ：1.下元虚寒 遗尿、频尿、夜尿、少腹清冷，宜温补下元，方用缩泉丸（《妇人良方》）。 2.膀胱湿热 尿频、尿急、尿痛、少腹急结，宜清热利湿，方用八正散（《局方》）。 上述脏腑辨证临床症群，在通常可单独出现，但在大多数情况下，常是几个脏腑的症候联合出现。 如心脾两虚证、脾肾阳虚证、肝肾阴虚证等。心脾两虚证是由心血虚与脾气虚联合表现而成，即既有属 于脾气虚的颜面萎黄、食欲不振、体困无力、少气懒言；又有属于心血虚的心悸、健忘、失眠、多梦。治疗 此证的代表方剂是归脾汤，方中含有健脾益气的党参、白术、茯苓、黄芪类；又含有补益心血的远志、圆 肉、炒枣仁类。只要掌握了脏腑单独证候，对其联合形式的临床表现是容易分析理解与认识的。 第三节 热病辨证 热病是伤寒和温病的总称，伤寒是寒邪致病，温病是热邪致病，病因虽然不同，但均有发热的特 点，均属外感范畴，故同称为热病，亦同称为外感病。中医传统依据《伤寒论》六经辨证辨伤寒，依据《温 热论》卫气营血辨证辨温病，又依据《温病条辨》三焦辨证对卫气营血辨证作补充。 一、六经辨证 将外感热病顺其传变途径分成太阳、阳明、少阳、太阴、少阴、厥阴等六个阶段，方剂均出自《伤寒 论》。 ( 一 )太阳证 头痛，发热恶寒，脉浮，为太阳证之基本症候群。如伴无汗、脉紧者为伤寒（狭义伤寒），代表方剂麻 黄汤；如伴有汗、脉缓者为中风，代表方剂桂枝汤；如伴口渴者为温病，《伤寒论》未曾立方。 太阳证之三证型如以八纲辨证原则来看，所谓伤寒即风寒表实，中风即风寒表虚，温病即风热表 证。前二种证型在《伤寒论》中明确提出了治法及治方，第三种证型即温病型，其治法与用方在明清以 后由温病学派提出，代表方剂如桑菊饮、银翘散（二方均出自《温病条辨》）。 (二)阳明证 壮热、烦渴、多汗、脉洪大有力为阳明经证症群；痞、满、燥、实为阳明腑证症群。经证代表方剂白虎 汤；腑证代表方剂承气汤（包括大承气汤、小承气汤、调胃承气汤）。 阳明证如以八纲辨证原则来看，当属里实热证，偏于里热者属阳明经证，偏于里实者为阳明腑证。 经证说明里热散于经，腑证说明里热结于腑，前者为无形，后者为有形。"痞"指心下痞鞭，"满"指脘腹 胀满，"燥"指大便燥结，"实"指腹中实痛。 (三)少阳证 口苦，咽干，目眩，往来寒热，胸胁苦满，心烦喜呕，嘿嘿不欲饮食，方用小柴胡汤；兼头痛，恶寒，发 中西医结合实用内科学 热者为太少合证，用柴胡桂枝汤；兼便结，苔黄厚者，为少阳阳明合证，用大柴胡汤。 少阳证如从八纲辨证标准来看，属半表半里证，在上述少阳七症状中，只要遇见其中之一症候者， 便可诊断为少阳证，此证之发病较多，现代医学所称之一切亚急性及慢性炎症之全身反应性症群，大 多属此类。 (四)太阴证 腹满而吐，食不下，自利益甚，时腹自痛，方用理中汤。此证以八纲辨证看，属脾胃虚寒证。 (五)少阴证 少阴之为病，脉微细，但欲寐，方用四逆汤。此证以八纲辨证看，属心肾阳虚证，阳虚乃至亡阳，大 有阳虚欲脱之象，理当急救回阳，四逆汤方证相合。以现代医学观点看，此证乃周围循环衰竭之象。 (六)厥阴证 消渴，气上冲心，心中疼热，饥而不欲食，食则吐蛔，方用乌梅丸。 厥阴证的临床表现比较复杂，历代医家对此证认识尚不一致，上述证候表现仅是厥阴证许多证候 中的一组证候，人们通常把这组证候视为厥阴证之代表证候。以八纲观点看此证属寒热错杂证；以现 代医学观点看，此证属肠蛔虫症或胆道蛔虫症类。 六经辨证是《伤寒论》之精华所在，说明寒邪犯人入里的六个不同阶段，首犯太阳，继则阳明；尚可 不经太阳，直中阳明。亦可由阳明退于太阳，由少阳可转入太阴、少阴、厥阴。《伤寒杂病论》成书于东汉 末年，在战乱中篇简散落，虽经王叔和重订，其原有完整面目，仍无从考证。历代医家如方有执、喻嘉言 等，对此均表遗憾，喻氏用“碎剪美锦，缀以败絮”（《尚论篇》）之语来比喻其美中之不足。当代医家阎德 润说：“关于三阴经于事实上并不相传”（《伤寒论评释》），陆渊雷认为：“既以全身虚寒证为少阴，胃肠 虚寒证为太阴，更无它种虚寒证而堪为厥阴者，乃不得不出于凑合，此拘牵六经之名数，削足适履之过 也”（《伤寒论今释》）。上述医家对六经辨证提出质疑，正说明这一辨证法则有进一步完善和发展的必 要。但六经所揭示的方药和证候，确是久用不衰，千古不二的财富，这一点历代医家是从无异议的。 二、卫气营血辨证 将外感热病顺其传变途径分为卫分、气分、营分、血分四个阶段。 ( 一)卫分证 头痛，发热恶寒（热多寒少），口渴咽干、咳嗽、脉浮数，方用桑菊饮、银翘散。 (二)气分证 壮热烦渴，大汗出，腹满而痛，大便秘结，舌红苔燥黄，脉洪大，方用白虎汤、承气汤类。 (三)营分证 潮热烦渴，躁动谵语，舌质红少苔，脉细而数，方用清营汤（《温病条辨》）加味。 (四)血分证 潮热烦渴，神昏谵语，抽风惊悸，斑疹，诸出血证，舌绛无苔，脉细数，方用化斑汤、安宫牛黄丸（二 方均出自《温病条辨》）。 此辨证乃温病学家叶天士在《内经》营卫气血的基础上，同时接受了张仲景六经分证的启发，结合 自己丰富的临床经验提出的。卫分证候基本属于六经辨证之太阳病，但重点放在邪热犯表方面；气分 证基本上属于六经的阳明证，但又通过对邪留三焦的阐发，增加了胸肺及肝肾方面的热病证候，似较 六经之阳明证表现更为广泛，更能概括临床；营分证是气分证的进一步深入和发展，其主要特点是热 盛伤阴；血分证是营分证的进一步发展，其主要特点是热盛伤阴的同时，又有热入心包、迫血妄行、热 盛动风等更为严重的临床表现。 三、三焦辨证 将外感热病按其发病部位、病情轻重、传变阶段分成上焦、中焦、下焦三证。 ( 一)上焦证

手太阴肺证：头痛，发热恶寒（热多寒少），自汗口渴，咳嗽，脉动数或两寸独大，宜解表宣肺，方用 桑菊饮、银翘散。

手厥阴心包证：舌绛质红，神昏谵语或舌蹇肢厥。宜清心开窍，方用安宫牛黄丸、紫雪丹（《温病条 辨》）。

(二)中焦证 足阳明胃证：发热、口渴、脉大，宜泻火救阴，方用白虎汤、人参白虎汤。

足太阴脾证：首重如裹，身热不扬，体痛且重，胸闷呕恶，苔腻脉缓，宜清热化湿，方用三仁汤、藿朴 夏苓汤。

(三)下焦证

足少阴肾证：身热面赤，手和足心热甚于手背，烦躁不寐，唇裂口燥，宜滋阴养血，方用知柏地黄汤 （《症因脉治》）、杞菊地黄汤。

足厥阴肝证：热深厥深，心中澹澹大动，手足蠕动，甚则瘾疯，宜养肝熄风，方用大定风珠、三甲复 脉汤（二方均出自《温病条辨》）。

三焦辨证为温病大师吴鞠通所创，上焦证相当于六经中之太阳、卫气营血中之卫分，然而增加了 热入心包的神昏、舌蹇、肢厥等证候，充分反映了热病（尤其是病情重笃的急性传染病）之始，即可逆传 心包的特点。中焦病既相当于六经的阳明、卫气营血的气分，又增加了足太阴脾湿合热的中焦湿热证 候，从而补充了六经与卫气营血之不足，恰当地反映了胃肠传染病中如肠伤寒、慢性痢疾等的临床特 点。下焦证则相当于卫气营血中之营分与血分，又具有六经中厥阴证之一部分特点。

第四节病因辨证

中医对病因的认识源于《内经》、《金匮要略》、《三因方》等书，大体把致病因素分成三类：外因、内 因、不内不外因。所谓内因亦称七情，外因亦称六淫，不内不外因则指饮食、劳倦、房室、虫兽、金刃所 伤。近代亦有学者将其概括为内、外二因者。

一、六淫

即风、寒、暑、湿、燥、火，它们本是自然界中六种气候变化，正常情况下称为六气，如果上述六种自 然现象超越了人体所[能适应]{.underline}的范围，有时是太过，有时是不及，就成为致病因素了，而这里所说的六 淫，就是指六气的太过或不及。淫者，邪也，太过或不及也。

(一)风

“风为百病之长”，意思是风可与所有致病因子相结合，共同致病，如风寒、风湿、风热……“风善行 数变”，意思是风性急速，变化无常，如热极生风、肝风内动等来势均甚急骤；另有风湿走注、痛处无定 等。风属木，性条达，主疏泄，因此对风邪的治疗多以疏散为法。

(二)寒

寒主收引，收引则不通，不通则疼痛，大凡痛证多以温散之法取效。寒易伤阳，寒之所在，阳气必 虚，大凡祛寒中药皆具有壮阳之性。

(三)暑

暑性炎热，耗气伤津。意思是暑具火热之性，既能伤阴，又能耗气。暑性夹湿，意思是暑病多伴吐泻 等症。另外暑病是在夏天特有之环境中发病，故谓夏日见暑。

中西医结合实用内科学 (四)湿

th,L 七 共 和 液 生 皆 为 l 之 属 病 和

如风寒、风热数日可愈，风湿之证则迁延日久，再如腹水、胸水、胜湿之作用。 病，程绵长为

其特点。湿性重着易阻气机，气机不通则疼痛，大凡治痛之药多有胜湿之作用。 ( 五 ) 燥 秋日多燥，故有秋燥之称。燥之为病见三干（眼干、鼻干、口干），燥为阳邪，易伤津液。 (六)火

火性上炎是中医对火热证的重要观点，发生于下焦之火热，多与湿合，万能为病，否则不可为病， 故有：“下无纯火”之说。火易伤阴，凡泻火之方剂，配以养阴药，则其效更确，如白虎汤中之知母、龙胆 泻肝汤之生地、泻白散之地骨皮等。火易迫血妄行，出血证半数以上由火所致，泻火即可止血，代表方 剂为三黄泻心汤。 二、七情 喜、怒、忧、思、悲恐、惊合称七情，属于正常的精神活动，通常并不足以致病。但是如果上述七种 情志表现来源于长期或突然的精神刺激，这种刺激超过了人体正常适应能力，它就成为导致脏腑功能 失调、气血紊乱、阴阳失和的致病因子，从而变生疾病。 1.喜 过喜则伤心，过喜则气散。 2.怒大怒则伤肝，大怒则气逆。 3.忧 常忧则伤肺，常忧则气郁。 4.思 多思则伤脾，多思则气滞。 5.悲悲哀则伤心肺，悲哀则气凝。 6.恐 恐惧则伤肾，恐则气血不足。 7.惊 惊则心、肾、肝、胆伤，惊则气乱。 中医病因概念大致以上述六淫、七情为主体，前者为外感病因，后者为内伤病因，内、外因珠联壁 合，形成了祖国医学病因辨证之主框架。除此之外尚有房事不节、饮食劳倦、虫兽金刃所伤等，另称不 内不外因，在病因辨证中仅居次要地位。近年尚有学者提出大气污染、化学毒品、放射尘埃等新的致病 因子，值得进一步研究，其对丰富与发展中医病因学说有重要意义。 (裴正学) 第五章中医内科方药体系 中医内科方药体系是中医方药之主流，所谓内科方药，其实质是泛指一切中药口服汤剂而言，这 些汤药一方面作为治疗内科病的主要方法，千百年来千锤百炼，形成了中医内科治疗学的主体框架： 另一方面在治疗非内科系统疾病时也同样产生着极为重要的作用。这里又充分体现了中医上病下治、 下病上治，全身一盘棋的整体观点。中医内科方药体系大体可分成下列6大系统：麻黄桂枝系、柴胡系、 白虎承气系、四君四物系、六味地黄系、桑菊银翘系。

第一节麻黄桂枝系

本系方剂皆出自《伤寒论》、《金匮要略》，其主方麻黄汤、桂枝汤原为外感风寒之主方，但通过各种 加减化裁，变化出一个庞大的方剂体系，不仅治疗外感有效，同时在治疗各种杂证方面也有极为显著 的效果。

一、麻黄汤类方

麻黄汤由麻黄、桂枝、杏仁、甘草、生姜、大枣等药物组成，水煎服用，治疗头痛，发热恶寒，身痛，无 汗，脉浮而紧的风寒表实证。近人通过实验证明，此方对感冒病毒有一定的抑制作用，因此证明古人所 谓风寒表证大多属今之病毒性上感。此方加生石膏，为大青龙汤，主治头痛，身痛，发热恶寒，无汗口 渴，烦躁，脉浮紧，此为风寒表实兼里热，即风寒表证入里化热之主方。近人用此方治上呼吸道感染恒 有疗效，如加金银花、连翘、公英、败酱等清热解毒药则疗效更确。大青龙汤去桂枝、生姜、大枣，名为麻 (黄)杏(仁)石(膏)甘(草)汤，中医谓此方适应于烦、喘、渴、咳四证。用现代医学观点来看，此方适合于 一切支气管、肺部之感染，包括急、慢性支气管炎、支气管肺炎，以及肺气肿、肺源性心脏病之肺部感

<!-- translated-chunk:10/261 -->