桂枝汤类方二十一

2022.10.01 781阅读 评论数 0 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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

伤寒若吐、若下后,心下逆满,气上冲胸,起则头眩,脉沉紧,发汗则动经,身为振振摇者,茯苓桂枝白术甘草汤主之。

茯苓四两 桂枝三两 白术  甘草各二两

上四味,以水六升,煮取三升,去滓,分温三服。

如果是太阳伤寒病,用吐下法的话,那绝对是庸医中的庸医,仲景本人肯定不会这么干。那么他所举的案例从庸医中的庸医那来?也不大可能。那么问题在哪里呢?在"伤寒"这一词,这里指的"伤寒"是指广义的伤寒,即《难经》所述:伤寒有五,一曰中风,二曰伤寒,三曰湿温,四曰热病,五曰温病。所以说本条所说的伤寒,是指广义伤寒中的中风、热病与温病。中风、热病与温病,温热象明显,才会易使医生误诊为阳明病而误用吐下法从而导致变证。

经过吐下后,里虚寒了不制水饮,水饮就上逆于心下、头部、冲于胸中,出现了心下胸中胀满、从坐的状态中站起来时就会头晕、脉沉紧等一派水饮上逆证。脉沉为病在里,说明表证基本上没有了,在表的温热病邪大多已经被下去了,但是,表邪用吐下法,表邪毕境不能完全的内陷完的,多少都有点残留的。紧为有虚寒,下得太厉害了,里的津血虚了,能量不足就寒了,寒脉就会紧。这个时候要用茯桂苓甘汤。如果医者,光看脉紧不管脉沉,就会以为表有伤寒,再发汗的话,祸患就大了。发汗则动经,身为振振摇。一发汗,就会脱阳、津血不足,津液不能濡养肌肉组织,肌肉就会紧急抽搐、无力就站不稳,身体摇摆,就变成了真武汤证了。真武汤温阳去里寒清热除水饮。

茯桂术甘汤,茯苓四两,化水饮利水渗湿,拦截水饮上逆。桂枝四两,使气得旁流,降逆,也解一下表邪。气上冲逆的病,往往都会隐藏着表邪的。白术,温太阴,除水饮,微解表,温胃气助消化。甘草补津液,调和诸药,缓解药毒,行药力。太阴得温,水饮得除,表邪得解,气得旁流,则水饮不再上逆,心下逆满气冲胸头晕得解。

 

三才解析法:

主治:凉滞寒饮多、津亏

病位:表里俱病

阳性药:桂枝4 温 辛甘 白术2 温 辛甘滋微苦

平性药:炙甘草2 平 甘滋   茯苓4 平 甘淡。

阴性药:无

 

四象解析法:

君药(主症):桂枝4温 辛甘

臣药(兼症):白术2 温 辛甘滋微苦

佐药(护胃气):炙甘草2 平 甘滋  茯苓4 平 甘淡

使药(反制,沟通阴阳):无

甘草医生声明:

本文仅供学习用,版权归相关权利人所有,未经授权,严禁转载。我们尊重原创,若您转载本文,请先征得版权相关权利人同意,并注明:来源甘草学园论坛与原作者姓名。文中方药仅供参考,请在专业中医师指导下辨证用药,切勿擅自试药!若因版权纠纷、擅自试药等引发问题,后果自负。涉及隐私、版权等各类问题请联系客服人员处理。

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