伤寒论 经方诊断 – 太阳病

  Six Jing diagnosis –Taiyang stage
 

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2a. 经方诊断 太阳病

2a. Six Jing diagnosis –Taiyang stage

 

Dr. Martin Wang

 

六经辩证来源于两千多年前的中医先祖张仲景先生的《伤寒论》。《伤寒论》介绍的是外感风寒邪气后人体的疾病变化演变,其诊断和治疗方法。所谓的伤寒,指的是人体受风寒邪气的侵袭所导致的疾病。但是本书也提到了伤寒病和温病的鉴别诊断和治疗原则。一般来说温病属于传染病,而且是发热性的传染病,而伤寒病不一定传染。

The Six Jing diagnosis system was introduced from book Shanghan Lun, more than 2000 years ago by Dr. Zhang Zhongjing. In Traditional Chinese medicine (TCM), he is called the Master in TCM.

The book Shanghan Lun describes the principle in the diagnosis and treatment of Wind- and Cold-attacked disease. The word Shanghuan means a disease that is caused by the Wind and the Cold. (The external factors that cause a disease is called Xieqi in TCM. Here, the Wind, the Cold is such Xieqi). It actually also discussed, though not indicated clearly, the principle in the diagnosis and treatment of a Wen disease (Wen here means an epidemic disease with fever).

在六经辩证中,疾病被分成六个阶段-尽管仲景先生将每个阶段也都称之为病。疾病从轻到重分别为太阳病,阳明病,少阳病,太阴病,少阴病,和厥阴病。

The Six Jing diagnosis system separates a disease into six stage, step, phase, or level. From the beginning, the shallow and light stage of the disease to its later stage, they are named Taiyang Bing, Yangming Bing, Shaoyang Bing, Taiyin Bing, Shaoyin Bing, and Jueyin Bing. The word Bing here means a disease. We can understand it as a stage, a step, a phase, and a level.

诊断太阳病的指标是:脉浮,头项强痛而恶寒。

The principle to diagnose the Taiyang Bing is: floating pulse, strong pain in the head and on the neck, and chilly feeling.

1. 脉浮。风寒邪气侵袭人体,人体外层首先受邪,故脉为浮脉。要注意的是如果脉沉,那么提示邪气直中少阴层面,要用不同的治疗方法。这个鉴别诊断非常重要。临床上,浮脉需要和大脉区别。

The pulse is floating. The Xieqi attacks the body surface layer, so that the pulse is floating. If the patient feels chilly, and has headache, but the pulse is deep, it will not belong to the Taiyang stage, it is in the Shaoyin stage. We should be careful with this distinguish. The floating pulse needs to be distinguished with the big pulse.

2. 头项强痛。实际上,这种痛也可以出现在后背脊柱两侧,大腿后方,脚踝外侧等足太阳膀胱经走向的区域。对于学院派中医来说,他们很容易将脚后跟痛当作肾虚。而在经方派,这种痛将被看作为太阳病,表证,而非里证虚证,特别是当病人有外感症状而且脉浮时是如此。

The patient has strong headache and pain on the neck. In fact, the pain can be also on the lower back, on the back of the leg, all along the distribution of Taiyang meridian. Sometimes, the pain is on the heel. For College style doctor, they would tend to consider the heel pain is due to kidney deficiency. In the Jing Fang style, especially when the patient has floating pulse and chilly, they will consider it as Taiyang disease.

3. 恶寒。病人怕冷,不喜欢待在冷房子里,喜欢穿盖的暖和些。哪怕实际体温达到摄氏 40 度,病人还是怕冷,还把被子往身上盖。这里,中医注重的是病人的感觉而不是客观测量的结果。这是中医和西医在诊断取证上的主要区别之一。病人这种怕冷的感觉可以是全身性的,也可以是局部性的。比如仅仅背部一点怕冷。怕冷的感觉可以持续几分钟,也可以是几个小时。在临床上,询问病人是否有怕冷的感觉十分重要。

Chilly. The patient feels cold, dislikes cold and wants to cover more for warm. In this case, even if his/her body temperature reaches 40 ºC, we still pay attention to the chilly feeling, not the fever. The patient may feel chilly or cold on the whole body, or only on and around the shoulder, or only on the back of the body somewhere. It can last for several hours or only several seconds. In clinic, as a TCM doctor, we must remember to ask the patient if he/she has such chilly feeling.

诊断太阳病,我们必须排除温病,特别是温病的早期阶段。温病的早期阶段,比如说SARS H1N1流感等,病人一得病就会发热,恶寒的感觉极其短暂或根本就没有。病人发热,口渴,出汗。病人喜欢待在冷房子里,不喜欢热。如果病人的表现是如此,我们就能肯定他得了温病。温病的这种表现和伤寒入里化热进入阳明经证阶段基本上一样。阳明经证者,病人身热口渴,不恶寒反恶热。所以我们也可以说温病是温热邪气首犯或直中阳明层次,而伤寒病是风寒邪气首犯太阳层次,所以,基本上能治疗伤寒病阳明经证的方剂,如白虎汤等,也可以用于温病初期,即温病的气分阶段。在这一点上,我们认为说伤寒论不治疗温病的说法是不对的。但是温病发展变化特别快,能否及时应用白虎汤等方剂是治疗的关键。

To diagnose the Taiyang stage of the Shanghan disease, we must remember to exclude the Wen disease, especially its early stage too. Patients in the early stage of the Wen disease, such as SARS, H1N1 flue, etc., have fever very soon after get the sick. The patient feels hot, very thirsty, and has strong sweat. The patient likes to stay in cold room, or drink cold water, but hate hot or warm. If a patient has such feelings, we should consider that the patient must has a Wen disease. Actually, the clinic manifestations of the Wen disease is pretty much same as the second stage of the Shanhan disease: the Yangming stage, in which the patient also feels hot, has fever, strong sweat, thirsty, not dislikes cold but dislikes hot. For the treatment, the herbs used for the Yangming stage can also be used for the treatment of Wen disease. For this reason, we believe that the idea is not correct that the Jing Fang style (the Shanghan Lun style) cannot be used for the treatment of Wen disease. 

太阳病有几个亚型,即麻黄汤证 (所谓的太阳伤寒证),桂枝汤证(即所谓的太阳中风证),小青龙汤证,大青龙汤,葛根汤证等。这是因为个体的体质不同,在受到同样的邪气侵袭后,身体的反应不同所致。

The Taiyang stage of Shanghan disease can be further more separate into a Cold-attacked Taiyang syndrome (we also call it Mahuang Tang syndrome), Wind-attacked Taiyang stage (Guizhi Tang syndrome), Xiao Qinglong Tang syndrome, Da Qinglong Tang syndrome, and Gegen Tang syndrome, and so on. This is because the difference in the body reaction to the same kind and same level of Xieqi attack.

麻黄汤证者,病人平时就不太容易出汗,得病后也不出汗。面目手脚常有膨胀或浮肿现象(演员李琦就是这种体质)

桂枝汤证者,病人平素体质瘦弱,易出汗 (如林黛玉体质)。

小青龙汤证者,平素胃肠功能差,即心下有水气,病人干呕、发热而咳,或咳、或利、或噎、或小便不利、少腹满、或喘者。

大青龙汤证者,病人素体有内热,喜欢冷饮。这种病人西方人多见。得伤寒后,病人除了表症外,有口干,心烦等内热表现。

葛根汤证者多为肌肉健壮的人,如体力劳动者或运动员。得伤寒病后易有前额痛,鼻窦炎发作,后项强痛等。

In the Mahuang Tang syndrome, the patient has no sweat (the person usually is hardly to have sweat), while the Wind-attacked Guizhi Tang syndrome, the patient sweat easily. For the former, we use Mahuang Tang, while for the later; we use Guizhi Tang for the treatment. The person who can be treated with Mahuang Tang is those who do not sweat easily, but easy to have local floating phenomenon in the body surface, such as swelling in the lips of the eyes, in the hands or feet.

The person who should be treated with Guizhi Tang is usually slim in body shape, easy to sweat.

The person who should be treated with Xiao Qinglong Tang (Xiao means small) is those who has poor digestive function, easy to have bloating in stomach, has nausea, fever and cough. He/she may have diarrhea, stock feeling in throat, difficulty in urination, bloating in lower stomach, or has asthma.

For the Da Qinglong Tang syndrome, the patient usually has hot-fire feeling inside the body. The person feels hot in the body and likes to drink cold or ice water. Such person can be found easily among western people. For them, after getting the Shanghan disease, they feel thirsty and annoyed, such inside fire phenomenon, as well body surface syndromes.

The patient who should be treated with Gegen Tang is those who are strong in muscle mass, such as labor workers and athletics. Upon attacked by the Shanghan disease, they frequently have pain in front of head, onset of sinus problem, and pain on the back of the neck.

除了以上常见的类型外,伤寒病还有以下几种特殊类型:

Special type of Taiyang stage:

(1). 膀胱蓄热证

(1). Hotness accumulation in urinary bladder.

病人有头项痛,恶寒不恶热这些表证,还有小腹胀痛,小便不利这样的里证。这是由于邪气入侵膀胱,热邪蓄积膀胱。作为治疗,仍需要用桂枝汤先解表,然后用桃核承气汤驱邪外出。

In the Taiyang stage, patient has chilly feeling and headache. The patient also feels bloating in the lower stomach area and has difficulty in urination. This is due to the Xieqi invasion into the urinary bladder. For the treatment, the sweat therapy is still the first thing needed to release the Xieqi out of the body. After that, if the patient still feel bloating in the lower stomach, and has difficulty in urination, use Taohe Cheng Qi Tang to expel remaining Hotness Xieqi from the urinary bladder.

 (2). 膀胱积血证

 (2). Blood accumulation in the urinary bladder.

当病人有头项痛,恶寒不恶热的时候,还有小腹胀痛,但小便正常。这是膀胱积血证。小便不受影响。此时脉搏沉弱或沉涩。此证需要用抵挡汤治疗。

If the patient has chilly, headache, panic, bloating feeling in the lower stomach, but no difficulty in urination, and his/her pulse feels deep-weak, or deep-entangled, this condition belongs to blood accumulation in the urinary bladder. In this case, Di Dang Tang is used for the treatment.

以上是伤寒病太阳阶段的诊断和治疗大纲。读者只要记住诊断要点是脉浮头项强痛而恶寒就能诊断。不必考虑是否发热或发热程度多高。有脉浮和恶寒感就将病情定在了太阳阶段。医学院毕业的医生会注重是发热重还是恶寒重而判断是风热还是风寒证。在经方诊断体系里,这是没有必要的。关于脉浮,读者需要自己体会和请教有经验的医生。中医单靠书本是不容易学好的。

The above is the principle for the diagnosis and treatment of the Taiyang stage of Shanhan disease. The reader only needs to remember the point for the diagnosis: floating pulse and dislike cold feeling, no matter the patient has fever or not. The floating pulse and the cold-dislike feeling fixes the diagnosis on the Taiyang stage already. For those of doctors who graduated from TCM schools may pay attention to whether the fever is more or the cold-dislike feeling is more severe or intense. In the Six meridian diagnosis systems here, it is not needed at all. For how to tell the pulse is floating, reader has to consult an experienced TCM doctor and to practice to feel it by himself. It is hard to learn TCM only from the book or the seminar. 

当疾病处于太阳表证的时候,如果诊断正确,用药准确,数小时后病情就会明显缓解。而且这种缓解指的是治愈,不留后患的治愈。这一点不像用抗生素或激素治疗导致的病情迁延不断。我们一般让病人喝一杯中药,然后针灸,所以一般一小时后病人会觉得症状明显缓解,感到明显轻松。这种治疗,成功率很高。我们用的中药是中药免煎颗粒剂。加水就能溶解,病人当场就能喝。用药得当的话,二十分钟后病人就能感觉到草药的治疗作用。这种情况读者可以自己实验;碰上常身热汗出口渴的病人(西方人多见),让他喝 6 克白虎加人参汤中药冲剂,看看病人是否能在二十分钟后说出身上已经开始凉快了。

If the disease is in the Taiyang stage and if the diagnosis is correct and the treatment is proper, the recovery is very fast. The patient could feel much better after even several hours. Such recovery means radical and complete. Not like the healing by the use of antibiotics or cortisone products, which could delay the recovery and the recovery usually needs several days.

We use herbal granules. That means the herbs have been cooked, extracted and dried into powder form. Upon use, you only need to add water to the granules to dissolve and to drink it on spot. We normally let client drink the herbal tea first, then use acupuncture. If the herbal formula is the right one, the patient can tell the healing effect of the herbs after 20 min. This can be repeated by reader yourself. If you have a patient who suffers from hot feeling, heavy sweat and thirsty, you can let him/ her drink herbal tea of Baihu Jia Rensheng Tang. You can see if he/she feels cooler, less sweat and less thirsty after 20 min.

表证之治疗主要是发汗解表(用麻黄汤类方),调和营卫(用桂枝汤类方),解表逐水气法 (用小青龙汤),解肌法(葛根汤),和解表清里热法(大青龙汤)等。关于药物的组成和作用,我们以后逐步讲解。另外,这些方剂都有它们自己使用的注意事项。用之不当,也会有副作用或加重病情 医学不是个轻松的事业。我们也准备在以后的文章中逐步讲解。请耐心等待。我们会一步步深入。

The main therapies for the Taiyang stage, the body surface syndrome, are the sweat therapy (using Mahuang Tang series), the Yin-Wei Harmony therapy (Guizhi Tang series), the surface-releasing and inside water-expelling therapy (Xiao Qinglong Tang series), the muscle-relaxing therapy (Gegeng Tang series) and surface-releasing and inside fire-reducing therapy (Da Qinglong Tang series). For the ingredients or the herbal formulae, and the function of each ingredient in the formulae, we will discuss later. In addition, there are special requirements for the use of each herbal formula in clinic. If the herbs are used improperly, there definitely will be side effects or even make the disease worse – Healthcare is not easy industry. This will also be discussed later.

如果邪气同时侵袭少阳和阳明层面,或者太阳表证尚未解而邪气还进一步进入了少阳或阳明,就会出现太阳阳明,或太阳少阳,或太阳少阳阳明三经同时存在的病症。关于常见的二阳和三阳合病并病情况的诊断和治疗,我们也得以后介绍。

If the Xieqi (the disease-causing energy entity) invades the Shaoyang and Yangming phases the same time, or if the Xieqi has already invaded into the deeper phase, which is the Yangming or the Shaoyang phase, but there are still some left in the Taiyang phase, there would be the co-exist of the Taiyang-Shaoyang, the Taiyang-Yangming, or even the Taiyang-Shaoyang-Yangming phases. For the diagnosis and treatment of the two Yang phases, or the three Yang phases, we will also discuss in later articles.

本系列文章将伤寒论段落进行了重新整理后来讲解的,而不是逐条逐句讲解。也可以说是对伤寒论作的简化性介绍。对伤寒论有研究的读者不必奇怪。因为我们认为有些章节虽然列在某个病下,但那是为了鉴别诊断的目的,而不见得就属于那个病症。比如说四逆散被列在厥阴病章,但它应该属于少阳病。而另外一些时候,有些病情属于误治后的处理,这种误治后的病情应当属于另外的病证中。比如栀子豉汤治疗发汗吐下后, 虚烦不得眠, 或发汗, 若下之而烦热, 胸中窒者。但这种胸中窒的病症当属于阳明胸证。理由后叙。

This series of articles introduce the Shanghan Lun after re-organize its chapters, not introduce or explain it according to its original paragraph. It can also be regarded as simplified introduction of Shanghan Lun. Readers who have studied Shanghan Lun before should not feel strange for this. Some paragraphs, though introduced in a chapter for a given disease, function there as for a distinguish aim. It actually does not belong to that given chapter. For example, herbal Si Ni San was listed in the Jueyin chapter (for the Jueyin disease), but it actually should belong to Shaoyang chapter. It was listed in the Jueyin chapter for distinguish with Si Ni Tang and Danggui Si Ni Tang – we believe so. Sometimes, a paragraph tells about the treatment of conditions that were due to improper treatment with suggested original herb formula. For example, herbal formula Zhizi Chi Tang was listed in the chapter for Taiyang stage, but it is for the treatment of annoyed feeling and poor sleep that happened after a sweat therapy, vomiting therapy or colon-cleansing therapy. Or, it is for the treatment of annoying hotness feeling with choking feeling in chest. Such choking feeling in chest apparently belongs to Yangming stage. We will talk about the reason for this later too.   

下一节我们讲阳明病诊断和治疗。谢谢对我们系列讲座的兴趣和耐心。

In next articles, we will discuss the diagnosis and treatment of Yangming stage of Shanghan disease. Thanks very much for your patience and interest to our seminar.

 

 

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