浅析柴胡桂枝干姜汤证

柴胡桂枝干姜汤证病机特点为半表半里邪热,津伤阳损,上热下寒,冲逆明显。其临床表现颇为繁杂,但主要不外半表半里寒热两方面。上热证见:晨起口苦,咽干,口干欲饮,无唾液,口中黏腻,口臭,眼干无泪,头晕,耳鸣,往来寒热,胸胁苦满,心烦,失眠多梦,上半身燥热,夜间手足灼热,舌干红瘦,少苔或无苔等。下寒证见:疲倦,纳差,不能饮冷食凉,脘腹、腰部畏寒,关节疼痛,颈背腰部疼痛,白天手足厥冷,或终日四肢厥冷,或下半身畏寒等。其他表现:心下满,大便干,小便不利,但头汗出,心悸,气上冲,微热等。本证辨识要点为口干或晨起口苦,四肢厥冷,尤其是双足冷,冬季尤甚。但必须排除因邪热郁闭体内,阳气无法宣通,出现恶寒肢冷等症状的真热假寒证。同时要与乌梅丸证、《金匮要略》肾气丸证等相鉴别。需要说明的是,"口干""四肢厥冷",不仅是患者的自觉症状,而且是客观的体征,即"口腔津液缺乏""四肢皮温低下"。

A Brief Analysis of Syndrome of Bupleurum and Cinnamon Twig and Dried Ginger Decoction

The pathogenesis characteristics of syndrome of Bupleurum and Cinnamon Twig and Dried Ginger Decoction are meso-exterior-interior pyretic pathogenic factor,damaged body fluid and yang,upper heat and lower cold,and obvious subjugating pulse.Its clinical manifestations are very complex,but mainly in meso-exterior-interior and cold-heat.The syndrome of upper heat is marked by bitter taster of mouth in the morning,dry throat,thirst,no saliva,greasy mouth,smelly month,dry eyes without tears,dizziness,tinnitus,fever,thoracic and hypochondrium fullness,irritability,insomnia,dreamy,hot and dry upper body,burning sense of hand and foot at night,dry and red and thin tongue with a little fur or no fur,etc.The syndrome of lower cold is marked by fatigue,anorexia,being afraid of cold food and drink,adverse to cold in abdomen and waist,joint pain,neck-back-waist pain,cold hand and foot in the daytime,or cold limbs all day,or adverse to cold in the lower body,etc.The other manifestations:Epigastric fullness,dry stool,disorder of urination,sweating on the head,palpitation,rising of qi,mild fever,etc.The syndrome differentiation points are:dry mouth or bitter taster of mouth in the morning,cold limbs especially cold feet in winter.Pay attention to pseudcold hot syndrome marked by adverse to cold and cold limbs due to pathogenic heat stagnated inside the body leading to yang qi failing to disperse must be excluded.At the same time,try to tell it from syndrome of Mume Pill or syndrome of Kidney Qi Pill in Essentials from the Golden Cabinet.Besides," dry mouth"," cold limbs ",are not only subjective symptoms of patients,but also objective signs,namely "oral fluid lack" and " low limb skin temperature".