《伤寒论》三阳下利浅析

常言"病下利者多发于阴",然阳证亦多见下利:(1)病在太阳经表,当以葛根汤疏表止利。若兼阳明经表、入里化热,则以葛根芩连汤解表清里;若兼太阴脾虚,则用桂枝人参汤解表温里。太阳变证、邪气内陷,在中焦者,以泻心汤辛开苦降;在下焦,滑脱不止者,以赤石脂禹余粮汤涩肠固脱,水湿偏渗者以五苓散分利水湿。(2)病入阳明成里热腑实,燥屎当结,当用承气汤急下存阴、通因通用。(3)病在少阳半表半里,胆腑郁热所致下利,应用黄芩汤和胆止利。若兼阳明里实,重者用大柴胡汤、轻者以柴胡加芒硝汤和解通下;若兼太阴不足者,则用柴胡桂枝干姜汤和解温阳。

An Analysis of Diarrhea due to Three-Yang Syndrome in Treatise on Cold Damage Diseases

It is commonly believed that diarrhea is due to yin syndrome,but yang svndrome may also lead to diarrhea:①If disease appears on the surface of taiyang meridian,Pueraria Decoction can be used If disease appears on the surface of yangming meridian,enters into the body and generates heat,Pueraria and Scutellaria and Coptis Decoction can be used to relieve exterior syndrome and clear heat in the body.If combined with taiyin spleen deficiency.Cinnamon Twig and Ginseng Decoction can be used to relieve exterior syndrome and warm interior.For taiyang deteriorated case and pathogenic factor lingering in upper energizer,Heart-Draining Decoction can be used for dispersion with pungent drugs and purgation witlh bitter drugs.For pathogenic factor lingering in lower energizer leading to serious diarrhea,Chishizhi Yuyuliang Decoction CSZYYLD) can be used to relieve diarrhea with astringents,while for fluid-retention syndrome,Five Substances Powder with Poria can be used.② If disease enters into yangming meridian leading to interior heat and excess,and coproma,Chengqi Decoction can be used to remove constipation.③If disease appears in shaoyang meridian with half exterior and half interior syndrome,leading to diarrhea due to stagnated heat of gallbladder,Scutellaria Decoction can be used to harmonize the gallbladder and stop diarrhea.If combined with interior excess of yangming,for serious case,Major Bupleurum Decoction can be used;for light case.Bupleurum and Natrii Sulfas can be used;If combined with taiyin deficiency,Bupleurum and Cinnamon Twig and Dried Ginger Decoction can be used to harmonize and warm yang.