The first section is the composition of prescriptions with mixed cold and heat.
Chaihu Guizhi Ganjiang Decoction consists of half a catty of Chaihu, three ounces of Guizhi (peeled), two ounces of dried ginger, four ounces of Trichosanthes kirilowii root, three ounces of Scutellaria baicalensis Georgi, three ounces of oyster (boiled) and two ounces of licorice (roasted licorice). This recipe is a variant of Xiaochaihu decoction with Pinellia ternate and Trichosanthes kirilowii, that is, ginseng, jujube, Pinellia ternate and ginger are removed, and Trichosanthes kirilowii root, cassia twig, dried ginger and oyster are added. Bupleurum chinense in the prescription is responsible for gastrointestinal qi stagnation, food stagnation, cold and heat pathogens, bringing forth the old and bringing forth the new, and interacting with Scutellaria baicalensis Georgi to remove heat and treat chest and hypochondriac pain; When the roots of Trichosanthes kirilowii are moist, oysters can be harvested to quench thirst; Scutellaria baicalensis Georgi bitter cold, dried ginger pungent warm, treat micro-knot; Cinnamomum cassia twig and Glycyrrhiza uralensis Fisch. are used to treat acute respiratory distress and exogenous pathogenic factors. Glycyrrhrizae Radix and Rhizoma Zingiberis Recens are adjusted to produce fluid; The original ginseng tonic and jujube full were not suitable for micro-knot, so they were removed. Therefore, if Bupleurum chinense goes to Pinellia ternata and Gualou decoction, it will be treated if there is a slight knot in the gas or external disharmony. Jin Jian, a medical doctor, said: "shaoyang has not been solved in the exterior and interior, so Chaihu Guizhi mixture is used, that is, the change of Xiaochaihu." Those who go to ginseng are not empty; Halve in summer, because you don't spit fast and help dry; The roots of Trichosanthes kirilowii can quench thirst and produce fluid; Adding Bupleuri Radix and Ramulus Cinnamomi to control yang deficiency, and adding concha Ostreae to soften yang deficiency; Dried ginger and cassia twig to dispel cold; Scutellaria baicalensis Georgi and Bupleurum DC. Can be used to make dried ginger. Drugs are cold and warm, and need to be reconciled with licorice. "
Ke Yunbo thought: "This recipe is all Bupleurum. I am upset and thirsty, so I will go to Xiajia to add trichosanthes." Chest full, slightly knotted, increase dates and oysters; Although urination is unfavorable, I feel nervous, so I don't go to Scutellaria baicalensis Georgi and don't add poria cocos. Although thirsty, you don't have to participate in cinnamon, so dried ginger is easy to ginger, and your chest is full. "I think this prescription is changed by Xiaochaihu decoction, and the views of various scholars are the same.
Medical Zong Jinjian proposed it as Chaihu Guizhi mixture, suggesting that this prescription is suitable for the syndrome of half exterior and half interior, but he thought that the loose knot was not in dried ginger but in oyster, so it was easy to treat dried ginger lightly. However, Koch noticed that dried ginger is easy to ginger, in order to dispel the fullness of the chest and hypochondrium, and cold drinks are the main reason for fullness, so the warmth of dried ginger should be used instead of ginger. Therefore, dried ginger is easy to be ginger, which is a major point that distinguishes Chaihu Guizhi Dried Ginger Decoction from Xiaochaihu Decoction, suggesting that Xiaochaihu Decoction focuses on reconciling the heat of half exterior and half interior, while Chaihu Guizhi Dried Ginger Decoction tends to disperse the cold of half exterior and half interior (Jue Yin? )。
In the second quarter, half of the onset position is outside and half is inside.
Xiaochaihu decoction is well known. Chaihu Guizhi Ganjiang Decoction evolved from Xiaochaihu Decoction. As can be seen from the above explanation, the location of this prescription is still the same as Xiaochaihu decoction, half exterior and half interior.
Moreover, many people have seen the difference between the two. For example, Liu Duzhou's Clinical Guide to Typhoid Fever and Typhoid Fever records: "When Mr. Chen Shenwu and Mr. Chen asked about the application of this prescription, Mr. Chen pointed out that Chaihu Guizhi Ganjiang Decoction was the most suitable prescription for treating yin deficiency and pathogenesis transformation of Shaoyang disease."
Zhang Luyu pointed out: "Xiaochaihu decoction is the prescription of yin and yang, which can advance and retreat together with malaria, plus cassia twig and dried ginger, and then from yang;" If you add Trichosanthes root and gypsum, you will go from the shade. " What is the mechanism of yin syndrome? What is from Yin to Yang? No explanation.
Hu Xishu, the master of classic prescriptions, broke his weapon in one sentence. He explained Chaihu Guizhi Ganjiang Decoction in the chapter of shaoyang disease in Treatise on Febrile Diseases, and clearly pointed out when explaining the prescription of Chaihu Guizhi Ganjiang Decoction: On May 6th, typhoid fever was a period when superficial diseases often spread to shaoyang, but it repeatedly broke out because of sweating, which caused great harm to body fluid, making the yang syndrome in half exterior and half interior become the yin syndrome in half exterior and half interior. It can be seen that Xiaochaihu decoction treats semi-exterior and semi-interior yang syndrome from yin and semi-exterior and semi-interior yin syndrome from yang. It is also known that the pathogenesis of yin syndrome refers to the change of disease location from yang syndrome to yin syndrome in half a table and half a room. Look at Zhongjing's exposition more clearly. According to article 147 of Treatise on Febrile Diseases, typhoid fever is repeated for five or six days, and the chest and hypochondriac are full of micro-knots, which is unfavorable, and you don't vomit when you are thirsty, but your head is sweating, cold and hot, and you are upset. It means that typhoid fever has been sweating for five or six days.
Sweat, diarrhea and pathogenic heat all hurt body fluids, which can't flow down, which is unfavorable for urination; Lack of body fluid, heat injury to body fluid, resulting in dryness, so thirst will not vomit. Jumped into bed together, and sweated on his head. Between cold and heat, evil is still in half the exterior and half the interior. I am upset because there is heat in the world. The micro-knot here is aimed at the card of "Great Sage Tang Xiong", that is to say, the knot is slight, which is obviously different from the card of "Great Sage Tang Xiong" whose card of "Yangming" is as hard as stone. That is, the half-exterior and half-interior yang syndrome becomes half-exterior and half-interior yin syndrome, which is manifested as the prescription of Chaihu Guizhi Ganjiang Decoction with upper heat and lower cold.
"synopsis of the golden chamber? Malaria tonic (3): "Chaihu Guizhi Ginger Decoction can cure malaria, with excessive cold, slight heat, or cold but not hot, and one dose is like a god." Malaria is a disease with alternating cold and heat. Chaihu Guizhi Ganjiang Decoction is suitable for malaria with cold excess and less heat, or cold but not heat, which shows that this prescription focuses on warming and dispelling cold.
There are only two articles on this article by Zhong Jing, and there is no direct mention of the symptoms of the Meiji Six Classics, but we can know that the main indications of this prescription are "but cold is not hot" and "cold is hot and upset". It can be seen that there are similarities and differences between this prescription and Xiaochaihu decoction syndrome: similar patients have the same disease location and are all used for semi-exterior and semi-interior syndrome; Different people have different diseases. Xiaochaihu decoction is used for yang syndrome and Chaihu Guizhi Ganjiang decoction for yin syndrome.
Section III Overview of Jueyin Disease
According to Confucian classics, the six meridians come from eight categories, that is, the diseases of the exterior and interior of the human body are divided into yin and yang. There are yin syndrome and yang syndrome in half exterior and half interior, and Xiaochaihu decoction is known as yang syndrome in half exterior and half interior, also known as shaoyang disease; Obviously, the syndrome of Chaihu Guizhi Ganjiang Decoction belongs to semi-exterior and semi-interior yin syndrome, which belongs to Jueyin disease. So, is it consistent to measure the prescription with the outline of Jue Yin disease?
The outline of Jueyin disease is: quenching thirst, gas hitting the heart directly, heartburn, hunger without eating, vomiting with eating, and more benefits. Its main characteristics are: half exterior and half interior cold, upper heat and lower cold, and obvious thrust. The indications of Chaihu Guizhi Ganjiang Decoction are as mentioned above: malaria can be treated with excess cold, slight fever, or cold without heat, alternating cold with heat, upset and so on. What is more noteworthy is that this prescription contains cassia twig, such as Trichosanthes root, oyster nourishing body fluid, astringing body fluid and quenching thirst. Dry ginger warming cold and Scutellaria baicalensis clearing heat are typical prescriptions for treating Jueyin disease, which is often effective in clinic.
Section 4 Clinical verification belongs to Jueyin
Example 1: Li, female, 88 years old. 5438-06-2002-106 initial diagnosis: paroxysmal atrial fibrillation in recent three years, uncontrollable after long-term hospitalization. Recent symptoms: precordial tightness, chest tightness, palpitation, cold hands and feet, dry mouth, backache, fatigue, dizziness, tinnitus, poor sleep, easy sweating, thin and white tongue coating, pale tongue, bilateral pulse inversion and sometimes knot. Electrocardiogram showed that V3, V5 and ST decreased, and T wave was low. The syndrome belongs to Jue Yin disease, with upper heat and lower cold, and blood deficiency and water deficiency. The main indications of Chaihu Guizhi Ganjiang Decoction combined with Danggui Shaoyao Powder are: Chaihu 12g, Scutellaria baicalensis 10g, Trichosanthes root 12g, raw oyster 15g, raw keel 15g, cassia twig 15g, dried ginger 6g, and roasted licorice.
Treatment results: After taking 7 doses of drugs, dizziness, fatigue and palpitation improved, and atrial fibrillation attacks decreased. No atrial fibrillation occurred after 2 months of medication, and the condition was stable after 2 years of follow-up.
Example 2: Wang, 1955 08 19 Initial diagnosis: I was ill for 6 days and didn't take western medicine. His symptoms are: cold, fever, bitter taste, dry throat, upset, fullness in the chest and hypochondrium, underwater sound when rubbing the upper abdomen, adverse urination, red tongue, white and slippery fur and thready pulse. This syndrome belongs to shaoyang disease, and it is also a syndrome of depression in water and drink. It is advisable to moderate shaoyang and control water drinking. The prescription is Chaihu Guizhi Ganjiang Decoction: Chaihu 9g, Scutellaria baicalensis 9g, Guizhi 6g, Ganjiang 4.5g, Poria 9g, Chenpi 6g, Alisma orientalis 6g and Glycyrrhiza powder 3g.
Treatment results: After taking 2 doses, the cold and heat were relieved, the chest and hypochondrium were full, the symptoms of abstinence disappeared, and urine was smooth. Modern research and clinical application of Treatise on Febrile Diseases by Meng. Beijing: College Press, 1998)
Example 3: Female, 23 years old. First visit:196165438+1October 20th. "Menopause" for 5 months, with more leucorrhea and no pregnancy. In the last 7 days, I felt bitter mouth, chest pain and hypochondriac pain, and I didn't think about diet. The day before yesterday, I felt whole body pain, low back pain, then menstruation, bright red color, foul breath, less urine, urethral pain when urinating, dry mouth, like hot drinks, upset, sweating at night, backache and abdominal pain, pale tongue and thready pulse. This element has little body blood, and Shaoyang has recently been affected by evil. It is planned to use Bupleurum, Guizhi and Ganjiang Decoction to nourish blood: Bupleurum 15g, Guizhi 10g, dried ginger 6g, Trichosanthes root 12g, Scutellaria baicalensis 10g, roasted licorice 6g, oyster 12g, and rehmannia root.
Treatment results: After taking 1 dose, the symptoms such as bitter mouth and backache are greatly reduced, and the leucorrhea is also less. Chest tightness, upset, thirst and other symptoms have been removed, and menstruation is still unclean. Continue to take 2 doses and recover after cleaning leucorrhea. (Li Peisheng, et al. Teaching Reference Series of TCM Colleges. Treatise on Febrile Diseases. Beijing: People's Health Publishing House, 1987)
Reporter: These three cases were treated by different doctors, but all of them used Chaihu Guizhi Ganjiang Decoction to treat common acute and chronic diseases. All 3 cases had chest pain, bitter taste, dry throat, upset, palpitation, dysuria, or four kinds of adverse reactions, which were manifested as upper heat and lower cold. Scholars believe that this prescription has the same disease position, but it has always been influenced by the explanation of treatise on febrile diseases in Neijing. They always think that half exterior and half interior are shaoyang, Xiaochaihu decoction is the representative of shaoyang disease, and Chaihu Guizhi Ganjiang decoction is modified from Xiaochaihu decoction, so it is still regarded as shaoyang, because the essence of six meridians is unknown.
We should know that the six meridians in Treatise on Febrile Diseases are not the zang-fu organs and meridians in Neijing, but the six meridians formed by eight classes plus the concept of half exterior and half interior. There are yang syndrome and yin syndrome in half exterior and half interior, yang syndrome is shaoyang disease, and yin syndrome is Jueyin disease. In case 2, the author thinks that "the syndrome belongs to shaoyang meridian disease, and water and drink stagnate internally", that is, "shaoyang disease, water and drink stagnate internally", that is, upper cold and lower cold, that is, half exterior and half interior yin syndrome.
Xiaochaihu decoction is used to treat half exterior and half interior yang syndrome, while Chaihu Guizhi Ganjiang decoction is used to treat half exterior and half interior yin syndrome. There is a clear difference between the two. This is what Mr. Chen Shenwu called "Yin Syndrome Turning Point" and what Zhang Luyu called "From Yang Syndrome", that is, from half-exterior and half-interior yang syndrome to half-exterior and half-interior yin syndrome. Six meridians belong to Jueyin disease.
Here, we can make this clear by comparing the prescriptions of Wu Mei Pills. The concept of Jueyin disease has been unclear in later generations, and the prescription of Jueyin disease is even more vague. However, it is consistent that Wu Mei Pill is a prescription for Jue Yin disease, and its prescription has the characteristics of both cold and heat, and its main indication is the mixture of cold and heat.
The prescription composition of Chaihu Guizhi Ganjiang Decoction is also cold and hot, which is mainly used to treat cold and heat. The prescriptions and indications of both sides are similar, so Chaihu Guizhi Ganjiang Decoction and Wu Mei Pill are the same in treating Jueyin disease.
In a word, from the prescription composition, Chaihu Guizhi Ganjiang decoction belongs to the syndrome of upper heat and lower cold in half exterior and half interior; From the analysis of the location of the disease, this prescription belongs to the syndrome of half exterior and half interior yin; According to the outline of six meridians and clinical treatment, this recipe belongs to Jueyin disease, so Chaihu Guizhi Ganjiang Decoction belongs to Jueyin disease.
In the past, people can use this prescription according to the symptoms mentioned in the regulations. It is widely used to treat diseases such as colds, malaria, hepatitis, coronary heart disease, endocrine disorders, gynecological diseases, chronic nephritis, prostatitis and so on. When the prescription belongs to Jueyin, its meaning will be further understood, and thus it will be more widely and accurately applied in clinic. At the same time, further analyze other prescriptions and syndromes of Jueyin disease, and further understand the essence of Jueyin disease.