黄疸病脉证并治第十五
金匮要略-黄疸病脉证并治第十五
黄疸病脉证并治第十五一、概述黄疸是以目黄、身黄、小便黄为特征的一类疾病。
本篇所论，包括了诸多以发黄为主症的疾病。
根据病因病机，可概括为：湿热发黄（湿重于热，热重于湿），寒湿发黄，火劫发黄，燥结发黄，女劳发黄，以及虚劳发黄等，其中以湿热发黄为重点。
本篇分为：谷疸、酒疸、黄疸、女劳疸、黑疸五种。
元代的罗天益《卫生宝鉴》把黄疸分为阴黄、阳黄两大类。
二、病因病机、分类与辨证（一）病因病机寸口脉浮而缓，浮则为风，缓则为痹。
痹非中风。
四肢苦烦，脾色必黄，瘀热以行。
（1）脾色必黄，瘀热以行：湿热发黄病机：湿热蕴脾，溢于血分风邪化热与湿互结，郁闭于脾，湿热陷入血分。
发为黄疸。
主症：全身发黄，四肢重滞不舒。
应用：治黄必活血，血行黄易去。
（二）湿热发黄与寒湿发黄的辨别脉沉，渴欲饮水，小便不利者，皆发黄。
（9）腹满，舌（身）痿黄，燥（躁）不得睡，属黄家。
（10）湿热发黄：（1）渴欲饮水，不喜热饮，或饮水不多；（2）腹满，硬、胀、拒按；（3）小便不利；（4）大便多燥结；（5）脉弦数有力或沉弦；（6）黄色鲜明如橘子色。
寒湿发黄：（1）喜热饮，或者不渴；（2）腹满，软，喜按；（3）小便难；（4）大便多溏；（5）脉沉迟；（6）舌萎黄（身萎黄），色如烟薰、晦暗。
（三）分类及其主症趺阳脉紧而数，数则为热，热则消谷，紧则为寒，食即为满。
尺脉浮为伤肾，趺阳脉紧为伤脾。
风寒相搏，食谷即眩，谷气不消，胃中苦浊，浊气下流，小便不通，阴被其寒，热流膀胱，身体尽黄，名曰谷疸。
额上黑，微汗出，手足中热，薄暮即发，膀胱急，小便自利，名曰女劳疸；腹如水状不治。
心中懊憹而热，不能食，时欲吐，名曰酒疸。
（2）夫病酒黄疸，必小便不利，其候心中热，足下热，是其证也。
（4）谷疸：病因病机：食谷不节，湿热蕴结脾胃。
主症：食谷即眩（食难用饱），胃脘痞闷，小便不通，全身发黄。
女劳疸：病因病机：房劳过度，肾虚有热。
主症：额上黑，微汗出，手足心热，薄暮加重，小腹拘急，小便自利，腹水。
茵陈五苓散临床运用-曾荣修ook
茵陈五苓散临床运用-曾荣修茵陈五苓散出于《金匮》黄疸病脉证并治第十五条中。
原文：黄胆病，小便不利者，茵陈五苓散主之。
此方是五苓散加茵陈，化裁之方，其病机由于湿热内蕴，小便不利，久则发黄，故以通阳利水为主，加茵陈以清其湿热，湿热清则黄疸自消矣，此方非通治黄疸方。
方药：茯苓20g，猪苓10g，泽泻10g，白术10g，桂枝10g，茵陈30g方义：茯苓、猪苓、泽泻均属淡渗利水之品，白术健脾利水，桂枝通阳利水，气化膀胱，茵陈为清湿热之要药，故加入方中合用，则燥湿健脾，温阳利水兼清湿热，令湿热从小便排出，故黄疸退矣。
凡属小便不利而黄变证各异的症候，俱投以此汤。
举案如下：刘某某，女，22，住劳动路95号1982年8月3日，初诊：上月下旬开始胃脘痞塞，厌油，溲黄少，乏力，医院检测小便：尿胆元阳性，胆红质0,肝功能7/8月报告：SGPT500以上（正常值170以下），ZNTT13(正常值2-12)，巩膜发黄，脉濡缓，苔白辨证：湿蓄于内，郁久化热。
治宜：清热利湿方药：茵陈30g，茯苓15g，猪苓10g，泽泻10g，白术10g，桂枝10g，二付。
1982年8月14日，五诊，之前共四诊，八剂均原方未减，目前胃脘痞塞消失，但白带多不黄，仍疲乏，目前转治下焦湿邪。
方药：苍术15g，法夏12g，茯苓12g，陈皮10g，茜草12g，乌贼骨12g，牡蛎30g，淮山30g，防己12g，惹仁12g，共四剂。
1982年8月18日，白带愈，精力复常，纳可，溲清长，查肝均正常。
此案寒湿壅塞中下二焦，中焦化热形成黄疸，先以清热利湿的茵陈五苓散治愈湿热，因下焦寒湿未去，故改用温化寒湿之法治之。
唐某某，男，53，放射科医生1981年4月14日，近来疲乏、纳减、溲黄、腹满、厌油、恶寒。
4月13日肝功能检查结果：TTZnTT正常，SGPT500以上，A/G=4.2/265，诊断为急性黄疸性肝炎。
脉浮无力苔腻。
辨证：湿热内蕴，兼太阳之邪传入膀胱。
治宜：清热利水方药：茵陈30g，茯苓20g，白术10g，猪苓10g，泽泻10g，桂枝10g，三付1981年4月22日，感冒愈，腹胀减，小便增多黄减，疲乏减。
黄疸病脉证并治第十五金匮
03
黄疸病的诊断与鉴别诊断
肝功能检查
总结词
肝功能检查是诊断黄疸病的重要手段，通过检测肝脏酶学指标和胆红素水平，评估肝脏功能和黄疸程 度。
详细描述
肝功能检查主要包括转氨酶、胆红素、白蛋白等指标的检测。转氨酶水平升高提示肝脏损伤，胆红素 水平异常则与黄疸程度相关。根据这些指标的异常程度，可以判断黄疸病的病因和病情严重程度。
西医治疗
药物治疗
使用降黄疸药物，如苯巴 比妥、糖皮质激素等，以 降低血清胆红素水平，促 进黄疸消退。
光照疗法
通过蓝光照射，使皮肤表 面的胆红素转化成水溶性 物质，从而促进黄疸消退。
换血疗法
对于严重黄疸病例，可采 用换血疗法，以降低血清 胆红素水平、防止核黄疸 的发生。
05
黄疸病的预防与调护
预防措施
疸病毒感染。
调护方法
多休息
黄疸患者应保证充足的 休息时间，有助于身体
恢复。
遵医嘱治疗
观察病情变化
保持良好心态
遵循医生的建议，按时 服药，不擅自更改治疗
方案。
留意黄疸症状的变化， 如发现异常应及时就医。
保持乐观的心态，积极 配合治疗，有利于病情
的康复。
饮食调理
多喝水
黄疸患者应多喝水，有助于促 进体内毒素的排出。
与其他疾病的鉴别诊断
总结词
鉴别诊断是黄疸病诊断过程中的重要环节， 医生需根据患者的临床表现、实验室检查结 果和其他辅助检查，排除其他可能导致黄疸 症状的疾病。
详细描述
在鉴别诊断过程中，医生需考虑多种可能导 致黄疸症状的疾病，如肝炎、肝硬化、胆结 石、胰腺炎、溶血性疾病等。通过对， 医生可以逐步排除其他疾病的可能性，最终 确诊黄疸病。
黄疸病脉证并治十五病篇
溶血性黄疸
由于红细胞大量破坏，释放出大量胆 红素，超过肝细胞的摄取、转化能力， 导致血清胆红素升高。常见于溶血性 贫血、输血反应等疾病。
02
黄疸病的病因与病理
病因
01
02
03
04
外感湿热
外感湿热之邪，导致脾胃运化 失常，湿热内蕴，肝胆疏泄不 利，胆汁外溢，发为黄疸。
饮食不节
饮食不节，过食肥甘厚味，损 伤脾胃，湿热内生，肝胆疏泄
型黄疸。
针灸治疗
针刺疗法
通过针刺特定的穴位，如胆俞、阳陵 泉等，以调节气血、疏肝利胆，从而 缓解黄疸症状。
艾灸疗法
通过艾灸特定的穴位，如足三里、中 脘等，以温阳散寒、健脾和胃，从而 改善黄疸病状。
其他疗法
01
02
03
饮食调理
黄疸患者应保持清淡易消 化的饮食，多摄入富含维 生素的食物，如绿叶蔬菜、 水果等。
预防感染
注意个人卫生，保持室内空气流通， 避免接触传染源，预防感染黄疸病毒。
定期体检
定期进行身体检查，及早发现黄疸病 征兆，及时采取措施进行干预。
调护方法
中药调理
针灸治疗
根据黄疸病的不同证型，选用相应的中药 进行调理，以清热解毒、利湿退黄为治疗 原则。
通过针灸刺激相关穴位，调节身体内的气 血运行，缓解黄疸症状。
黄疸病脉证并治十五 病篇
目录
• 黄疸病的定义与分类 • 黄疸病的病因与病理 • 黄疸病的诊断与鉴别诊断 • 黄疸病的治疗方法 • 黄疸病的预防与调护 • 黄疸病的研究进展
01
黄疸病的定义与分类
定义
定义
黄疸病是指由于胆红素代谢障碍 ，引起血清内胆红素浓度升高， 导致皮肤、巩膜和黏膜等黄染的 疾病。
黄疸病脉证并治十五病篇共78页
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▪
27、只有把抱怨环境的心情，化为上进的力量，才是成功的保证。——罗曼·罗兰
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28、知之者不如好之者，好之者不如乐之者。——孔子
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29、勇猛、大胆和坚定的决心能够抵得上武器的精良。——达·芬奇
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30、意志是一个强壮的盲人，倚靠在明眼的跛子肩上。——叔本华
16、云无心以出岫，鸟倦飞而知还。 17、童孺纵行歌，斑白欢游诣。 18、福不虚至，祸不易来。 19、久在樊笼里，复得返自然。 20、羁鸟恋旧林，池鱼思故渊。
黄疸病脉证并治十五病篇Fra bibliotek ▪
黄疸病脉证并治十五病篇
阻塞性黄疸
胆结石、肿瘤、炎症等。
02
黄疸病的诊断与鉴别
黄疸病的诊断标准
皮肤、巩膜黄染
黄疸病最明显的症状是皮 肤和巩膜出现黄染，通常 先从面部开始，逐渐扩散 至全身。
肝功能异常
黄疸病患者的肝功能检查 通常会显示异常，如转氨 酶升高、胆红素升高等。
消化道症状
黄疸病患者可能出现食欲 不振、恶心、呕吐、腹胀 等症状，有时还会出现腹 泻或便秘。
黄疸病脉证并治十五 病篇
目录
• 黄疸病的定义与分类 • 黄疸病的诊断与鉴别 • 黄疸病的治疗方法 • 黄疸病的预防与保健 • 黄疸病的案例分析
01
黄疸病的定义与分类
黄疸病的定义
01
黄疸病是一种以皮肤、巩膜黄染 为主要表现的疾病，通常伴有恶 心、呕吐、食欲不振等症状。
02
黄疸病的发生与肝胆功能异常有 关，导致胆红素代谢紊乱，进而 引起皮肤黄染。
黄疸病的分类
01
02
03
溶血性黄疸
由于红细胞破坏过多，导 致胆红素生成过多，进而 引发黄疸。
肝细胞性பைடு நூலகம்疸
由于肝细胞受损，导致胆 红素摄取、转化和排泄能 力下降，引发黄疸。
阻塞性黄疸
由于胆道阻塞，导致胆红 素排泄受阻，引发黄疸。
黄疸病的病因
溶血性黄疸
遗传性疾病、免疫性疾病、药物反应等。
肝细胞性黄疸
西医治疗
药物治疗
使用降黄疸药物，如苯巴比妥、糖皮质激素等，缓解黄疸症状。
光照疗法
通过蓝光照射，使体内的胆红素转化为水溶性物质，加速排出体外。
换血疗法
对于严重黄疸病患者，通过换血来降低血清胆红素水平。
其他治疗方法
黄疸病脉证并治第十五(Jaundice, pulse syndrome, treatment, fifteenth)
---------------------------------------------------------------最新资料推荐------------------------------------------------------黄疸病脉证并治第十五（Jaundice, pulsesyndrome, treatment, fifteenth）黄疸病脉证并治第十五（Jaundice, pulse syndrome, treatment, fifteenth）黄疸病脉证并治第十五（Jaundice, pulse syndrome, treatment, fifteenth） Jaundice, pulse syndrome, treatment, fifteenth 1., how do you understand income from the Yellow House? Golden, said: the jaundice of Huang family income, from the wet. The cause of jaundice is many, but it is related to dampness. Or is exopathic dampness, spleen and stomach; or excessive drinking, damage the stomach and wet, or spleen yang deficiency, movement disorders, endogenous dampness. Due to the constitution of patients with Yin and Yang, the rise and fall of the points, so after the onset of illness vary. SHIXIE, if from Yang heat into heat; if the cold is cold from yin. Whether it is suffocating heat, or cold dampness, prevent bile in hepatobiliary Shuxie function, so that blood spilled on the surface, there will be jaundice. So jaundice is from dampness, without dampness, without yellowing. 2. the main Valley jaundice pathogenesis, syndrome and treatment. The valley of jaundice disease because of improper diet; pathogenesis is damp, invagination of blood syndrome; food Valley is dizzy, heart1 / 15discomfort, abdominal fullness, fever, yellow, dysuria, treatment for eliminating damp heat. Decoction of rhubarb (rhubarb, rhubarb, Gardenia) 3. the differentiation of alcoholic jaundice. Because of excessive drinking of alcoholic jaundice disease; the pathogenesis is damp, fumigation in the heart; the symptoms are fever, heart trouble, can not eat, when to vomit, heart hot, hot feet, yellow body, dysuria, treatment for heat leakage, with zhizidahuang Decoction (Gardenia rhubarb and citrus fermented black bean).4. the differentiation of female labor. Coital jaundice disease because of excessive labor room; its pathogenesis is the intrinsic kidney blood stasis heat syndrome; forehead black, lower abdomen full foot in hot, sweating, yellow, urination; Treatment for (coital jaundice and blood stasis) for removing blood stasis and dampness; with Xiaoshifanshi powder (Xiaoshifanshi) How to use the5. clinical yinchenwuling powder? This article explains Yinchen five Lingya card briefly, when measured in square card. Part five Lingya power in the qingrelishi autigo. In the gall of extreme heat, dampness Tuihuang, five Ling scattered infiltration desiccant diuresis. The whole Party and the role of strong, thus the indications of this side wet weight in hot jaundice, the disease in pregnant---------------------------------------------------------------最新资料推荐------------------------------------------------------ yellow, yellow eyes, yellow urine, also have nausea burnout, body weight, appetite, dysuria, mild abdominal fullness, greasy tongue fur, pulse moisten relief and other symptoms. How to use the 6. clinical rhubarb saltpeter Decoction? Rhubarb saltpeter Decoction for real heat syndrome of jaundice. The original symptoms of abdominal distention, dysuria and red, sweat, the jaundice due to heat dampness, coalescence in, hot in the real cause of abdominal distention. The damp heat block, the bladder gasification is disadvantageous, then the urine is disadvantageous but the red. Sweat, is in the heat forced out Jin, rather than the table card. Table and no disease, the heat has become solid, governance when seized, Tongfu catharsis heat, dehumidification yellow. Should the rhubarb saltpeter decoction, rhubarb in Tongfu Xiere, cooling blood for blood stasis; niter Xiaoyu Xiere, were used to clear heat and blood stasis. Gardenia, Phellodendron Xiere was cold and dampness, except yellow. Because the party is more fierce, must see clinical abdominal fullness, pain with tenderness, constipation, dysuria, slippery pulse number strong real heat syndromes can be selected. 7., ychd zhizidahuang Decoction and rhubarb saltpeter Decoction three the cure syndrome3 / 15pathogenesis? Yinchenhao Decoction, zhizidahuang Decoction and rhubarb saltpeter Decoction Junzhi jaundice, the disease on the side, Hot on wet to use zhizidahuang Decoction; damp heat in middle Jiao Sheng Ju, disease, should be treated with Yinchenhao Decoction; acute illness weight, heat into it, the disease tends to in person, should be treated with rhubarb saltpeter decoction. The pathogenesis and clinical manifestations of the 8. Xiaojianzhong Decoction to treat jaundice. Xiaojianzhong Decoction for the treatment of asthenia of Zhongjing, treated with man in the Yellow jaundice, urination. The formation of jaundice associated with wet and dysuria, Xiaojianzhong Decoction and the urination, the yellow and wet nothing, but because in deficiency, blood deficiency, skin loss caused by the card in addition to Rong, yellow body, still visible anorexia less gas, abdominal pain, body tired limbs trapped loose stools, so small in Tang spleen construction, capital source, gas exuberant, blood filling, virtual yellow self-healing. 9. of alcoholic jaundice in what circumstances should spit or dismount? Because of drinking alcoholic jaundice caused by injury, damp, lifting machine. The pathological changes are more focused on the upper, middle, lower, and the treatment can be based on the trend of---------------------------------------------------------------最新资料推荐------------------------------------------------------ pathogenesis and make the best use of the situation, and choose the appropriate method. In this regard, the provisions of that wine jaundice, or no heat, Jing said, abdominal fullness, vomit and nasal dryness; the first spit floating pulse, string to the and wine jaundice, heart, vomit, spit; alcoholic jaundice, if damp is in the upper part, then the manifestations of vomiting, nasal dryness, hot heart, floating pulse, the disease tends to, when the vomiting; if the damp heat in the lower partial heat than wet, see abdominal fullness, pulse string, as in the condition, the application of law. Six. Discussion questions 1. Yang Huang three card should be how to identify? Clinically, jaundice is the first to distinguish Yin, Yang, Yang and huang, Still need further in damp hot yellow (Yang, yellow) within the category of dampness Sheng, Sheng Sheng or hot and humid. Wet Sheng characteristic is greasy tongue fur, with a languid little food, nausea and vomiting was the main syndrome, treated with Herba Artemisiae Scopariae and five powder, dampness heat; heat - Characteristics of tongue yellow dry with short red urine, constipation, sweating, abdominal fullness was the main syndrome treated by rhubarb saltpeter decoction, heat leakage; characteristics of damp heat Sheng Ju is yellow and greasy fur,5 / 15with short red urine, heart depressed primary evidence, treatment with Yinchenhao Decoction eliminating damp heat. 2. Gardenia Rhubarb decoction syndrome and Yinchenhao Decoction prescription should be how to identify card two. Zhizidahuang Decoction and Yinchenhao Decoction were prescription for treating Yang Huang, the two party with gardenia, rhubarb, the function is similar, but the two of the pathogenesis, main symptoms and the drug effect is different. Gardenia Rhubarb decoction syndrome in heart disease and biased, pathogenesis of damp heat block, gas barrier, heat and humidity, the main card for heart regret or pain, so in line with Zhishi gas Sanjie pain, fermented black bean Chufan, rhubarb amount is only half of Yinchenhao Decoction, the effect on discharge heat Chufan; Yinchenhao Decoction syndrome in the womb, the disease is under the pathogenesis of damp heat, damp heat with abnormal movements, Sheng, the main card for heart discomfort, abdominal fullness, so in the reuse of qingrelishi with gardenia, wormwood, rhubarb, its effect on clearing heat. 3. Zhong Jing, how to discuss jaundice, which treatment method? Golden Chamber of jaundice jaundice, discussed a wide range of. Yellow syndrome caused by pathogenic factors from various, such as yellow, yellow, hot cold fire rob yellow, yellow, yellow dry---------------------------------------------------------------最新资料推荐------------------------------------------------------ knot female labor and virtual yellow are described, In view of Zhongjing’s treatment of jaundice, eight methods have been applied in the positive treatment and the strain reform. The specific treatment methods include jaundice, pulse floating and the decoction of Guizhi and astragalus, which is the method of sweating. The alcoholic jaundice floating pulse should be used to vomit, spit. As a fever and yellow, shortness of breath, chest full of dry, irritated and red hot urination demonstration, with rhubarb saltpeter Decoction for purgation, this. The abdominal pain and vomiting yellow, the midstage pattern, with Xiaochaihutang, and for this method. Skin yellow, slow pulse, smoked food, eat is difficult to use full bore, will be difficult to urinate, dizziness and abdominal fullness in cold syndrome, the temperature method. Jaundice annoyance, late afternoon fever, chest discomfort, or can not sleep, desire for drinking water, heat syndrome, with zhizidahuang decoction, Yinchenhao Decoction, the clearing method. The man in yellow, the urination of deficiency syndrome, Zhi Yi asthenia Xiaojianzhong decoction, the reinforcing method. With the blood stasis syndrome coital jaundice, include black forehead, micro sweating, hand foot in hot, dusk is, urgent7 / 15urination, abdominal bladder, such as water, aversion to cold, less abdominal fullness, body as yellow, black stool will, when the pond, with Xiaoshifanshi powder, this is the law. 4., how to understand the yellow house of disease, but the benefit of his urine? All the patients are yellow, but they urinate, pointed out the treatment of jaundice. This corresponds to the eighth article, the income from the home, from the wet.. Jaundice can not be separated from jaundice. Pathogenic dampness stops, stagnation and heat, damp heat block, gasification, dereliction of duty, urination adverse, damp heat can not be excreted, fumigation, flooding, yellow. In view of the pathogenesis, treatment with free urine, small convenience of wet way, the Yellow back. Therefore, a rule is Tom Lee urine yellow. The ancients also have cure dampness, adverse urination., The rule also ; the negative urine, the non treatment. The 5. golden and the syndrome, jaundice, method, prescription. In this paper, jaundice and jaundice and Shaoyang syndrome table deficiency syndrome and treatment. The table and its deficiency, except for icterus and aversion to cold fever, floating pulse spontaneous form deficiency, still should be used when sweat solution, cinnamon and Astragalus decoction, Ramulus Cinnamomi and peony, licorice,---------------------------------------------------------------最新资料推荐------------------------------------------------------ ginger, jujube reconcile camp Wei jiebiao, plus Huangqi Fuzheng and water wet to support evil. And in the Yellow Shaoyang syndrome, is in the process of abdominal pain and vomiting, Shaoyang heat invading the stomach phenomenon, can use Bupleurum Decoction, abdominal pain and vomiting and see if, hot flashes, constipation, then use Dachaihu Decoction (bupleurum, baicalin, paeoniflorin, rhubarb, ginger, jujube) Shaoyang, capture Yangming in real. If the abdominal pain and vomiting, no hot flashes and see chills and fever, stool soft, with Xiaochaihu Decoction (bupleurum, Scutellaria, pinellia, licorice, ginseng, ginger, jujube) shaoyang. 6. what is jaundice? What are its main characteristics? Jaundice and yellow sweat complexion, how to identify? Jaundice is in the name of symptoms, body yellow, yellow, yellow urine as the main symptoms, especially in the yellow eyes as the main feature. From the pathogenesis, its contents are damp cold yellow, yellow, yellow and dry knot, yellow, yellow and other virtual fire disaster, but the heat yellow as the focus. Identification of jaundice and yellow: jaundice from the spleen caused by intrinsic; yellow is the spleen and stomach qi and blood deficiency caused by jaundice; being yellow, yellow, yellow9 / 15urine disease, especially in the yellow eyes as the main character; the Yellow gloss is not fresh, two mesh and urine is not yellow, and often accompanied by dizziness, tinnitus, palpitation little sleep; In order to jaundice damp heat, diuresis activity; chlorosis to spleen and stomach, nourishing qi and blood. Yellow sweat and jaundice is different in color yellow yellow sweat sweat Rubai juice, clothing dyeing coloring, body edema, urination is mainly characterized by damp heat caused by no yellow eyes, yellow body disease. 7. Gardenia Rhubarb Decoction and rhubarb saltpeter Decoction syndrome should be how to distinguish? Rhubarb Decoction and rhubarb saltpeter Decoction gardenia is damp, hot on wet jaundice. Gardenia and rhubarb were used in both Chinese and Mongolian medicines. But the disease side partial stomach, with symptoms of heart trouble, heat pain, vomiting, the partial intestinal disease, symptoms of abdominal distention, constipation by refusing sweating. In treatment, with gardenia king intended to heat Chufan in zhizidahuang decoction, and the rhubarb saltpeter Decoction with rhubarb saltpeter, for you to tongfuxiere. 8. of the rhubarb saltpeter Decoction of Yinchenhao Decoction and syndrome should be how to identify? Yinchenhao Decoction syndrome and syndrome is the same as the---------------------------------------------------------------最新资料推荐------------------------------------------------------ rhubarb saltpeter Decoction under the jaundice, but in pathogenesis, different syndromes of performance. Yinchenhao Decoction syndrome is damp heat two Sheng, with heart uneasy, abdominal fullness and main symptom. By 62 with 22 Artemisia, rhubarb, gardenia fourteen pieces of clearing away the heat. Rhubarb saltpeter Decoction syndrome is heat in reality, with full abdomen refused to press, two will be detrimental to the main disease. With the rhubarb saltpeter, treats each 42, with fifteen pieces of Gardenia Qingre catharsis, Lishi except yellow. What are the 9. main points of syndrome of cold cereal jaundice? Why not use the method to treat? In the valley of jaundice in slow pulse and weak pulse, food difficult to use full, full bore dizziness, urine will difficult, for cold dampness, deficiency syndrome of Taiyin disease, because it is a virtual lunar Yangming. The spleen is cold with not digesting food, dampness on offense, repression of the Qing Yang, turbid damp and dirty, bladder gasification is blocked, so there is enough food to eat, fever dizziness, difficult urination and other symptoms, because Zhongyang deficiency, the pulse will see later to like. Slow pulse weakness is the cold dampness proof, as the key differentiation of the cold11 / 15valley. The cold dampness caused by jaundice syndrome can not be used to dismount the valley, under the rule of misuse of injured spleen yang, not only full abdomen is not decreased, but there will be a hiccup equivariant card, make an illness aggravating. 10. what are the contraindications to the treatment of jaundice? Jaundice treatment taboo is mainly in the following three points: jaundice early table card, do not use fire attack. Jaundice at the beginning of each febrile symptoms. This fever often due to damp heat of steam, treatment should be clearing heat. If the mistake cold, fire, robbery caused by sweating, dry and wet evil, evil fire and internal consistency, so that the heat dampness, change fever tired breath, chest full of dry, as a yellow fever, stomach heat syndrome, is bound to aggravate the disease. Belong to icteric heat, not become solid, cannot capture. The golden pointed out: the wine for a long time for jaundice, black jaundice, green black eye, then heart like garlic shaped stool is black, Ji mashed condiment, benevolent skin claw, the floating pulse is weak, although the old black yellow. Excessive drinking leads to excessive heat and dampness and governs the clearing away of heat and dampness. If because of its annoyance and heat, can not eat, to spit the disease, mistaken in many thermal Yangming---------------------------------------------------------------最新资料推荐------------------------------------------------------ misuse of purgation, harming healthy, can lead to blood heat headed in the camp, blood stasis stagnation, blood stasis, such as bad card form black jaundice. Disable the bitter cold dampness yellow. Jaundice is the most common form of heat, But it belongs to the deficiency of spleen and stomach. True heat, will dry red tongue, short red urine, abdominal distension. Deficiency of the cold, visible pale tongue, white urine, innocent, can also see abdominal fullness. If the trial is not clear, and does not distinguish, instead of spleen deficiency as Yangming heat, or clear fire or with gardenia rhubarb, is bound to hurt the stomach, so that students become hiccup embolism. 11. how to judge the prognosis of jaundice? The prognosis of jaundice as follows: 1. The new easy to cure the disease, chronic illness difficult therapy. Golden cloud: jaundice disease is, when to the eighteen day period, from more than ten days treatment, anti TV refractory. The clinical examination, disease early, shallow and evil is filled, it is easy to win more evil; as soon as the disease time, Xie Sheng is bad, evil is invincible is difficult to cure. II. It is difficult to cure within the genus, but easy to treat in the watch. Zhang Zhongjing pointed out: the jaundice and thirst,13 / 15the refractory jaundice; jaundice but not thirsty, the hair on the genitals, cure jaundice; person will vomit; Yang, cold and heat by vibration. This article explains: see jaundice thirst, vomiting, disease in the humid, inside of the climate, so it is difficult to treat jaundice, cold, fever, vibration and not thirsty disease, disease in the table, to do more to damp heat evil, no more than in the solution table is scattered, it is easy to cure. The spleen and kidney are defeated two times, so the disease is difficult to cure. Golden pointed out repeatedly in the discussion of coital jaundice: black forehead, slightly sweating, hot foot, dusk is, urgent urination, urinary bladder, called coital jaundice, abdominal water does not rule; the Yellow Jiari ASR and anti fever, aversion to cold, this is the work of the female. Acute abdominal bladder, less full body, as the amount of yellow, black, hot feet, because the water for black jaundice, abdominal distension, stool will be black, When the female workers of the pond, disease, non water. The belly full is difficult to treat. This is the female labor jaundice, kidney failure, abdominal fullness, and Tim Spleen Qi deficiency. The kidney is the congenital foundation, the spleen is the acquired root, the spleen and kidney two decline, then the inborn and postnatal are exhausted, therefore---------------------------------------------------------------最新资料推荐------------------------------------------------------ difficult treatment.15 / 15。
黄疸病脉证并治第十五金匮
▪
【讨论 】医家多重视湿热发黄，而忽视仲景所谓的瘀血发黄。《说文》
谓：“瘀，积血也“，在血分不可作”郁”。“瘀热”即瘀血发黄，《伤寒
论》亦提到“瘀热” 发黄，如236条云：“瘀热在里，身必黄，茵陈蒿汤主
之”；262条云：“伤寒瘀热在里，身必黄，麻黄连翘赤小豆汤主之”。对此
一般都作“郁热”解，有片面性，只强调在气分，而忽视了与血分之关系。
集》）。关氏总结： “阳黄的治疗以清热利湿为常法，重视疏肝利水之惯例，
以治中焦为要害，突出活血、解毒、化痰。提出： “治黄必活血，血行黄易
却；治黄要解毒，毒解黄易除；治黄要化痰，痰化黄易散。”
▪ 火劫发黄
▪
【原文】 师曰：病黄疸，发热烦喘，胸满口燥者，以病发时火劫其汗，两热所得。
然黄家所得，从湿得之。一身尽发热而黄，肚热，热在里，当下之。(8)
▪
若嗜酒过度，湿热内蕴脾胃，扰及于心，则心中懊憹而热。若热壅气滞则心中热
痛。湿热使脾胃升降受阻，则不能食，时欲吐。湿热下流，气化不行，则小便不利，
足下热。
▪
若湿热郁滞胃肠，而未扰及心神者，即见神情安静，语言不乱，若以腹满，鼻燥，
欲吐，脉浮为主症，是病势趋于上；若以腹满，鼻燥而脉沉弦为主症，是病势趋向于
下。
▪
【治法】 若以心中热为主，用清心泻热法。若病邪偏上，用催吐法，方选瓜蒂散
方(见宿食病中)；若病邪偏下，用攻下法，方选大黄硝石汤。
▪
【方药】 栀子大黄汤（酒疸主方）
▪
【方析】 栀子大黄汤方中栀子、豆豉清心除烦；大黄、枳实泻胃肠瘀热积滞，导
引邪热下行。
▪ 女劳疸-肾虚瘀热
▪
【原文】 黄家日晡所发热，而反恶寒，此为女劳得之；膀胱急，少腹满，
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小结
谷疸—寒热不食，食即头眩，心胸不安，久久发黄 谷疸 —茵陈蒿汤—清泄湿热（13） 酒黄疸者—其脉浮者，先吐之； 治法 沉弦者，先下之（5） 酒疸 酒疸，心中热，欲呕者，吐之愈（6） 证治—心中懊●或热痛—枙子大黄汤—清热泄实 （15） 女劳疸—黄家，日晡所发热，而反恶寒，膀胱急，少腹 女劳疸 满，身尽黄，额上黑，足下热，腹胀如水状， 大便必黑，时溏---硝石矾石散—除湿祛瘀(14)
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【分析】 变治法： 湿热在上—症见心中热，或欲吐，鼻燥， 脉浮者宜先用吐法。 湿热在下—症见腹满，脉沉弦者宜先用 下法。
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2．证 治
【原文】 酒黄疸，心中懊●，或热痛，枙子 大黄汤主之。（15）
栀子大黄汤方： 栀子十四枚 大黄一两 枳实五枚 豉一升
【提要】 本条论述酒疸热盛的证治。
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2．湿重于热
【原文】 黄疸病，茵陈五苓散主之。（18）
茵陈五苓散方： 茵陈蒿末十分 五苓散五分
【提要】 本条论述湿重于热的黄疸治法。
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【分析】 病机：黄疸湿热蕴结，湿重于热。 主症：形寒发热，食欲减退，小便短少 或不利，苔腻不渴。 治法：利湿退黄。 方剂：茵陈五苓散。 方义：方中以五苓散化气行水；茵陈清 利湿热，可知本条是指湿重而内热不甚 的黄疸。
【原文】 酒疸下之，久久为黑疸，目青面黑，心中 如啖蒜齑状，大便正黑，皮肤爪之不仁，其脉 浮虽黑微黄，故知之。（7） 【提要】 本条论述酒疸误下变为黑疸的证候。 【原文】 黄疸之病，当以十八日为期，治之十日以 上瘥，反剧为难治。（11） 【提要】 本条是论述黄疸病的预后。
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【原文】 疸而渴者，其疸难治；疸而不渴者， 其疸可治。发于阴部，其人必呕；阳部， 其人振寒而发热也。（12） 【提要】 本条再论黄疸病的预后。 【原文】
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方义： 方中以栀子、黄柏清里泄热、大黄、 硝石攻下瘀热，全方共奏清热通便，利 湿除黄之功。 鉴别： 茵陈蒿汤、栀子大黄汤、大黄硝石 汤均治湿热黄疸。其病位偏上，热重于 湿者，宜用栀子大黄汤；湿热俱盛，病 在中焦者，宜用茵陈蒿汤；病情急重， 里热成实，病位偏于中下者，宜用大黄 硝石汤。
2012-5-12 2
【原文】 师曰：病黄疸，发热烦喘，胸满口 燥者，以病发时，火劫其汗，两热所得。 然黄家所得，从湿得之。一身尽发热而 黄，肚热，热在里，当下之，（8） 【提要】 本条论述火劫而发黄的治法以及湿 邪在黄疸发病中的作用。
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【分析】 病因： 病因：黄疸的形成多与湿热有关。火劫 发黄是因火攻发汗，湿从燥化，热势增 重所致。 主症： 主症：全身发黄，发热，心烦，口渴， 气喘，胸满，腹满而热。 治法： 治法：通腑泄热。
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分析
病机：饮酒过度，湿热上蒸。 主症：阳黄，黄色如橘 心中懊●或热痛—酒毒湿热上蒸心 — 胸。 兼症：呕恶不能食，小便不利，便难身 热。 治法：泄热除烦。 方剂：栀子大黄汤。
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20
枙子大黄汤与茵陈蒿汤证治鉴别表
鉴别点 枙子大黄汤 茵陈蒿汤证
药物组 枙子、大黄(一两)、 茵陈、大黄(二两)、 成 枳实、豆豉 枙子 功用 主症 泄热除烦 心中懊● 通利湿热 食谷即眩，腹满， 小便不利 腹中
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4.误治成哕 误治成哕
【原文】 黄疸病，小便色不变，欲自利，腹 满而喘，不可除热，热除必哕。哕者， 小半夏汤主之。方见痰饮中。（20） 【提要】 本条指出黄疸误治变哕的治法。
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【分析】 病机：误治伤阳，胃气上逆。 主症：（苦寒伤脾胃，胃失和降）哕逆。 治法：温胃止哕。 方剂：小半夏汤。 方义：小半夏汤以温胃化饮，降逆止哕， 待哕逆止，再辨证论治。
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9
主症： 谷疸—食谷即眩，胃脘痞闷，小便不通 全身发黄。其中以食谷即眩征。 酒疸—心中懊●而热，不能食，时吐， 小便不利， 全身发黄。其中以心 中懊●而热为特征。 女劳疸—额上黑，微汗出，手足心热， 薄暮加重，小腹拘急，小便自利。 其中以额上黑为特征。
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（四）辨湿热与寒湿发黄
附方： 瓜蒂汤：治诸黄。方见喝病中。 《千金》麻黄醇酒汤：治黄疸。 麻黄三两
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病因病机 分类
1.谷疸
湿热发黄 寒湿发黄
食谷即眩，小便不通，身体黄 (湿热)(2) 食难用饱，饱则发烦头眩，小便 必难(寒湿)(3)
42
2012-5-12
心中懊●而热，不能食，时欲吐 （2） 2.酒疸 小便不利，心中热，足下热（4） (热盛) 或无热，靖言了了，腹满欲吐， 鼻燥(5) 3.女劳疸—额上黑，微汗出，手足中热， 薄暮即发，膀胱急，小便自利 （肾虚）（2）
黄疸病脉证并治第十五
论二首 脉证十四条 方七首
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1
一、病因病机、分类与辨证 病因病机、
（一）湿热发黄
【原文】 寸口脉浮而缓，浮则为风，缓则为痹， 痹非中风，四肢苦烦，脾色必黄，瘀热以 行。（1） 【提要】 本条论述湿热黄疸的发病机理。 【分析】
病机：脾色必黄，瘀热以行——如脾脏所蕴 积的湿热溢入血分，行于体表，必发生黄疸。
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湿热发黄与寒湿发黄鉴别表
鉴别点 肤色 湿热发黄 黄色鲜明如橘子色 寒湿发黄 黄色晦暗
腹满或腹痛拒按，烦 腹痛按之濡，躁而不烦， 一般症状 躁不得眠，口渴欲饮，手足清冷畏寒，口渴不 身热心烦 欲饮或喜热饮 大便干结或溏而不爽， 大便溏薄，小便淡黄， 色酱黄，小便赤黄， 尿臊味不重 色如浓茶 舌偏红，苔黄腻，脉 舌淡，苔白腻，脉沉迟 滑数有力 13
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湿热发黄四汤证鉴别表
鉴别 茵陈五苓 茵陈蒿汤 枙子大黄 大黄硝石汤证 表 散证 证 汤证 证型 湿重于热 湿热并重 热重于湿 热盛里实 黄色鲜明，黄色鲜明， 黄色鲜明，黄色鲜明， 主证 小便不利，寒热不食， 纳呆，苔 食即头眩， 白腻脉浮 心胸不安， 缓 小便不利 治法 利湿退黄
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（二）寒湿发黄
【原文】 阳明病，脉迟者，食难用饱，饱则发 烦头眩，小便必难。此欲作榖疸。虽下 之，腹满如故，所以然者，脉迟故也。 （3） 【提要】 本条论述谷疸寒化的病机。
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【分析】 病机：寒湿蕴结于脾胃。 主症：全身发黄，腹满，不能饮 食，饱食则烦闷，头眩，小便难。
【原文】 脉沉，渴欲饮水，小便不利者，皆 发黄。（9） 腹满，舌痿黄，躁不得睡，属黄家。 （10） 【提要】 以上两条论述湿热发黄与寒湿发黄 的不同症状。
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【分析】 9条：湿热发黄 主症：全身发黄，黄色鲜明，渴欲饮 水，小便不利，脉沉。 10条：寒湿发黄 主症：全身发黄，黄色晦暗，腹满， 胃中不和而不得安卧
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【分析】 病机：少阳邪热犯胃。 主症：身黄，腹痛，呕吐，往来寒热， 胸胁苦满。 治法：和解少阳，或兼通腑实。 方剂：小柴胡汤或大柴胡汤。 方义：往来寒热，胸胁苦满，腹痛而 呕，但属邪在少阳，治宜和 解少阳，方用小柴胡汤。
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3.兼燥结血瘀证 3.兼燥结血瘀证
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（四）黄 疸
1．热盛里实
【原文】 黄疸腹满，小便不利而赤，自汗出， 此为表和里实，当下之，宜大黄硝石汤。 （19）
大黄硝石汤方： 大黄 黄柏 硝石各四两 枙子十五枚
【提要】 本条论述黄疸病热盛里实的证治。
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【分 析】
病机：湿热熏蒸，热盛里实。 主症： 热盛—阳黄，鲜明如橘，小便不利而 赤，自汗，发热心烦口渴。 里实—腹满疼痛拒按，大便秘结，舌 苔黄脉沉实。 治法：通腑泻热，利湿退黄。 方剂：大黄硝石汤。
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心中懊●而热，不能食，时欲吐， 名曰酒疸。（2） 夫病酒黄疸，必小便不利，其候 心中热，足下热，是其证也。（4） 【提要】 本条进一步指出黄疸病机、分类 及主症。
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【分 析】
分类：谷疸、酒疸、女劳疸。 病机： 谷疸——食谷不节，湿热蕴结脾胃。 酒疸——嗜酒过度，湿热蕴结脾胃。 女劳疸——房劳过度，肾虚有热。
二便
舌脉
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二、证 治
（一）谷 疸
【原文】 谷疸之为病，寒热不食，食即头眩， 心胸不安，久久发黄，为谷疸，茵陈蒿 汤主之。（13）
茵陈蒿汤方： 茵陈蒿六两 枙子十四枚 大黄二两
【提2 14
分析： 寒热—营卫不和 不食—运化失职 饮食所伤 食即头眩,心胸不安—强食助 湿热熏蒸 湿热,湿热上冲 久久发黄为谷疸—郁蒸日 久，汁外溢 病机：湿热蕴蒸脾胃，湿热并重。 治法：清泄湿热（保肝退黄）。
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病位
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心中、心下
(三) 女 劳 疸
【原文】 黄家日晡所发热，而反恶寒，此为女劳 得之。膀胱急，少腹满，身尽黄，额上黑， 足下热，因作黑疸。其腹胀如水状，大便 必黑，时溏，此女劳之病，非水也。腹满 者难治。硝石矾石散主之。(14)
硝石矾石散方： 硝石 矾石（烧）等分
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（三）分类与主症
【原文】 趺阳脉紧而数，数则为热，热则消榖， 紧则为寒，食即为满。尺脉浮为伤肾，趺 阳脉紧为伤脾。风寒相搏，食榖即眩，榖 气不消，胃中苦浊，浊气下流，小便不通， 阴被其寒，热流膀胱，身体尽黄，名曰榖 疸。 额上黑，微汗出，手足中热，薄暮即发， 膀胱急，小便自利，名曰女劳疸；腹如水 状不治。
【提要】 本条论述女劳疸转变为黑疸兼有瘀血湿 热的证治。