摘要：在医道那片广袤无垠、神秘莫测的天地里，证候与治法的关系，恰似一场没有固定剧本的精彩大戏，处处充满着变数与惊喜。你瞧，证候治法绝非是那种可以事先约定、死板教条之物，它就像一位灵动的舞者，要随着证候的变化而随机应变，以实事求是的态度，灵活地制定出最适宜的治法。这就
在医道那片广袤无垠、神秘莫测的天地里，证候与治法的关系，恰似一场没有固定剧本的精彩大戏，处处充满着变数与惊喜。你瞧，证候治法绝非是那种可以事先约定、死板教条之物，它就像一位灵动的舞者，要随着证候的变化而随机应变，以实事求是的态度，灵活地制定出最适宜的治法。这就好比战场上的将军，得根据敌人的动态和战场的形势，随时调整作战策略，方能克敌制胜。
辛温之始：仲景谨慎下的解表风云
遥想张仲景所处的时代，那是一个医道探索初期的朦胧世界。在《伤寒杂病论》问世之前，以温热药治疗广义伤寒表证的方法，可谓是风靡一时，就像如今街头巷尾流行的一种时尚潮流。大家都习惯性地用温热之药来驱散体表的寒邪，仿佛这是一种约定俗成的治病法则。
然而，张仲景这位医道巨擘，却有着与众不同的见解和谨慎的态度。他虽然将麻黄汤、桂枝汤作为基本解表方剂，但在具体运用上，那可是慎之又慎，就像一位技艺高超的工匠在雕琢一件珍贵的艺术品。他对各种误汗后变证的治疗尤为独到，那些因误用汗法而引发的复杂病情，在他的笔下都能得到妥善的处理。《伤寒杂病论》甚至被后世誉为补偏救弊之书，就像一座照亮医道黑暗的灯塔，为后人指引着正确的方向。
我曾听闻这样一个故事，有一位患者，患了伤寒表证，起初医生按照常规的温热药治疗方法给他用药，结果患者不仅没有好转，反而出现了烦躁、口渴等变证。后来，医生仔细研读了《伤寒杂病论》，根据书中对误汗后变证的论述，重新调整了治法，患者才逐渐康复。这个故事就像一面镜子，清晰地映照出张仲景谨慎用药、灵活治法的重要性。
辛凉初现：晋唐宋元的探索之路
时光流转，到了晋唐时期，医道上又有了新的变化。此时，虽已有辛凉解表方药，但就像一颗刚刚破土而出的幼苗，还十分稚嫩。既无系统的理论认识，又往往药不分经，寒热杂陈，就像一盘没有经过精心调配的大杂烩。医生们在用药时，常常是摸着石头过河，心中没有十足的把握。
到了宋金元时期，医家们对辛温发汗易致变证、造成弊害的认识逐渐加深。这就好比一场激烈的辩论赛，诸医学名家纷纷著述立说，辩辛温发汗之难用，倡辛凉解表之易施。他们就像一群勇敢的探险家，在医道的未知领域中不断探索，寻找着更安全、更有效的治疗方法。这一时期的影响十分深远，就像一颗投入平静湖面的石子，激起了层层涟漪，为后来辛凉解表法的发展奠定了坚实的基础。
据相关史料记载，在宋金元时期，因辛温发汗而导致病情加重的案例屡见不鲜。有一位患者，患了外感病，医生一开始用辛温发汗的方法治疗，结果患者出现了高热、神昏等症状。后来，另一位医生根据当时医家们对辛温发汗弊害的认识，改用辛凉解表的方法，患者才转危为安。这个案例就像一个警钟，提醒着医家们要谨慎使用辛温发汗之法。
辛凉定局：明清医家的智慧结晶
明清时期，温热病学家们将辛凉解表作为基本法则，就像给医道制定了一条明确的规则。但他们也并非一味地推崇辛凉解表，而是认为外感热病表证初期不可过用寒凉药物，否则表闭不解，病也不除。这就好比一把双刃剑，用得好能治病救人，用不好则会伤人害己。
辛凉解表法的创立，经历了漫长的历史时期，是几代医家的反复探索。它就像一颗璀璨的明珠，在医道的历史长河中逐渐闪耀出耀眼的光芒。从辛温发汗到辛凉解表的发展历程，体现了外感热病表证治法的进步，也反映出古今医家对外感热病认识的不断深入和古今温病概念的变迁。
寒温之争：千年未决的医道谜题
张仲景的时代没有辛凉解表法，而且后世的辛凉解表方药也进不了他的六经诊治体系，这就好比两个不同世界的人，有着各自独特的语言和规则。于是，就有了长达千百年的寒温论争，就像一场没有硝烟的战争，在医道的舞台上持续上演。
在这场论争中，外感病后期是应该急当救阴液，还是应该急救回阳，成为了一个争论的焦点。这就好比在黑暗中寻找光明，医家们各执一词，争论不休。因为亡阳和亡阴都可发生，不是伤寒必然亡阳，温病必然亡阴。伤寒与温病，都是传染病，都可以衰竭而亡，就像两条不同的道路，最终都可能通向死亡的深渊。
有一位老中医，曾经遇到过一个外感病后期的患者，病情十分危急。有的医生主张急当救阴液，有的医生则主张急救回阳。老中医经过仔细的辨证，根据患者当下的证候，果断地采取了相应的治疗方法，最终患者转危为安。这个案例就像一个谜题的答案，告诉我们不能事先约定治疗方法，必须根据当下的证候来决定。
医道如海，深不可测。从辛温发汗到辛凉解表的发展历程，就像一部波澜壮阔的史诗，记录着医家们的智慧和探索。我们应当从这段历史中汲取教训，明白证候治法要随机应变，实事求是。在面对疾病时，我们要像医道中的智者一样，冷静分析，灵活应对，用最适宜的治法为患者的健康保驾护航。因为，在医道的世界里，每一次正确的选择，都可能挽救一条生命，创造一个奇迹。
作者简介：梁世杰 中医高年资主治医师，本科学历，从事中医临床工作24年，积累了较丰富的临床经验。师从首都医科大学附属北京中医院肝病科主任医师、著名老中医陈勇，侍诊多载，深得器重，尽得真传！擅用“商汤经方分类疗法”、专病专方结合“焦树德学术思想”“关幼波十纲辨证”学术思想治疗疑难杂症为特色。现任北京树德堂中医研究院研究员，北京中医药薪火传承新3+3工程—焦树德门人（陈勇）传承工作站研究员，国际易联易学与养生专委会常务理事，中国中医药研究促进会焦树德学术传承专业委员会委员，中国药文化研究会中医药慢病防治分会首批癌症领域入库专家。荣获2020年中国中医药研究促进会仲景医学分会举办的第八届医圣仲景南阳论坛“经方名医”荣誉称号。2023年首届京津冀“扁鹊杯”燕赵医学研究主题征文优秀奖获得者。事迹入选《当代科学家》杂志、《中华英才》杂志。
A shift in medicine: a millennia-long exploration from bitterness to bitterness
In the vast and mysterious landscape of medical science, the relationship between symptoms and healing is like a great drama without a fixed script, full of variables and surprises. You see, the treatment of Syndromes is by no means something that can be agreed upon in advance or be rigidly dogmatic. It is like a flexible dancer who adapts to the changing of syndromes and flexibly formulates the most appropriate treatment method with an approach to seek truth from facts. It is like a general on the battlefield, who must adjust the battle strategy at any Time according to the enemy's dynamics and the situation on the battle field in order to defeat the enemy.
The beginning of hardship: Zhong Jing's cautious settlement of the weather
Looking back, the era in which Zhang Zhongjing lived was a hazy world at the beginning of medical exploration. Before the publication of the Annals of Typhoid, the method of treating generalized typhoid symptoms with warm medicine was very popular, like a fashion trend that is now popular on the streets. Everyone has a habit of using warm medicine to disperse the cold from the body, as if it were a well-established law of healing.
However, Zhang Zhongjing, a giant of medical science, has a different perspective and a cautious attitude. Although he used turmeric soup and laurel soup as basic dietary remedies, he used them carefully, as if a skilled craftsman were caring for a precious work of art. His treatment of various post-perspirant syndromes is particularly unique, and those complex conditions caused by the wrong sweating method can be properly handled under his writing. The Theory of Typhoid Syndrome was even hailed as a book of remedies for prejudices, like a beacon that illuminated the darkness of medical science, and guided future generations in the right direction.
I once heard a story about a patient who had a symptom of typhoid fever. At first, the doctor treated him according to the usual treatment of warm medicine. Instead of improving, the patient developed symptoms such as irritability and thirst. Later, the doctor carefully studied the Annals of Typhoid and readjusted the treatment according to the book's description of the changes after mistaken sweating, and the patient gradually recovered. This story is like a mirror that clearly reflects the importance of Zhang Zhongjing's prudent use of medicine and flexible treatment.
The First appearance of Sin Li: The Journey of Exploration by Song Yuan of Jin and Tang
Time went by, and during the Jin and Tang period, there were new changes in medical practice. At this time, although there were already antidotes, it was like a seedling that had just burst out of the ground and was still very young. There is no systematic theoretical understanding, and often the drugs do not know the time of day, are cold and hot, like a plate of noodles that have not been carefully prepared. When the doctors used medicine, they often crossed the river with their hands on stones, without complete certainty in their minds.
By the Song and Jin Yuan period, medical practitioners' understanding of the vulnerability of intense sweating to illnesses grew. It was like a heated debate, with medical experts writing about how difficult it was to sweat and how easy it was to apply cold soothing to the face. They are like a group of brave explorers who are constantly exploring the uncharted frontiers of medicine in search of safer and more effective treatments. The influence of this period is very far-reaching, like a stone thrown into the calm lake, stirred up layers of ripples, for the later development of Xin Liang relieving superficies method laid a solid foundation.
According to relevant historical records, during the Song and Jin Yuan period, cases of intense sweating causing the condition to worsen were common. One patient suffered from an external infection. The doctor initially treated the patient with cold sweating, but the patient developed high fever and fainting. Later, another doctor, based on the understanding of the doctors at the time of the evils of sweating warmly, changed the method of cold soothing the face, and the patient was saved. The case serves as a wake-up call for doctors to be cautious about using the technique of sweating.
Sin Li's Conclusion: The Crystallization of the Wisdom of Ming and Qing Doctors
During the Ming and Qing Dynasties, feverologists regarded silicosis as a basic law, as if it were a clear rule for medical science. However, they also did not always promote the use of cold remedies, but believed that cold medicine should not be used in the early stage of the symptom of an external fever, otherwise the symptom will not be closed and the disease will not be eliminated. It is like a double-edged sword, which, when used well, can cure a disease and save a person, but when used poorly, it will hurt others and harm oneself.
The establishment of Xin Liang relieving superficies method has experienced a long historical period and is the repeated exploration of several generations of physicians. It is like a shining pearl that gradually shines brightly throughout the history of medicine. The development process from Yin sweating to Yin cooling reflects the progress of the symptoms and treatment methods for foreign fever diseases, and also reflects the continuous deepening of the understanding of foreign thermal diseases by ancient and modern medical practitioners and the changes in the concept of traditional and modern fever illnesses.
The Cold War: A thousand-year-old medical mystery
In Zhang Zhongjing's time, there was no Xin Liang relieving superficies method, and the later Xin Liang relieving superficies prescription could not enter his system of diagnosis and treatment of six meridians. This is like two different worlds, each with its own unique language and rules. As a result, there has been a cold-weather dispute that has lasted for thousands of years, like a war without smoke, continuing on the stage of medical science.
In this debate, whether it is more urgent to rectify the deficiency of yin fluids or to restore yang energy in the later stages of a disease caused by external factors has become a focal point of discussion. It's like looking for light in the dark, and the doctors argue and disagree. Because degeneration of the yang and yang can occur, it is not that typhoid fever necessarily degenerates the yang, and mild illness necessarily defeats the yang. Typhoid and febrile diseases, both infectious diseases, can fail and die, like two different paths that can ultimately lead to death.
An old Chinese medicine practitioner once met a patient who was in the advanced stage of an exposure to a foreign infection and who was in a very critical condition. Some doctors advocate treating the deficiency of yin fluids as a priority, while others suggest focusing on restoring yang energy as a matter of urgency. After careful diagnosis, the old Chinese medicine decisively adopted the corresponding treatment according to the patient's present symptoms, and eventually the patient turned to safety. This case is like the answer to a puzzle that shows us that we cannot agree on treatments in advance and must decide on the symptoms in the moment.
The realm of medicine is vast and profound, like an ocean that is impossible to fully comprehend. The development from sweating to cooling the watch is like a magnificent epic documenting the wisdom and exploration of medical practitioners. We should draw a lesson from this history and understand that the syndrome and treatment should be adaptable and to seek truth from facts. When faced with diseases, we should be like wise men in medical science, calmly analyze, respond flexibly, and use the most appropriate treatment to protect the health of the patient. Because in the world of medicine, every right choice can save a life and create a miracle.
Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine with an undergraduate degree. He has been engaged in traditional medicine clinical work for 24 years and has accumulated a wealth of clinical experience. Following Chen Yong, chief physician of liver disease at Beijing Traditional Medicine Hospital, affiliated with Capital Medical University, and renowned old Chinese medicine, he has been treated for many years and received great attention. He specializes in the treatment of difficult diseases using "conversational traditional therapy" and special treatments combined with the academic ideas of Jiao Shude and Guan Yubo's ten-level diagnosis.He is currently a researcher at the Shude Tang TCM Research Institute in Beijing, a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance workstation of Jiao Shude's protégés (Chen Yong),He is a standing committee member of the International Expert Committee on E-learning and Health Care, a member of the Jiao Shude Academic Heritage Special Committee of the Chinese Association for the Advancement of Chinese Medicine Research, and the first cancer specialist to be included in the chapter of the Chinese Pharmaceutical Culture Research Association. Won the 2020 China Association for the Promotion of Traditional Chinese Medicine Zhongjing Medical Branch held the eighth session of the Medical Saint Zhongjing Nanyang Forum "Classic Prescription Famous Doctor" honorary title. The winner of the first Beijing-Tianjin-Hebei "Pingui Cup" Yanzhao Medical Research Essay Award in 2023. His work was featured in the journal Current Scientist and the journal Chinese Talent.
来源：首都专家梁世杰一点号