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上热下寒的症状,现代大部分人都有。因为现代生活压力大、节奏快,很多人都有熬夜、饮食不合理、嗜食油腻、吸烟喝酒、疏于运动等不良习惯。长此以往,体内气机运转不畅,痰、湿、热等毒邪就会淤积在人体内部,导致人体出现各种不适症状,最常见的就是既上火又怕冷的上热下寒问题。
上热下寒的主要症状
上热下寒,就是因为体内淤堵不通,导致上焦火不能暖于下焦,而下焦寒不能制约上焦火,从而表现出口干、口苦、咽痛、眼涩、头晕、头痛、心烦、多汗、口舌生疮、面部长痘的上焦热症状,和腰腹冷痛、背凉、腹泻、腹痛、手脚发凉、腰膝酸软、女性宫寒不孕、男性杨伟早谢等下焦寒的症状。
体内既有热又有寒,一吃清火药就腹泻,一吃滋补药就上火。体内寒热错杂,症状繁多,清不得、补不得。调理时必须准确辨证,对症分步调理才会有效。这种情况调理起来难度非常大,所以医患之间的配合通常要求也比较高。
根据临床经验,我简单地把上热下寒分为三大类,一个是上焦热重,一个是下焦寒重,一个是中焦脾胃不通。
上焦热重——引火汤为基础方
症状:咽干咽痛甚至化脓、牙痛、口干唇燥、骨蒸颧红、头昏目眩、心烦不眠、耳鸣、健忘、手足心热、目赤肿痛、口舌生疮、舌质嫩红、下肢冷、腰酸、食生冷油腻易腹泻、溲清、便溏。
分析:肾为先天之本,内寄命门之火,为水火之脏。肾阴即元阴、真水;肾阳即元阳、真火。肾中水火共济,则阴平阳密。肾水充足时,能够压制肾火将其封藏于肾中,以温煦脏腑。当肾水亏虚,肾火没有东西与之抗衡,火性炎上,就会向上焦逃窜,从而导致身体出现一系列的上火症状。此时这个火,并非“实火”,而是虚火。所以治疗此证时,宜潜不宜升,宜温不宜清。
方药:引火汤出自清代名医陈士铎《辨证录》,方子由熟地、巴戟天、茯苓、麦冬、五味子组成。方中重用熟地、麦冬、五味子填补真阴,巴戟天引火就下,茯苓导水利湿,使炎归于水中随水下行至肾脏,如此虽不降火却让火自降,阴阳得以相配而收“阴平阳秘”之效。
下焦寒重——柴胡桂枝干姜汤为基础方
症状:头部多汗,口干口苦,咽干目眩,颜面痤疮不断,心烦头痛,口渴多饮,腹满而吐、食不下、小腹冷痛、长期腹泻,胸胁胀痛,手指发麻,小便不畅等。
分析:阳气过于虚弱,阴寒之邪就会过剩,就会逐渐沉降,积聚于下,造成“下寒”;同时,肾脏之中的元阳(命门之火)不能鼓动肾水上升,心火得不到肾水滋养,就会“上热”。
方药:柴胡桂枝干姜汤出自东汉张仲景的《伤寒论》,方子由柴胡、黄芩、桂枝、干姜、天花粉、牡蛎、炙甘草组成。方中柴胡、黄芩、清利肝胆,主清上热;干姜、桂枝振奋胃阳,宣化停饮,主清下寒;天花粉生津止渴,牡蛎逐饮开结,甘草温暖脾阳。这个方子最重要的药是柴胡,它能够调畅气机,让身体内的气机运转起来,气机通畅,阴阳就能交互。所以这个方子既能清上面的热,又能温下面的寒,所以很适合上热下寒但下焦寒重的患者。
中焦不通——半夏泻心汤为基础方
症状:腹胀、食欲不振、心口下堵胀、嗳气、打饱嗝、肚子咕噜咕噜响,同时伴有口干口苦、口舌生疮、失眠、情绪波动大、腹泻、四肢冷、周身畏寒怕冷、腹部喜温喜按等症。
分析:脾胃处于我们的中焦,而心在上,肾在下,心肾的气机交通,需要通过脾胃才能正常进行。所以治疗此类疾病,重在调理脾胃,培补中气,中焦通畅了,上焦之火与下焦之寒能够顺利会师,水火既济,上寒下热的症状自然就消除了。
方药:半夏泻心汤出自东汉张仲景的《伤寒论》,方子由半夏、黄连、黄芩、干姜、甘草、大枣、人参组成。方中半夏降气除痞兼化痰健脾,黄芩、黄连清上焦热,党参、大枣、甘草、干姜健运脾胃,以治疗下寒。此方寒热互用调和阴阳,辛苦并进调畅升降,补泻兼施顾护胃气,众药合用,自能平调寒热,消痞散结。
结语
上热下寒,寒热错杂的病症,在中医上是相对比较难调理的病症,病机复杂、症状也多,治疗时需要抓住关键症状来辨证分析。另外,每个人体内的寒热比例不同,选方用药时,药量也需要结合患者的具体症状来加减化裁。
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