基于六维辨证观新解白虎汤证治  

Baihutang Syndrome and Treatment:A New Interpretation Based on Six Dimensional Syndrome Differentiation Theory

作　　者：李勋欣 于河[1] 王雨菡 汪伯川 王振东 崔丽军 刘铁钢[1] 谷晓红[1] LI Xun-xin;YU He;WANG Yu-han;WANG Bo-chuan;WANG Zhen-dong;CUI Li-jun;LIU Tie-gang;GU Xiao-hong(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029

出　　处：《中国实验方剂学杂志》2021年第15期181-187,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家重点研发计划项目(2018YFC1704100,2018YFC1704101)。

摘　　要：六维辨证观是北京中医药大学谷晓红教授基于理论教学与临床经验总结提出的辨证观念,强调从病因、病位、病期、病势、病理、病性6个不同维度对病证进行辨析,有利于中医临床思维的锻炼和形成。白虎汤证作为伤寒温病皆可见到的一种证态,目前对于其辨证及治疗仍需要深入探讨。文章从六维辨证角度出发,汇总了谷晓红、于河两代温病学教师在教学过程中对白虎汤证治的理解和思考,并结合伤寒温病学派的不同观点对其进行重新解读。将白虎汤证所处阶段概括为因感外邪入里所致肺胃脏腑功能失调的气分期,此期邪盛而正不衰,处于里热壅盛、津液耗灼状态,症状可见大热、大汗、口渴及符合里实热盛的脉象表现。同时提出白虎汤证之病位可扩展至肺胃,治以白虎汤而有防阳明太实,土克水,预护肾阴之效。通过六维辨证观对白虎汤证愈后转归的动态辨析可知,伤寒温病虽都可见到白虎汤证,但具体病期传变、病势转归、病理兼夹、治疗方药又有区别,由此衍生的一系列白虎汤类方不仅扩展了白虎汤的应用范围,丰富了其研究价值,对临床应用也具有重要意义。Six dimensional syndrome differentiation theory,put forward by professor GU Xiao-hong at Beijing University of Chinese Medicine based on her theoretical teaching and clinical experience,emphasizes that the syndrome differentiation should be carried out from six dimensions including etiology,disease location,disease stage,disease condition,pathology,and disease nature,which is conducive to clinical thinking training and formation of traditional Chinese medicine(TCM). The differentiation and treatment of Baihutang syndrome frequently seen in cold damage and warm disease still need to be explored. Guided by the six dimensional syndrome differentiation theory coupled with diverse viewpoints of cold damage and warm disease schools,this paper summarized and reinterpreted the understandings and thoughts of GU Xiao-hong and YU He,warm disease specialists of two generations. Considering the lung-stomach dysfunction caused by the internal invasion of exogenous pathogens,Baihutang syndrome was staged into Qi aspect. In this stage,exuberant pathogens and sufficient healthy Qi allowed the prevailing of internal heat and the consumption of body fluid,manifested as high fever,profuse sweating,thirst,and the pulse corresponding to interior excess and heat syndrome. This paper also pointed out that the Baihutang syndrome involved both lung and stomach,and the adoption of Baihutang contributed to preventing tu from restricting shui in the case of extreme excess of Yang brightness and protecting the kidney Yin. As revealed by the dynamic analysis of prognosis of Baihutang syndrome based on the six dimensional syndrome differentiation theory,even though the Baihutang syndrome could be present in both cold damage and warm disease,the specific disease stage,transmission and change,condition,prognosis,pathology,and medication differed. On this basis,a series of prescriptions have been modified from Baihutang,which has expanded the application scope of Baihutang and enriched its research value,thus better promoting its clinical applicat

关 键 词：六维辨证观 白虎汤证 白虎汤 伤寒 温病 白虎汤类方 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]