《温热经纬》辨治痢疾刍议  

Discussion on Syndrome Differentiation and Treatment of Dysentery in Compendium on Warm Febrile Disease

作　　者：董君莹 赵兴杰[2] 李晓红[2] 史瑞[2] DONG Junying;ZHAO Xingjie;LI Xiaohong;SHI Rui(Beijing University of Chinese Medicine,Beijing 100029,China;Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院,北京100078

出　　处：《山东中医药大学学报》2022年第1期115-119,共5页Journal of Shandong University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(编号:81874386)。

摘　　要：总结《温热经纬》对痢疾辨证论治的特点。从发病时节、病因、病位、病机、临床表现、辨证论治方面进行阐述,强调痢疾大多由湿热引起。在辨证中重视四诊及整体情况,辨寒热、气血、虚实,寒者辛温疏利,热者宣通祛热;在血分者重用行血,在气分者偏于导气;实者可疏利清热、导气行血,虚者不可一味攻积清夺。在对不同治法的运用上,淡渗注重寒温并用,强调兼气虚下陷表现者方可升提,反对滥用补虚之法,提倡以通腑之法因势利导。在对不同分型痢疾的辨治方面,强调小便通畅者,疫毒痢可治;对噤口痢,治以清热益气;对湿热痢,治以清热燥湿行气;认为虚寒痢少见,应慎用补涩。强调大便时间长而仍欲便不得者为阴虚痢,腹内窘迫欲解,便后仍不舒者为里实,认为食欲恢复者预后较好。提出泄泻多寒,痢疾多热,故治疗泄泻常用温燥,治疗痢疾多用清利。This paper summarizes the characteristics of syndrome differentiation and treatment of dysentery in Compendium on Warm Febrile Disease.From the aspects of onset season,etiology,location,pathogenesis,clinical manifestations,syndrome differentiation and treatment,it is emphasized that most dysentery is caused by dampness-heat.In syndrome differentiation,attention should be paid to the four diagnostic methods and the overall situation,distinguishing cold and heat,qi and blood,deficiency and excess.Those suffering from cold are relieved with pungent-warm and those suffering from heat are dispersed to dispel heat.If the disease is in blood aspect,we should promote blood circulation.If it is in qi aspect,moving qi should be considered.Dredging and clearing heat,and moving qi and promoting blood circulation can be used for excess syndrome,while purgation should not be used for deficiency syndrome.In the application of different treatment methods,eliminating dampness with bland medicinal emphasizes the combination of cold and warm.Only those with qi deficiency and sinking,elevating qi can be promoted.Abuse of tonifying deficiency should be opposed strongly.Relaxing and facilitating bowel movement should be advocated.In the treatment of different syndrome types of dysentery,it is emphasized that those in pestilent dysentery with unobstructed urine can be treated.To anorectic dysentery,clearing heat and replenishing qi should be used.Clearing heat,drying dampness and moving qi should be used to treat dampness-heat dysentery.It is considered that deficiency-cold dysentery is rare,so supplementing and astringing should be used with caution.It is emphasized that those who have long defecation time and still want to defecate but fail are of yin deficiency dysentery,and those who still do not feel comfortable after defecation were of interior excess syndrome.The prognosis of patients with appetite recovery is better.It is proposed that diarrhea is mostly cold syndrome while dysentery is mainly heat syn drome,so the treatment of

关 键 词：痢疾 《温热经纬》 王孟英 辨证论治 病因病机 湿热痢 温燥 清利 

分 类 号：R254.6[医药卫生—中医内科学]