基于新型代谢模型探讨《伤寒论》热证生理基础  

Discussion on the physiological basis of heat syndrome in Treatise on Febrile Diseases based on novel metabolic models

作　　者：肖党生[1] 方辉[1] 杨介钻[1] 应佩君 鲁海峰[1] XIAO Dangsheng;FANG Hui;YANG Jiezuan;YING Peijun;LU Haifeng

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310003

出　　处：《中医临床研究》2022年第3期1-4,共4页Clinical Journal Of Chinese Medicine

基　　金：国家自然科学基金面上项目支持(项目名称:基于人体口腔、肺及肠道微生物组大数据的肺腺癌发生发展机制及其早期预警模型研究,基金号81874038)。

摘　　要：中医学领域的热证同现代医学中的发热存在差异,新型代谢模型是中西医融合的切入点,并能够弥合这种差异。现代医学认为,发热是致热源作用于下丘脑,导致体温调定点上调而引起的发热。从新型代谢模型来看,热证形成的病机是火行异常、热能在人体内积聚,是机体内化气和化阴过程失衡的表现。根据《伤寒论》六经理论,热证可以按照六经进行分类。阳明热证是获取能量物质的过程出现异常,太阳热证是水热排泄异常,少阳热证是能量物质在人体内代谢中间过程出现异常。这种异常包括氧化代谢和基因表达过程。致热源和感染性疾病导致的热证属于阴分发热。临床热证多以一经病变为主,累积多经,可以根据各经特征进行辨证施治。Heat syndrome in traditional Chinese Medicine(TCM)is different from the febrile disease in modern medicine.Novel metabolic models are beneficial for the integration of TCM and modern medicine and can also afford physiologic explanation on the difference between TCM and modern medicine,and can bridge the difference.Modern medicine believes that febrile disease is caused by pyrogenics acting on hypothalamus,which leads to the up-regulation of temperature setting point.In novel models,heat syndrome is the abnormality of Huoxing(火行)and caused by the accumulation of heat energy in our body,which is the imbalance between Qi(气)transformation and Yin(阴)transformation.Heat syndrome can be categorized according to the theory of six meridians in Treatise on Febrile Diseases.The pathophysiology of heat syndrome in Yangming(阳明)meridian is the abnormal absorption of energy agents.The pathophysiology of heat syndrome in Taiyang(太阳)meridian is the abnormal expenditure of heat energy and abnormal excretion of water.Pathophysiology of heat syndorme in Shaoyang(少阳)meridian is the abnormal intermediate metabolisms of energy agents in living organisms,including the oxidation of energy agents and gene expression.Heat syndrome which is caused by pyrogens and infectious diseases belongs to the heat syndrome caused by abnormality of Yin transformation.Clinical heat syndromes are always based on abnormality of one meridian and supported by other meridians.So,the characteristics of each meridian should be taken into account in the treatment of heat syndromes.

关 键 词：热证 六经 气化 致热源 感染性疾病 

分 类 号：R364.2[医药卫生—病理学]