浅析“救阴不在血,而在津与汗”  

A Brief Analysis of"Saving Yin Through Body Fluid and Sweat Rather than Blood"

作　　者：冯琪琪 叶孟娜 李耀林 张民杰 秦艳虹 FENG Qi-qi;YE Meng-na;LI Yao-lin;ZHANG Min-jie;QIN Yan-hong(Shanxi University of Chinese Medicine,Taiyuan,Shanxi,China,030000;The Hospital of Shanxi University of Chinese Medicine,Taiyuan,Shanxi,China,030000)

机构地区：[1]山西中医药大学,山西太原030000 [2]山西中医药大学附属医院,山西太原030000

出　　处：《河南中医》2022年第9期1314-1318,共5页Henan Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81874489)。

摘　　要：叶天士指出:“救阴不在血,而在津与汗。”强调的不是“津与汗”的治疗方法,而是重视阴精的理念。温病不同阶段,温热病邪伤阴程度不同,顾护调养阴精的重点亦不相同。邪在卫分,温热之邪结聚,郁遏气机,宣降失常,治以辛凉轻清疏透,兼清热生津,药选连翘、牛蒡子、栀子皮、桑叶、薄荷、淡豆豉,配合麦冬、花露、芦根汁等。卫分不解,传入气分,温热毒邪深入,热伏于里,津伤更甚,当急泻热、补津液,心胃火燔者,选黄连、石膏泻热养阴;心火上炎,舌绛干,津液亏损者,予导赤散清心利水养阴;胃津亡者,予玉女煎清胃热滋阴。气分不解,热邪深入营血,煎灼津液,脉道不利,津少化血乏源,当“先清营热,勿得滋腻为稳”,药选犀角、玄参、羚羊角等。入血就恐耗血动血,直须凉血散血,药选生地黄、牡丹皮、阿胶、赤芍等。邪入血分,还可能伤及阴精,当“甘寒之中加入咸寒”,选用甘咸寒濡润之品。温病治疗需全程顾护津液,气分强调汗,通过辛凉清解之法,透邪外达;卫分侧重津液,泻热养阴,可战汗透邪;营血之分关注津液,侧重血,清热化瘀凉血并用,脉道通利,津液自行;血分重伤津液累及阴精,则滋厚填精,急以救阴。Ye Tian-shi points out that"saving yin is through body fluid and sweat rather than blood".The emphasis is not on the treatment of"body fluid and sweat",but on the concept of attaching importance to yin essence.At different stages of warm dis-ease,the degree of yin injury caused by the pathogenic factors of warm diseases is different,and the focus of protecting and nouris-hing yin essence is also different.When the pathogen is in the defense aspect,the pathogen of warm heat accumulates,which blocks qi movement and leads to abnormal dispersing and descending,so the treatment is to dredge with pungent,cool,light and clear drugs,to clear heat and generate fluid.Lianqiao(Fructus Forsythiae),Niubangzi(Fructus Arctii),Zhizipi(Fructus Gar-deniae),Sangye(Folium Mori),Bohe(Herba Menthae),Dandouchi(Semen Sojae Praeparatum)combined with Maidong(Radix Ophiopogonis),juice of Lugen(Rhizoma Phragmitis),etc.are often used.If the pathogen is in the defense aspect is not removed,and has entered qi aspect,then warm-heat-toxin pathogens will go deeply,the heat will be latent in the body,and the fluid injury is even more serious.The treatment should focuses on purging heat and urgent replenishment of body fluid as quickly as possible.For those with burning fire in the heart and stomach,Huanglian(Rhizoma Coptidis)and Shigao(Gypsum Fibrosum)are used to purge heat and nourish yin.For those with inflammation of heart fire,dry tongue and loss of body fluid,Red-Guiding Powder is given to clear the heart,promote urination and nourish yin.For those who have used up stomach fluid,Jade Lady Decoction is used to clear the stomach heat and nourish yin.If the pathogen in the qi aspect is not removed,heat pathogen has entered nutrient blood burning fluid,the vessel will be blocked,and the body fluid lacks the source for generation,so the treatment should"first clear nutrient heat in order to avoid getting greasy.Therefore,Xijiao(Cornu Rhinocerotis),Xuanshen(Radix Scrophulariae),Lingyangjiao(Cor-nu Saigae Tataricae),etc.can be used.Pathogens enterin

关 键 词：救阴 血 津 汗 温病 《温热论》 叶天士 

分 类 号：R223.14[医药卫生—中医基础理论]