伤寒与温病的辨析要点  

Differentiation of Cold Damage and Warm Disease

作　　者：孙维旭[1] SUN Weixu(Chinese Medicine Hospital of Puyang City,Henan Province,457003)

机构地区：[1]河南省濮阳市中医院,河南省濮阳市457003

出　　处：《中医杂志》2022年第21期2033-2036,共4页Journal of Traditional Chinese Medicine

基　　金：第五批全国中医临床优秀人才研修项目(国中医药办人教函[2021]271号);河南省中医药传承与创新人才工程(仲景工程)中医药学科拔尖人才(豫中医科教[2018]5号)。

摘　　要：伤寒与温病在临床表现上具有一定相似性,尤其是表现为“发热、恶寒、无汗”的伤寒与温病容易造成混淆。通过文献分析并结合临床实践,提出在辨析伤寒与温病时应注意四个要点:第一,应重视伴随症状,如“发热、恶寒、无汗”伴咽喉肿痛、咯吐黄痰、胸闷胸痛等呼吸道症状突出者,可考虑为太阴温病,首选清热解毒等治法;如“发热、恶寒、无汗”伴皮肤、骨节疼痛等症状,可考虑为伤寒,首选辛温解表等治法;第二,应充分借助血常规检查、胸部CT等现代医学手段,如有肺炎表现可首先采用太阴温病的清热解毒等治法;第三,应依据疗效调整治疗方案,尤其治疗后效果不佳者需及时调整治疗;第四,伤寒与温病共存的情况治疗则需二者兼顾。Cold damage and warm diseases may be confused with each other by similarities in clinical manifesta-tions,especially in the symptoms of fever,aversion to co1d and absence of sweating.Through literature review and based on clinical practice,four issues have been proposed to help differentiate cold damage and warm diseases.First-ly,it is suggested to put focus on accompanying symptoms of“fever,aversion to co1d and absence of sweating”.For patients accompanied with prominent respiratory symptoms such as sore swelling throat,expectoration of yellow phlegm,chest oppression and pain,it may be considered as taiyin(太阴)warm diseases,and the preferred treatment method is clearing heat and resolving toxins.Regarding the accompanied symptoms of skin and joint pain,it is sug-gested to treat it as cold damage with the method of releasing the exterior with acrid-warm medicinals.Secondly,mod-ern tests such as routine blood examination and chest CT should be fully utilized.If there is pneumonia,the preferred treatment should be clearing heat and resolving toxins for taiyin warm diseases.Thirdly,the treatment plan should be adjusted according to the therapeutic effect,especially in those who are not responding to the treatment.Lastly,it is suggested to treat both conditions in case of coexistence of cold damage and warm diseases.

关 键 词：伤寒 温病 吴瑭 温病条辨 

分 类 号：R254[医药卫生—中医内科学]