内科疾病营分期病机证治探讨  

Discussion on Pathogenesis,Syndrome and Treatment of Internal Diseases by Ying Stage

作　　者：郭海[1] 赵晓峰[1] 陈茜 龚婕宁[2] GUO Hai;ZHAO Xiaofeng;CHEN Qian;GONG Jiening(The Affiliated Huaian First People's Hospital of Nanjing Medical University,Huaian 223300,Jiangsu,China;Nanjing University of Chinese Medicine,Nanjing 210046,Jiangsu,China)

机构地区：[1]南京医科大学附属淮安第一医院,江苏淮安223300 [2]南京中医药大学,江苏南京210046

出　　处：《辽宁中医药大学学报》2023年第3期5-9,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：科技部科技基础性工作专项(2009FY120300)。

摘　　要：温病营分证主要病机为营热较盛、营阴受损、心神被扰,基本治疗原则是清泄营热,透热转气,主要选用清营汤。内科杂病营分病证主要病机是营阴受损,邪扰心神,主要有寒、热、虚、实四种病理变化。由于营气通于心,所以杂病营分病证的主要症状表现为心悸、心慌、心烦等心神被扰和乏力、多寐等心神不足症状。也可表现为心悸、肢体水肿等营阴瘀滞的现象和心动异常引起的脉结代、脉微细、脉动无力等表现。根据温病营分证“入营犹可透热转气”的治疗原则,内科疾病营分病变的基本治疗原则是调营安神,透邪转气。针对营分证寒热虚实等不同病理变化,可分别采用温营、清营、养营、利水和营等方法治疗。营分寒证治法是温补心阳,养营安神定悸,方药选用桂枝甘草龙骨牡蛎汤;营分实热证治法为清营泄热,方药选用清营汤;营分虚热证治法是养营清心,滋肾育阴,主要选用黄连阿胶汤;营分阴虚证治法宜养营润液,滋补肝肾,选用炙甘草汤和加减复脉汤治疗;营分实证治法宜通阳化气,利水和营,方药选用苓桂术甘汤加减;营分郁滞证治法为调营和营,常选用桂枝汤和旋覆花汤加减。内科疾病营分病证应争取疾病从营分病变转出气分,当根据营分病变寒热虚实的不同机制选用不同方药进行尽快诊疗,以免延误病情,深入血分引起动血、耗血、出血等多种变证。The main pathogenesis of febrile diseases by Ying stage is the excess of Ying-heat,the impairment of Ying-Yin and the disturbance of mind.The basic treatment principle is to clear away the heat,diathermy turn to Qi,and the main prescription is Qingying Decoction(清营汤).The main pathogenesis of Ying stage in internal medicine is impairment of Ying-Yin and disturbance of mind by evil,and there are four kinds of pathological changes of cold,heat,deficiency and excess.The main symptoms of Ying stage in internal medicine are palpitation,upset,sleep and lack of energy.It can also be manifested as heart palpitations,limb edema and other Yin stasis stagnation and pulse intermittence and stopping,fine,weak and other manifestations caused by abnormal heartbeat.According to the therapeutic principle of“entering Ying stage can transfer heat to Qi stage”,the basic therapeutic principle of medical diseases is modulating Ying to tranquilize the mind and transfer Ying to Qi.For the different pathological changes of syndrome,such as cold,heat,deficiency and excess,warming Ying,cleaning Ying,nourishing Ying,dredging water and mediating Ying can be used to treat respectively.The treatment of cold syndrome by Ying stage is warming and invigorating the heart Yang,nourishing Ying and tranquilizing the mind,and the prescription is Guizhi Gancao Longgu Muli Decoction(桂枝甘草龙骨牡蛎汤).Treatment for excess heat syndrome is cleaning Ying and releasing heat,and the prescription using Qingying Decoction.The treatment of deficiency-heat syndrome is nourishing Ying and clearing the heart,nourishing the kidney and nourishing the Yin,and the main choice is Huanglian Ejiao Decoction(黄连阿胶汤).Yin deficiency syndrome by Ying stage should be treated with nourishing Ying and liquid,nourishing the liver and kidney,and Zhigancao Decoction(炙甘草汤)and Modified Fumai Decoction(加减复脉汤)were selected.Excess syndrome treatment should be circulating Yang Qi,dredging water and mediating Ying,Linggui Zhugan Decoction(�

关 键 词：温病 营分证 内科疾病 营分病期 

分 类 号：R254.2[医药卫生—中医内科学]