从阳明而发之谵语防治探讨  

Prevention and Treatment of Delirium from Yangming

作　　者：于路游 杨金萍 窦立雯 王瑞雄 YU Luyou;YANG Jinping;DOU Liwen;WANG Ruixiong(Institute of Literature and Culture of Traditional Chinese Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]山东中医药大学中医文献与文化研究院,山东济南250355

出　　处：《山东中医药大学学报》2023年第3期289-292,共4页Journal of Shandong University of Traditional Chinese Medicine

基　　金：国家中医药管理局《中华医藏》编纂项目经典医籍影校对照整理丛书专项(编号:GZY-KJS-2021-059)。

摘　　要：谵语多由津亏液竭、热扰神明所致。阳明合病、并病出现谵语,多因误汗、误下致邪入阳明所致。汗出使津液外散,增津伤热燥之祸;误下又耗烁体内之津液,添津枯耗竭之灾。故以整体观念为指导,依据阳明“胃家实”的发病机制,病从太阳阳明而发者,治以清里疏表;病从少阳阳明而发者,治以枢转少阳之机;邪气转归于阳明里实者,治以通腑泄热。并提出以下预防措施:以小柴胡汤未病先防,祛邪止于少阳,使邪去正自安;用大柴胡汤和里攻表,止邪于少阳阳明;选用期门一穴,散厥阴血中热邪,阻截病传途径。综合考虑谵语病发前后的致病因素,未病先防于前,既病防变于后,防治结合,掌握疾病的传变规律。Delirium is mostly caused by exhaustion of body fluid and heat disturbing mental activity.Combination of diseases or overlap of diseases of Yangming can cause delirium,mainly due to misuse of sweating and purgation resulting in pathogens invading into Yangming.Sweat makes body fluids outside scattered,causing fluid consumption and heat dryness,while misuse of purgation consumes body fluid again,increasing the fluid exhaustion.Therefore,under the guidance of holism and according to the pathological mechanism of“stomach excess”of Yangming,the disease originated from Taiyang and Yangming should be treated by clearing interior and expelling exterior pathogen.Disease originated from Shaoyang and Yangming should be treated by facilitating qi movement of Shaoyang.The pathogenic qi into interior excess of Yangming should be treated by relaxing bowels and discharging heat.The following preventative methods have been advocated including:Xiaochaihu Decoction(小柴胡汤)used in prevention before disease onset to expel pathogen till Shaoyang and eliminating pathogen to maintain health.Dachaihu Decoction(大柴胡汤)used in harmonizing interior and expelling pathogen till Shaoyang and Yangming.Qimen point(LR 14)was selected to dissipate pathogenic heat in the blood of Jueyin and block the transmission path of the disease.After comprehensive consideration of pathogenic factors before and after delirium disease onset,prevention before disease onset,controlling development of existing disease,combined prevention and treatment,we can master the regularity of disease transmission and change.

关 键 词：谵语 阳明病 津亏液竭 热扰神明 清里疏表 太阳阳明 枢转少阳 通腑泄热 

分 类 号：R222.15[医药卫生—中医基础理论]