阴阳毒与A组链球菌感染  

Yin-Yang Toxin and Group A Streptococcal Infection

作　　者：刘旻[1,2,3] 谢云雪 王睦天 LIU Min;IE Yunxue;WANG Mutia(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin,China,300381;National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin,China,300381;Tianjin University of Traditional Chinese Medicine,Tianjin,China,301617)

机构地区：[1]天津中医药大学第一附属医院,天津300381 [2]国家中医针灸临床医学研究中心,天津300381 [3]天津中医药大学,天津301617

出　　处：《河南中医》2023年第10期1464-1468,共5页Henan Traditional Chinese Medicine

基　　金：国家重点研发计划项目(2018YFC1707503)。

摘　　要：阴阳毒是《伤寒杂病论》中唯一以“毒”命名的疾病,为毒邪蓄结阴阳二经所致,病变部位广泛,毒发势重,有传染性,可分为阴毒和阳毒。A组链球菌(group a streptococcus, GAS)引起的感染起病急骤,其临床症状、病程与阴阳毒证候群吻合。阳毒对应猩红热,猩红热特征为全身泛发的大量细小网状皮疹,咽喉红肿糜烂,与阳毒咽喉痛、唾脓血且发斑吻合。阴毒对应链球菌中毒性休克综合征,其临床表现腹膜炎、心内膜炎,对应阴毒的“腹中绞痛,毒气攻心,心下坚强,短气不得息”等症,后期因休克及弥散性血管内凝血使体温偏低,对应“呕逆,唇青面黑,四肢厥冷”。治疗需以解毒为主,升麻鳖甲汤解毒、活血散瘀、阴阳并济,不同于伤寒所用之汗法、下法、清法与温法,为后世治疗热入血分证提供了参考。Yin-yang toxin is the only disease named"toxin"in Treatise on Cold Damage and Miscellaneous Diseases.It is caused by the accumulation of toxic pathogens in the yin-yang meridians.The lesion site is extensive,the toxic potential is heavy,and it is infectious.There is yin toxin and yang toxin.The onset of infection caused by group a streptococcus(GAS)is sudden,and its clinical symptoms and course are consistent with the yin-yang toxin syndrome group.Yang toxin corresponds to scarlet fever,characterized by a large num-ber of small reticular rashes spreading throughout the body,redness-swelling-erosion of the throat,which is consistent with yang toxin throat pain with saliva pus,and blood,and spots.Yin toxin corresponds to streptococcal toxic shock syndrome,with clinical manifesta-tions of peritonitis and endocarditis.It corresponds to symptoms such as"abdominal colic,toxic qi attacking the heart,inferior cardiac hardness,and continuous short breath in yin toxin.In the later stage,due to shock and disseminated intravascular coagulation,the body temperature is low,corresponding to"nausea,blue lips,black face,and cold limbs".The treatment should be primarily detoxification.Cimicifuga and Turtle Shell Decoction can remove toxin,activate blood and disperse stasis,consider yin and yang toxin,which is differ-ent from sweating method,purgative method,clearing method and warming method used in the treatment of cold damaged disease,and provides a reference for the treatment of heat entering the blood aspect.

关 键 词：阴阳毒 阴毒 阳毒 A组链球菌 《金匮要略》 张仲景 

分 类 号：R222.3[医药卫生—中医基础理论]