基于“三焦理论”探讨三仁汤治疗湿热型内伤发热与验案举隅  

Discussion of the Sanren decoction on damp-heat type internal injury fever based on the theory of triple energizer

作　　者：雍彦礼[1] 景姗姗 赵齐 孙凤[1] 郭玮[1] 李鹤然 尚溪瀛[1] 常亚娟[1] YONG Yanli

机构地区：[1]黑龙江中医药大学附属第一医院,黑龙江哈尔滨150040 [2]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《中医临床研究》2023年第34期134-137,共4页Clinical Journal Of Chinese Medicine

基　　金：黑龙江省自然科学基金项目(LH2020H084);黑龙江省中医药科研项目(ZHY18-054);黑龙江省孙凤名中医工作室建设项目;黑龙江省第二批省级名中医学术经验继承项目。

摘　　要：关于三焦,近现代学者多认为其有形,其被认为是淋巴系统、网油、胰腺等,也有医家认为其无形而有功用,在组织之间、血管周围沟通脏腑、关联经络,承载一身之阳气与水液的运行,无处不在。这一认识为后世通过调理三焦治疗内科疑难病症提供了理论依据。三焦是功能而非具体物质,其主要生理功能为通行元气、运行水液、传化水谷,意在通过调节通道的畅达使得脏腑各司其职,恢复各脏腑之间的联系。内伤发热一般起病较缓,病程较长,其总病机为脏腑功能失调,气血阴阳失衡。中医治法治则方面,一般以补中益气汤、四物汤、金匮肾气丸等益气、补血、滋阴以补虚,柴胡疏肝散、血府逐瘀汤、保和丸等解郁、活血、化痰、祛湿、消食以泻实。对于西医学中的功能性低热、血液病、肿瘤、结缔组织病等,只要辨证为内伤发热,在明确病因病机的基础上予中医辨证论治,往往收效显著。湿热型内伤发热以内生湿邪郁而化热为主要病机特点,但其本质为三焦郁(瘀)滞而发热。三仁汤具有宣上、畅中、渗下的作用,使得三焦通利,常用于治疗内生湿热证。文章基于“三焦理论”探讨三仁汤治疗湿热型内伤发热的机制,阐述三仁汤组方依据,分析其治疗湿热型内伤发热的优势所在,并举病案佐证之。About triple energizer,modern and contemporary scholars think that it is tangible,and think that it is the lymphatic system,net oil,pancreas,etc..Some doctors think that it is invisible and functional,that is,it communicate Zang-fu organs(脏腑)and meridians between tissues and around blood vessels,and supports the circulation of Yang Qi(阳气)and fluid in the human body.This understanding provides a theoretical basis for the treatment of difficult medical diseases by regulating triple energizer.The author believes that Sanjiao is intangible and functional rather than specific substances,and its main physiological function is to transport vital energy and fluids,and transfer water and grain,which is intended to make Zang-fu organs perform their respective functions and restore the connection between Zang-fu organs by unchoking the passage.Internal injury fever generally has a slow onset and a long course.The overall pathogenesis is dysfunction of Zang-fu organs and imbalance of Qi(气),blood,Yin(阴)and Yang(阳).In terms of the TCM treatment rules,patients with deficiency syndromes are treated with the Buzhong Yiqi decoction(补中益气汤),the Siwu decoction(四物汤),or Jingui Shenqi Wan(金匮肾气丸)to invigorate Qi,tonify blood and nourish Yin,patients with excess syndromes are treated with Chaihu Shugan San(柴胡疏肝散),the Xuefu Zhuyu decoction(血府逐瘀汤)or Baohe Wan(保和丸)to relieve depression,invigorate the blood circulation,dissipate phlegm,remove dampness,and promote digestion.As long as these diseases,such as functional hypothermia,blood diseases,tumors,and connective tissue diseases in western medicine,belong to internal injury fever,the treatment is often effective on the basis of clearing etiology and pathogenesis and syndrome differentiation.The pathogenesis of damp-heat type internal injury fever is characterized by heat cohesion caused by internal dampness stagnation,but its essence is triple energizer stagnation or silting leading to fever.The Sanren decoction(三仁汤)has

关 键 词：三焦理论 内伤发热 湿热型 三仁汤 验案 

分 类 号：R289.5[医药卫生—方剂学]