基于六维辨证探讨吴鞠通“通下法”在温病急危重症的应用  

Discussion on the treatment of emergency and critical illnesses of warm diseases using WU Jutong’s Promoting bowel movemets method based on the six-factor syndrome differentiation theory

作　　者：李倩倩 董斐[2] 田园硕 白辰 于河 刘铁钢 谷晓红[2] LI Qianqian;DONG Fei;TIAN Yuanshuo;BAI Chen;YU He;LIU Tiegang;GU Xiaohong(School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学中医学院,100029 [2]北京中医药大学中医疫病研究院,100029 [3]北京中医药大学第一临床医学院,100029

出　　处：《环球中医药》2024年第7期1227-1232,共6页Global Traditional Chinese Medicine

基　　金：国家重点研发计划(2018YFC1704100,2018YFC1704101);国家中医药管理局中医药创新团队及人才支持计划(ZYYCXTD-C-202006);北京中医药大学校级课题(中医经典理论挖掘与传承专项)(2021-JYB-ZYWJCC 006)。

摘　　要：六维辨证是笔者团队基于中医理论与临床经验总结提出的辨证思路,旨在临床辨证中把握整体,抓住机要,从病期、病位、病势、病因、病性、病理六个维度分辨证态,有助于全面识清病机,指导临床治疗。吴鞠通善用“通下法”治疗温病急危重症,强调适时攻下、逐邪外出、截断病势、顾护阴津,对其相关方证的辨证和治疗仍需梳理清楚。文章结合六维辨证分析吴鞠通“通下法”在温病急危重症的临床应用。从病因病性角度,温热主以承气汤类方泄热攻下,湿热主以宣清导浊、化湿通腑;从病期角度,气营血期均可通下以给邪(邪热、瘀热)出路;从病势角度,辨邪正态势、传变态势、邪气趋势而采用纯攻下、攻补兼施等;同时结合病理、病位而兼证兼治,以期为急危重症的中医临床诊治提供一定的参考。Six dimensional syndrome differentiation theory,put forward by the author’s team based on her theoretical teaching and clinical experience,emphasizes that the syndrome differentiation should be carried out from six dimensions including etiology,disease location,disease stage,disease condition,pathology,and disease nature,which is conducive to comprehensively understand the pathological mechanism and guide clinical treatment.WU Jutong has skillfully utilized the“purgation method”to treat emergency and critical illnesses of warm diseases,emphasizing timely elimination of pathogenic factors,expulsion of evils,and interrupting disease progression.It is necessary to clarify the differentiation and treatment of related syndromes.This article discussed the treatment of emergency and critical illnesses of warm diseases using WU Jutong’s purgation method based on the six-factor syndrome differentiation theory.From the perspective of etiology and disease nature,heat is expelled and eliminated through formulas like Chengqi Decoction,while damp-heat is resolved and cleared through promoting the clear and directing the turbid to eliminate dampness.From disease stage,during the stages of qi,nutrient and blood,purgation method can be used to expel pathogenic factors(pathogenic heat and stasis heat).From the perspective of disease condition,pure purgation method or a combination of purgation method and supplementing methods are applied based on different manifestations of pathogenic factors,transformation,and the tendency of pathogenic qi.At the same time,the treatment is also based on the pathology and disease location,aiming to provide references for the diagnosis and treatment of emergency and critical illnesses in Chinese medicine clinical practice.

关 键 词：六维辨证 吴鞠通 《温病条辨》 通下法 温病 急危重症 

分 类 号：R22[医药卫生—中医基础理论]