《痢疾明辨》辨治痢疾经验拾粹  

Experience of Differentiation of Dysentery in Syndrome Differentiation and Treatment of Dysentery

作　　者：陈宇 王珂 家泽宇 史瑞[2] CHEN Yu;WANG Ke;JIA Zeyu;SHI Rui(Second Clinical Medical College of Beijing University of Chinese Medicine,Beijing 100105,China;Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China)

机构地区：[1]北京中医药大学第二临床医学院,北京100105 [2]北京中医药大学东方医院,北京100078

出　　处：《山东中医药大学学报》2025年第2期243-248,共6页Journal of Shandong University of Traditional Chinese Medicine

基　　金：北京中医药大学“岐黄英才·名医培育计划”项目(编号:Y2023B06);国家自然科学基金面上项目(编号:81874386)。

摘　　要：《痢疾明辨》为清代吴士瑛所著,该书总结了吴士瑛辨治痢疾的经验心得。从病因、辨证、自初症到坏症的病机及处方、六种特殊痢疾的辨证施治以及痢疾和泄泻的鉴别进行阐述。病因上强调暑、湿、热三邪之气与食积相互蕴结,结合《黄帝内经》伏邪理论,提出“伏邪致病”。辨证上,继承其老师舒驰远的思想,分列六经四纲,六经即太阳、阳明、少阳、太阴、少阴和厥阴,四纲即陷邪、秋燥、时毒和滑脱。对六种特殊痢疾的辨治提出了自己的见解,特别是在胎前痢的诊治上,创新性地提出了“治痢以安胎”的思想,卓有见地。吴士瑛认为泄泻和痢疾的病因和症状截然不同,泄泻多寒湿,治疗上常选用温燥之品;痢疾多湿热,治疗上常选用清利之品,应仔细鉴别施治。细论古今治法之得失,对痢疾的临床诊治有指导意义。Differentiation of Dysentery was written by WU Shiying in the Qing Dynasty.This book summa-rized his experience in the syndrome differentiation and treatment of dysentery.This paper expounds the etiology,syndrome differentiation,pathogenesis and prescription from the initial disease to the secondary disease,differentiation and treatment of six special kinds of dysentery and differential diagnosis of dysentery and diarrhea.In terms of etiology,WU Shiying emphasized that dysentery is caused by the mutual accumulation of three pathogenic factors,including summer-heat,dampness and heat as well as the food accumulation.At the same time,he put forward“latent pathogen causing diseases”based on the theory of latent pathogen in Huangdi’s Canon of Internal Medicine.In terms of syndrome differentiation,WU Shiying inherited the thoughts of his teacher,SHU Chiyuan,and classified them into six meridians,namely Taiyang,Yangming,Shaoyang,Taiyin,Shaoyin and Jueyin,and four prin-ciples,which include invasion of pathogen,autumn dryness,seasonal toxin as well as fecal incontinence.He put forward his own views on the treatment of six special kinds of dysentery,especially in the diagnosis and treatment of pregnant patients with dysentery,and innovated the idea of“treating dysentery to prevent abortion”.He believed that dysentery is completely distinct from diarrhea due to the differences in etiology and symptoms.Diarrhea is mostly caused by cold and dampness,so warm and dry herbs are often chosen for treatment.However,dysentery is mostly caused by dampness and heat,clearing and draining herbs should be used for treatment.Therefore the treatment should be followed by careful identification of their difference.A detailed discussion of the gains and losses of treatment methods in ancient and modern times is of guiding significance for the clinical diagnosis and treatment of dysentery.

关 键 词：《痢疾明辨》 吴士瑛 痢疾 伏邪致病 六经四纲 治痢以安胎 

分 类 号：R254.6[医药卫生—中医内科学]