湿热证辨治

Identification and Treatment of Damp-heat Pattern

《湿热条辨》中所称的湿热证主要是指外感湿热病证即"湿温",其与临床常见的内伤湿热证在临床特征方面既有交集又有所不同。前者以"始恶寒,后但热不寒,汗出,胸痞,舌白,口渴不引饮"作为提纲,后者除了上述诸症外,还可表现为上焦之头晕、耳鸣、胸闷、咳嗽,中焦之纳呆、腹胀、恶心、呕吐、胁痛、黄疸、阴囊湿疹,下焦之癃闭、尿浊、尿频急、尿痛、大便溏滞等诸多症状和体征。提纲是湿热辨证的基准,而三焦的不同表现则可作为定位的佐证。湿热论治时,首当分辨湿热权重,据舌质舌苔的不同表现而应用不同的祛湿之法,勿过早投用苦寒之剂,以免湿邪滞留不去;其次当恪守分消走泄之祛湿大法,遵循宣上、畅中、渗下的祛湿原则,并以畅中为要。

Damp-heat pattern appearing in Treatise on Differentiation and Treatment of Damp-heat Diseases refers to the infective damp-heat disease（damp-warm）,which is different from the common internal damp-heat disease in some clinical features. The outline of the former is aversion to cold at beginning,followed by fever without cold,sweating,chest fullness,white tongue coating and thirst with no demand for water. Besides the above,patients with the latter often have many other symptoms and signs such as dizziness,tinnitus, chest tightness and cough in the upper energizer, poor appetite, abdominal distension, nausea, vomiting, pain in hypochondrium,jaundice and scrotal eczema in the middle energizer,uroschesis,turbid urine,urinary frequen- cy,urgency and pain,and sticky stool in the lower energizer. The outline is the base of pattern identifica- tion of damp-heat,while those different manifestations in the triple energizer can serve for positioning. When treating damp-heat pattern,firstly,we should weigh dampness and heat by tongue coating and choose the proper method for dispelling dampness to avoid using bitter-cold herbs untimely resulting in dampness re- tention. Secondly,the method of dampness elimination through the triple energizer and the principles of clearing dampness including dispersion,digestion and diuresis should be followed,while digestion in the middle energizer is the most important one.