《务存精要》湿温病辨治思想探析

Study on the Differentiation and Treatment Thoughts of Damp and Febrile Disease in Wucun Jingyao

基于《务存精要》之湿温病医案,从病名溯源、病因病机、辨证施治、组方用药四方面剖析了马氏治疗湿温病的经验和治疗思想。马氏根据湿温病的易发季节与好发地域及人群,以卫气营血辨证、六经辨证及脏腑辨证等辨证方法相结合;治法以辛苦、辛凉、辛温、芳香、淡渗为要;用药平和、活用鲜药、善配冲服、成药入汤;组方以调畅气机、通利三焦,顾护宫城、防邪内陷之思想贯穿始终。这些辨证用药特色和组方思想对现代临床,尤其是伤寒、沙门菌属感染、某些肠道病毒感染等表现类似症状的疾病具有一定借鉴和指导意义。

On the basis of febrile disease cases in Wucun Jingyao, this paper analyzes Ma＇s experience and therapeutic thoughts for treating damp and febrile disease form four aspects including tracing the etiology and pathogenesis from disease name, syndrome differentiation and treatment and prescriptions applications. According to damp and febrile disease affected easily season, region and population, Ma combined several syndrome differentiations such as wei-qi-ying-blood syndrome dif- ferentiation, six-meridian syndrome differentiation and zang-fu syndrome differentiation. His treating method is mainly focus on pungent-bitter, pungent, pungent-warm, aromatic and infiltration. Ma usually uses mild herbs, makes flexible use of fresh herbs, and is good at applying powders and prescribed herbs in decoction. His prescriptions are aiming at regulating qi activi- ties, smoothing sanjiao, reinforcing healthy qi and resisting the external evils attacking the internal. His syndrome differentia- tion thoughts, prescription applications and combinations have a certain reference and guiding significance for modern clinic, especially for typhoid Salmonella infection and some similar symptoms of enterovirus infections.