以湿论治泄泻的历代中医文献诠析

Interpretation of Chinese Medical Literature on Treating Diarrhea with Dampness

泄泻是一种临床上常见的消化道疾病,早在《内经》中就对其病因病机等有较全面的论述,此后历代医家对其的研究不断充实,逐步形成"以湿论治泄泻"的治则大法。先秦两汉时期是泄泻病研究的初始阶段,《内经》阐述了病因病机及治疗原则,即"湿盛则濡泻",但没有记载具体的遣方用药。金元时期是泄泻病研究的重要时期,认为各种证型泄泻都与湿邪有着密切关系,还提出"通利小便"为上策,此意"利小便所以实大便也"。明清时期对泄泻病的研究日趋丰富,可从湿热、暑湿、寒湿的角度来辨证施治,且不能过早使用固涩收敛之剂,常用茯苓、陈皮、厚朴、白术、泽泻等祛湿药,指出"无湿不成泄"。因此,利湿是治疗泄泻病的重要大法。诠析历代文献,旨为泄泻病的临床诊治提供依据。

Diarrhea is a common digestive tract disease in clinic. The etiology and pathogenesis of diarrhea were discussed comprehensively as early as in The Yellow Emperor’s Inner Classic.Since then, the research on diarrhea by physicians in successive dynasties has been enriched, and the principle of "treating diarrhea with dampness" has gradually been formed. Pre-Qin and Han Dynasties are the initial stages of diarrhea research. The Yellow Emperor’s Inner Classic expounds the etiology, pathogenesis and treatment principles, which means predominant dampness causing diarrhea, but does not record the specific prescription medication. The Jin and Yuan Dynasty is an important period for the study of diarrhea. It is believed that the diarrhea of various syndromes is closely related to damp pathogens. It is also suggested that the best way is to "promote urination",which means "promoting urination helps defecation". During the Ming and Qing Dynasties, the research on diarrhea became more and more abundant, which could be treated by syndrome differentiation from the perspectives of damp-heat, summer-dampness and cold-dampness, and the astringent agent could not be used prematurely. Poria cocos, tangerine peel, magnolia officinalis, atractylodes macrocephala and alisma were commonly used to dispel dampness.pointing out that "no moisture, no leakage." Therefore, diuresis is an important method to treat diarrhea. To provide basis for clinical diagnosis and treatment of diarrhea disease, the literatures of past dynasties were analyzed.