“瘀热在里，身必发黄”刍议

Simple Discussion About“Internal Heat Results in Yellow Body Color”

黄疸,作为中医的一个独立病证,一直是肝胆疾病领域的重点关注问题。历代医家在学习和实践过程中总结出各自的见解和诊疗思路,丰富了黄疸辨证论治的体系。《伤寒论》在论述湿热黄疸时,重点提到“瘀热在里,身必发黄”的病机,关于“瘀热”的理解各家存在争议,认为“瘀热”并非热壅血瘀之意,而是强调湿热郁滞于脾胃气分。“瘀热在里,身必发黄”中的“瘀热”应作“郁热”解,即从“湿热郁滞于里”考虑。从文字使用背景、发黄证病因病位分析和遣方用药特点和经典病例四方面分析均可证明茵陈蒿汤所治的发黄是阳明热与太阴湿郁滞在体内所致。因此在治疗此类黄疸时,应把握祛湿、清热、健脾三个要点。

Jaundice,an independent disease in TCM,is always a significant problem in the area of hepatobiliary and pancreatic disease.Physicians of generations summarized their opinions and diagnosis and treatment,which have enriched the system of jaundice.When discussing jaundice disease caused by dampness and heat,Treatise on Febrile Diseases focused on the pathogenesis that“internal heat results in yellow body color”.As for the comprehension of“internal heat”,physicians’opinions vary from person to person.The author thinks that“internal heat”doesn’t mean the blood stasis due to heat,but emphasizes that the stagnation of dampness and heat in spleen and stomach.The“internal heat”,which comes from the sentence“internal heat results in yellow body color”,ought to be understood as“stagnated heat”.In other words,we’d better stand on the point“that hot and dampness stagnate inside our body”.It can be proved from four aspects,text background,analyzing of pathogen and pathogenesis,characteristics of medication,and classic case,that this type of jaundice results from the hot in Yangming and dampness in Taiyin.So,in the treatment of jaundice disease caused by dampness and heat,we should grasp three points,removing dampness,clearing heat and strengthening spleen.