对“甘温除热法”的再认识及其临床应用总结

The understanding and clinical application of the thought“relieving fever with sweet and warm-natured drugs”

甘温除热理论是李东垣学术思想的重要内容,用于治疗由气虚引起的内伤发热,其中,脾胃虚弱和阴火上冲是气虚发热的病机关键,补中益气汤类方是甘温除热法遣方用药的代表方,能够全面调节机体免疫功能。李东垣首倡阴火理论,通过补中焦,升清阳,复元气来泻阴火。创立的甘温除热大法,实为治疗真寒假热证的反治法,当属于中医“热因热用”的范畴,为后世医家治疗内伤发热另辟蹊径。现代临床研究也发现甘温除热法治疗发热疗效显著,现多将其用于内、外、妇、儿各科,治疗癌症晚期发热、外科术后发热、血液疾病及免疫疾病发热等其他非感染性、不明原因的发热,能明显缩短患者退热时间,取得良好的效果,不仅体现了中医的异病同治和辨证论治的灵活性,亦对指导临床具有重要意义。

The thought of“relieving fever with sweet and warm-natured drugs”is an important content of Li Dongyuan′s academic thought,which is used for treating the internal damage fever caused by qi deficiency.According to this theory,the main mechanism of qi deficiency with fever is deficiency of spleen and stomach and yin fire upward invading and the representative prescription of“relieving fever with sweet and warm-natured drug”is Buzhong Yiqi Decoction,which can improve immunity.Li Dongyuan fist raised yin fire theory,meaning purging yin fire by tonifying the middle,ascending clear yang,and restoring original qi.The thought of“relieving fever with sweet and warm-natured drugs”can be used for curing cold syndrome with pseudo-heat symptoms,belonging to the scope of“hot drugs treating pseudo-heat”,which provides reference for physicians to treat internal damage heat.In modern clinical researches,it has been found that this approach can be applied for noninfectious fever such as fever in advanced cancer,postoperative fever,fever due to blood diseases or immune diseases,or other fever with unknown causes.It can shorten the duration of fever with a good effect.In summary,the thought of“relieving fever with sweet and warm-natured drugs”has shown the flexibility in syndrome differentiation and simultaneous treatment of different diseases,which is valuable for clinical practice.