膜原及达原饮的临床指征探析

Analysis of membrane-source and clinical indications of Dayuan Yin

膜原是疫疠发病的重要部位,达原饮是治疗温疫邪客膜原的代表方,但因其辛温燥烈影响了本方的临床应用。本文从《温疫论》原文出发,结合后世医家的认识,提出膜原及达原饮方证的本质为中焦的湿遏热伏重证,因疫病发病急,传染性强,病死率高,首重祛邪,用达原饮辛温燥烈,疏利膜原,促进湿热证传变为单纯热证,即吴又可促邪溃败之意,符合分消走泄的湿热治疗原则。同时也提出温疫治疗始终要围绕邪气论治,并凝练归纳了达原饮证的应用指征,探讨了本次新型冠状病毒肺炎中膜原及达原饮的理论价值。

Membrane-source(pleurodiaphragmatic interspace)is an important location for the onset of epidemic disease in the body,and Dayuan Yin(Membrane-source Decoction,DYY)a typical formula indicated for the disease.However,the clinical application of the formula is limited by its acrid-warm and drying nature.Based on original texts from Wenyi Lun(Treatise on Warm-Heat Pestilence)published in the Ming Dynasty,as well as understanding by physicians in later generations,this article discusses the essence of membrane-source and proposes that DYY is indicated for critical condition caused by pattern of dampness trapping hidden deep-lying heat in the middle energizer.As epidemic disease is highly infectious with sudden onset and high mortality rate,first priority in its treatment should be dispelling pathogens hidden inside the human body.Owing to its acrid-warm and drying property,DYY can soothe and drain the membrane-source and transform the dampness-heat pattern into pure heat pattern,which corresponds to the idea of defeating the pathogen by transmitting and changing it proposed by Wu Youke,a famous Chinese epidemiologist and the author of Wenyi Lun.Such practice is still in line with the therapeutic principle of dispersing and purging pathogens through different channels separately in the treatment of dampness-heat pattern.Meanwhile,it is also proposed that the treatment of warm epidemic disease should always center on the pathogens.Besides,the indications of DDY are summarized.Finally,the theoretical significance of membrane-source and DDY is discussed in the current fight against the novel coronavirus pneumonia,also known as the coronavirus disease 2019(COVID-19).