狐惑“病在血脉”病因病机分析

Analysis on Etiology and Pathogenesis in Blood and Vessels of Huhuo Disease

通过分析《金匮要略》狐惑证候,认为狐惑病因病机在于血热、血虚,并伴有一定程度的血脉郁热,病情迁延日久导致血瘀,同时湿邪贯穿病程始终。张仲景及现代医家治疗狐惑的理法方药均为佐证。张仲景运用甘草泻心汤、赤豆当归散、苦参汤、雄黄辨证治疗狐惑,以补益中气为本,调治血脉为纲,祛除湿浊为要,内外兼治。现代医家多以凉血活血祛湿、行气活血泄湿、通络清热祛湿等法治疗本病,处方着力点均在祛除血脉之邪。此外,《金匮要略》将百合病、狐惑、阴阳毒合篇论述,百合病病机、阴阳毒证治亦可佐证狐惑“病在血脉”之病因病机。

Through analyzing the syndromes of Huhuo disease in Synopsis of Prescriptions of the Golded Champer,the author believes that the etiology and pathogenesis of Huhuo disease lie in blood heat and blood deficiency,accompanied by a certain degree of accumulated heat in blood and vessels,and the prolonged illness leads to blood stasis,while the dampness pathogen runs through the whole course of the disease.The theories,methods,prescriptions,and medicinals applied by ZHANG Zhongjing and contemporary doctors in the treatment of Huhuo disease provide some support for this view.ZHANG Zhongjing used Gancao Xiexin Decoction(甘草泻心汤),Chidou Danggui Powder(赤豆当归散),Kushen Decoction(苦参汤),and Xionghuang(Realgar)to treat Huhuo disease based on syndrome differentiation,taking tonifying the middle qi as the foundation,regulating blood and vessels as the guiding principle,removing dampness and turbidity as the key,and treating both inside and outside.Most contemporary doctors treat Huhuo disease by the following methods:cooling blood,promoting blood circulation and removing dampness;promoting qi and blood circulation,and purging dampness;dredging collaterals,clearing heat and removing dampness,etc..The focus of the prescriptions is to eliminate the pathogenic factors in blood and vessels.In addition,in Synopsis of Prescriptions of the Golded Champer,Baihe disease,Huhuo disease,yin toxin,and yang toxin were discussed together in one chapter.The pathogenesis of Baihe disease and the syndromes and treatments of yin toxin and yang toxin also support the pathological changes of Huhuo disease in the blood and vessels.