基于“天地人”三才探讨中医疫病“寒”“温”证候的历史演变及启示

Discussion on the historical evolution and enlightenment of traditional Chinese medicine epidemic disease‘cold’‘warm’syndrome based on the theory of‘nature-earth-human being’

文章基于“天地人”三才,从还原历史条件的角度入手,探讨伤寒和温病在发病上存在差异的可能成因。通过查阅史料,对汉末医圣张仲景生活地域和清中前期叶天士、薛雪两家生活地域的民众,从时代气候、地理位置、饮食劳作三方面进行考证,对比和分析两时两地民众所处环境和机体状态的差异。考证结果显示,从气候因素而言,张仲景时期(184—205年)处于接近小冰河时期谷底的下降期,叶天士、薛雪时期(1710—1740年)处于小冰河时期谷底的上升期,二者最冷月平均气温接近,但温度变化趋势相反;从地域因素而言,东汉末年南阳盆地与清代吴地均有河流众多的特点;从宿主因素而言,东汉末年南阳盆地民众人均粮食供给量平均约为633 g,劳作多而热量摄入少,而清中前期吴地民众人均粮食供给量平均为950 g,劳作少而热量摄入相对较多。基于中医病因整体观,从“天地人”三才的角度分析可知,“寒”“温”证候的历史演变,一方面与气候异常变化趋势有关,另一方面也与不同时期民众的体质状态影响的病邪从化密切相关,这一结果正与中医疫病的发病观相一致。并基于此,结合当代病原微生物学及免疫学相关理论进行分析,以期为防治新发突发传染病的发生、发展与传播提供新的思路。

Based on the theory of‘nature-earth-human being’,the possible causes of the difference between febrile disease and warm disease were discussed.By studying historical data,the differences in the climate,geographical location,and feeding conditions between the people living in the late Han dynasty when ZHANG Zhongjing lived and the people living in the early of middle Qing dynasties when YE Tianshi and XUE Xue lived were compared and analyzed.From the perspective of climate factors,the period of ZHANG Zhongjing(AD 184-205)was in the descending period close to the bottom of the Little Ice Age,and the period of YE Tianshi and XUE Xue(AD 1710-1740)was in the rising period of the bottom of the Little Ice Age.Although the average temperature was similar,yet the temperature variation trend was opposite.From the perspective of regional factors,there were many rivers both at Nanyang basin in the period of ZHANG Zhongjing and at Wudi in the period of YE Tianshi and XUE Xue.From the perspective of host factors,the average per capita food supply of the people at Nanyang basin in the period of ZHANG Zhongjing was about 633 g,while it was 950 g at Wudi in the period of YE Tianshi and XUE Xue.And the people had more work and less caloric intake in the period of ZHANG Zhongjing,yet the people had less work and more caloric intake in the period of YE Tianshi and XUE Xue.Based on the holism concept of traditional Chinese medicine(TCM),it was found that there were large differences in the evolution of TCM epidemic disease syndrome with the theory of‘nature-earthhuman being’.The differences were not only related to the abnormal change trend of climate,but also related to calorie intake with different people at different area.And based on this,combined with the pathogenic microbiology and immunology related theories to analyze,in order to provide new ideas for preventing the occurrence,development and spread of new infectious diseases.