《伤寒论》“津液自和”对诊治小儿外感热病的启示

The enlightenment of“Jin Ye Zi He”(autonomous recovery of body fluids)in Shanghanlun(Treatise on Cold Damage)to externally contracted febrile diseases in children

《伤寒论》首次提到“津液自和”,即身体自汗出、小便利,是维持身体阴阳平衡的基础,也是身体抵御和祛除邪气的重要条件。广义的津液是指一切体液及其代谢产物总称,津液在外感热病的发生、发展及预后转归中有重要作用。津液失和包括津液量的异常、津液蒸腾气化和运行输布异常。伤寒、温病、瘟疫学说分别从不同角度论述外感热病,三者虽为不同辨证体系,但病邪由浅入深、由表及里的发展趋势是一致的。小儿代谢快,对津液需求多,津液易失调,故小儿外感热病较之成人更易出现津液失和,临证治疗可解表宣透、清热生津、畅达气机以实现津液自和、邪去正安。通过“津液自和”治疗外感热病,具体包括:辛温解表、汗而发之,辛凉解表、以汗达邪,清泻(透)里热、养阴生津以及祛湿退热、畅达气机。

The term“Jin Ye Zi He”(autonomous recovery of body fluids)was first seen in Shanghanlun(Treatise on Cold Damage),which suggests that the body returns to its normal state of sweating and urination.This is the basis for maintaining the balance of yin and yang in the body,and also an important prerequisite for resisting and eliminating pathogenic factors.In the broad sense,Jin Ye(body fluids)refers to the general body fluids of various types and their metabolites,and plays an important role in the occurrence,development and prognosis of externally contracted febrile diseases.The loss of harmony of body fluids includes abnormal body fluid volume,transpiration and transformation,and abnormal flow and distribution.The theories of cold damage,warm diseases and pestilence explain externally contracted febrile diseases from different angles.Although the three are different syndrome differentiation systems,they agree on the development trend of the disease from the shallow to the deep and from the outside to the inside.Children have fast metabolism,higher demand for body fluids,and therefore the tendency to experience imbalance in body fluids,which suggests that they are more likely to have body fluid loss than adults.For the treatment,it is proposed to relieve and diffuse the exterior,clear heat and promote fluid production,and restore the smooth movement of qi,to achieve autonomous recovery of body fluids,dispel evil and restore healthy qi.The methods to do so include treating superficies syndrome with sweat promotion using pungent and warm herbs,relieving exterior syndrome with pungent-cool drugs to dispel evil with sweat,clearing internal heat,nourishing yin to facilitate fluids production and removing dampness and heat,to aid the movement of qi.