陈士铎疫疠证治思想探析

CHEN Shiduo’s Thought of Syndrome and Treatment on Epidemic Diseases

[目的]探析明末清初时期浙江医家陈士铎诊治疫疠的学术思想。[方法]通过文献研究法,筛选陈士铎著述中涉及疫、疠之条文并进行研读,从病名、病因、病机、症状、鉴别、治法、方药等方面归纳其诊治疫疠的学术思想。[结果]陈氏详细阐述了瘟疫、疠风、瘴疠等疾病的辨治方式。火热成毒、闭而不宣所致瘟疫以全身症状乃至神志异常为主要表现,具有传染性,且病死率高;热毒、湿蒸之气所致疠风、瘴疠均具传染之性,疠风以皮生斑点、破而成疮乃至腐烂及须眉掉落为临床特点,瘴疠则以头痛、腹满为核心表现,而由酒湿所致疠风则不具可传染性。陈氏在多部医籍中针对各类疫疠之疾创设了多种治法方药,并提出疫病与伤寒可通过是否于冬月得病及传经与否进行鉴别,春疫与春温则在病邪性质与预后方面有所差别。[结论]陈士铎身处疫灾频发之时空,关于疫疠证治的论述丰富、零散而颇具特色。其防治疫疠的理法方药可为当今传染性疾病诊疗工作提供借鉴,也提示在中医疫病学经典传承内容建设中,除应重视传统中医典籍与温病学家专著外,其他学派医家著作与综合性医书中相关内容的整理亦值得关注。

[Objective]To explore the academic thought of CHEN Shiduo,a Zhejiang traditional Chinese medicine doctor,in the late Ming and early Qing dynasties on the diagnosis and treatment of epidemic diseases.[Methods]By means of literature research,CHEN Shiduo’s articles related to epidemic diseases were screened and studied,and his academic thoughts were summarized from the aspects of disease name,pathogenic factors,pathogenesis,symptoms,identification,treatment and prescriptions.[Results]Mr.CHEN elaborated on the diagnosis and treatment of plague,leprosy,malaria and other diseases.The plague,which is characterized by systemic symptoms and even abnormal mind,is infectious and has a high fatality rate.Leprosy and malaria caused by heat toxin and moist evil are infectious.Leprosy is characterized by skin spots,broken into sores,even rotting,and hair dropping.Malaria is characterized by headache and fullness of the abdomen,while the leprosy caused by alcohol dampness is not infectious.In many medical books,Mr.CHEN created a variety of therapeutic prescriptions for various kinds of epidemic diseases.In addition,it was also suggested that epidemic diseases and exogenous febrile diseases could be identified by whether they were infected in the winter and whether they passed on their meridians,while spring epidemic disease and spring-warm syndrome were different in the nature of pathogenic factors and prognosis.[Conclusion]Mr.CHEN Shiduo was in the time and space of frequent epidemic disasters.His works have rich,scattered and distinctive discussions on the syndrome and treatment of pestilence and plague.His principles,methods,prescriptions and medicine for the prevention and treatment of pestilence and plague can provide reference for the diagnosis and treatment of infectious diseases today.It also suggests that in the content construction of classical inheritance of traditional Chinese medicine epidemiology,in addition to attaching importance to traditional Chinese medicine classics and the works of febrile pathologists,the sorting of relevant contents in other doctors and comprehensive medical books should also be paid attention to.