从《温疫论》探讨吴又可治疗疫病的临床思维

Wu Youke′s Clinical Thinking on Treating Epidemic from Perspective of Wen Yi Lun

吴又可借助于膜原提出温疫初起,不同于伤寒表证,提出治法为达原饮促邪溃败。邪客膜原(达原饮证)本质是中焦的湿遏热伏重症,舌诊可见舌质暗红或舌质紫绛,以舌上苔白厚腻如积粉为标志性症状。吴又可治疗疫病,第一步是用辛温燥烈的达原饮、三消饮疏利气机,促邪溃败,将湿遏热伏传变为单纯的热证,目的只是治疗疫病初起的邪客膜原证,并非治疗疫病的主方。三消饮较达原饮,更能体现吴又可的临床思维。第二步是依据邪气溃败后的传变选择相应的治法,里传入胃用大承气汤攻下,表传用白虎汤清解里热,才是治疗的重点。因此吴又可认为治法全在后段功夫,始终着眼于促邪溃败和逐邪外出。吴又可治疗疫病的临床思维对治疗中焦湿遏热伏证具有较强的临床指导价值。

Wu Youke,by using Moyuan theory,proposed the initial onset of the epidemic is different from the surface syndrome of typhoid fever,and he propose the treatment method of promoting the collapse of the evil factors with Dayuan Yin.The essence of Xie Ke Mu Yuan(Dayuan Yin syndrome)is the severe Dampness and Heat retention in the Middle Energizer.Tongue examination shows a dark red or dark purple tongue,with white and thick coating on the tongue as a hallmark symptom.Wu Youke′s first step in treating epidemics is to use Dayuan Yin and Sanxiao Yin,which are spicy,warm,and dry in character,to promote Qi circulation,promote the breakdown of the evil factors and transform Dampness and Heat into a simple Heat syndrome.The purpose is only to treat the Xie Ke Mu Yuan syndrome at the beginning of the epidemic,but not the main formula for treating the epidemic.Sanxiao Yin is more reflective of Wu Youke′s clinical thinking than Dayuan Yin.The second step is to choose the corresponding treatment method based on the transformation of the evil factors after its collapse.The key to treatment is to use Da Cheng Qi Decoction to attack the evil factor in Stomach and Bai Hu Decoction to clear and relieve internal Heat.Therefore,Wu Youke believed that the key treatment lies almost entirely in the later stages,always focusing on promoting the collapse of the evil factors and the expelling of them.Wu Youke′s clinical thinking in treating epidemics has strong clinical guidance value for treatment of the syndrome of Dampness and Heat retention in the Middle Energizer.