张福利教授从“圆运动模型下的温病”论治卒中相关性肺炎的思路与经验

Professor Zhang Fuli's Ideas and Experiences of Treating Stroke Associated Pneumonia from Pattern Differentiation of Febrile Disease by Using the Architecture of Circular Motion

卒中相关性肺炎,继发于中风急性期,以发热、咳嗽、咳痰为主症,起病急骤,发展迅速,病情凶险,总体符合清代叶天士、吴鞠通等总结的温病证治规律。民国名医彭子益以圆运动理论为立论,提出的“圆运动模型下的温病”,有别于叶、吴阐述的温病辨治体系。张福利教授在学承叶、吴的同时,参合彭氏观点,认为卒中相关性肺炎确有别于前者的温病证治路径,属“外感-内伤”复合型病证,“肝阳鼓越”引起的“圆运动分离”是其发生的重要内因,温邪经口鼻内入与痰浊交结于“肺络”是肺感染发生的关键,此病属“因于时气,成于本气”,当从“圆运动模型下的温病”辨治,提出在开窍醒神、清宣肺络的前提下,应重视脏腑气机调复,恢复圆运动流转。文末附验案一则,为此病的证治思路与方法提供借鉴。

Stroke associated pneumonia is secondary to the acute phase of stroke,which is mainly characterized by fever,cough,and expectoration.This disease has the characteristics of sudden onset,and rapid development,and endangers lives of the patients.The course of the disease generally conforms to the rules of pattern differentiation and treatment of febrile disease summarized by Ye Tianshi and Wu Jutong in Qing Dynasty.Peng Ziyi,a famous doctor of traditional Chinese medicine(TCM)in the Republic of China,took the theory of circular motion and proposed the‘pattern differentiation of febrile disease by using the architecture of circular motion’,which is distinguished from the viewpoints of Ye and Wu.Professor Zhang Fuli,while studying Ye and Wu,also joined Peng's viewpoint and believed that stroke associated pneumonia does have a different warm disease treatment path from the former.Stroke associated pneumonia belongs to the complex syndrome of“external contraction and internal damage”,and the“separation of circular motion”caused by“liver yang bulging”is an important internal cause of its occurrence.The key to the occurrence of lung infection is the entry of warm pathogen through the mouth and nose and the pathogen congeals with phlegm turbidity in the“lung collaterals”.Stroke associated pneumonia is caused by seasonal qi and formed due to weakness of the body.The treatment of such diseases must refer to‘pattern differentiation of febrile disease by using the architecture of circular motion’.Professor Zhang proposed that the treatment should be based on orifice-opening and mind awakening,and lung-diffusing and collateral-purging.Attention should be paid to the regulation of viscera and bowels and qi movement,and then the circular motion will restore naturally.At the end of the article,a medical case is attached to provide reference for the pattern and treatment of such disease.