流行性出血热中医病因病机及诊治要点分析

Analysis of TCM etiology and pathogenesis of epidemic hemorrhagic fever and key points in its diagnosis and treatment

流行性出血热是由汉坦病毒引起的一种传染病,属中医“疫病”范畴。中医防治流行性出血热疫情疗效明显,但各家寒温迥异的辨治方法亦为后世辨治疫病带来困惑。通过总结资料,从“分类-分期-分证”视角对流行性出血热“因机证治”进行重新审视。从“分类”的角度将其归属于“寒疫”范畴,从“分期”的角度将其分为“热毒-厥脱-肾损-正虚”四个阶段。每个阶段又分多个证型:“热毒”阶段,以寒戾嗜营、热毒损络为核心病机,主要证型有太阳经证、太阳腑证、邪郁少阳证、阳明热盛证、气营两燔证。“厥脱”阶段,以热厥气脱为核心病机,主要证型有热厥气脱证、元气外脱证。“肾损”阶段,以疫毒伤肾为核心病机,分为少尿期和多尿期,少尿期以毒损肾络为要,主要证型有膀胱蓄血证、水热互结证、结胸证、湿阻三焦证等;多尿期以肾虚失摄为要,主要证型有肾虚不固证、余邪未尽证。“正虚”阶段,以气血阴阳的亏虚为核心病机,主要证型有脾肾阳虚和肝肾阴虚等。治疗流行性出血热:热毒期,到气即可凉营;厥脱期,见厥即要固脱;肾损期,少尿务必通腑,多尿补肾缩泉。

Epidemic hemorrhagic fever(EHF)is a kind of infectious disease caused by hantavirus,belonging to the category of epidemic diseases in traditional Chinese medicine(TCM).Though traditional Chinese medicine proves effective in the prevention and treatment of the disease,the differences in their syndrome differentiation and treatment from the perspective of cold or heat by different doctors have also brought a lot of confusion to the later generations in this respect.This study summarizes the related data,and reexamines the aspects of etiology,pathogeneses,syndromes and treatment of EHF from the perspective of its"classification,stages and syndromes",classifying it into the category of"cold pestilence",and dividing it into four stages:heat-toxicity,heat syncope and qi desertion,kidney damage,and vital qi deficiency.While in each stage,it can be divided into several syndrome patterns as well.In the heat-toxicity stage,its core pathogenesis lies in the cold pathogen invading yingfen and heat toxin damaging meridians,mainly involving syndrome patterns such as the Taiyang meridian syndrome,Taiyang fu-organ syndrome,stagnant pathogen of Shaoyang syndrome,syndrome of exuberant heat in Yangming,and the syndrome of flaring heat in qifen and yingfen.While in its second stage,heat syncope and qi desertion constitute its core pathogeneses,and its main syndrome types include the syndrome of heat syncope and qi desertion,and the syndrome of primordial qi external collapse.The kidney damage stage,with pestilence impairing the kidney as its core pathogenesis,can be further divided into an oliguria stage and a polyuria stage.In the oliguria stage,the main pathogenesis lies in pestilence impairing kidney collaterals,and the main syndrome types include the syndrome of blood amassment in the bladder,the syndrome of intermingled water and heat,the chest bending syndrome,and the syndrome of damp obstructing sanjiao,etc.In the polyuria stage,the main pathogenesis is kidney deficiency and inadequate gasification,with the main syndromes involving the syndrome of unconsolidation due to kidney qi deficiency,and the syndrome of lingering remnant pathogens.In the vital qi deficiency stage,the deficiency of qi,blood and yin and yang counts the core pathogenesis,and its main syndrome types are the spleen and kidney yang deficiency and the liver and kidney yin deficiency.In short,when treating EHF,in its heat-toxicity period,cool yingfen as soon as heat-toxicity invades qifen;in the heat syncope and qi desertion period,relieve qi desertion as soon as the heat syncope syndrome occurs;in the stage of kidney damage,unblock fu-viscera as soon as there is less unination,and nourish the kidneys and reduce urination when there is excessive urination.