从热邪、湿邪角度探讨不明原因发热的中医治疗

Treating fever of unknown origin in TCM from the aspects of heat and dampness pathogenic factors

不明原因发热病因不明,西医治疗往往困难。总结了10余年诊治经验,发现采用中医治疗,疗效明显。不明原因发热属于中医内伤发热范畴,患者常有气、血、阴、阳亏虚或气郁、血瘀、湿阻病史,导致五邪产生,发热为内生邪气所致,病理性质属热。患者多苔厚黏腻,发热反复,从舌苔表现及病程缠绵判断,病理性质属于湿邪。因无外感诱因,故其湿邪属于内湿。因此,不明原因发热患者的临床表现主要体现在热邪、湿邪两方面,属于湿热并重。因病程久,容易阻滞三焦气机,日久湿、热、毒邪壅滞,弥漫三焦。治疗原则宜清上、畅中、渗下同用,清热、利湿、解毒并行,需较强力度用药方可使弥漫三焦之湿热毒邪俱除。遣方用药上,甘露消毒丹用药作用于上下、内外,升降出入,莫不关乎三焦之枢,故为最佳之选。采用力度较轻的王氏连朴饮、达原饮、杏仁滑石汤、三仁汤治疗,效果不如甘露消毒丹。研究从发热的特点、治疗思路、治法确立、方剂选择等方面阐述了不明原因发热的中医治疗,以期为临床提供参考。

Because the etiology is unknown,it is often difficult to treat fever of unknown origin(FUO)in Western medicine.The author summarized the experience of diagnosis and treatment for more than 10 years and found that traditional Chinese medicine had an obvious curative effect on FUO.The author believes that FUO belongs to the category of internal injury fever in traditional Chinese medicine.Patients often have a history of Qi(),blood,Yin()and Yang()deficiency,or Qi stagnation,blood stasis,and dampness obstruction.These diseases lead to the production of five pathogens.The fever is caused by endogenous pathogen Qi,and its pathological nature is heat.Most patients with FUO can be seen thick and sticky tongue coating,and fever is repeated.From the manifestation of tongue coating and the lingering course of the disease,we can judge that the pathological nature is caused by dampness.Because there is no exogenous inducement,its dampness pathogen belongs to internal dampness.Therefore,the clinical characteristics of patients with FUO are mainly reflected in the two aspects of heat pathogen and dampness pathogen.Because the patient has a long course of disease,it is easy to block the triple energizer Qi circulation.Over time,dampness,heat,toxin stagnate and diffuse the triple energizer.In principle,clearing the upper,middle and lower energizers should be accompanied by clearing away heat,dampness and toxins.Therefore,it is necessary to use more powerful medicines to remove the damp heat toxin that has been diffused in the triple energizer.In terms of prescription and medication,Ganlu Xiaodu Dan(甘露消毒丹)has better curative effects.The prescription can better dredge the triple energizer,so it is the best choice.Wangshi Lianpo Yin(王氏连朴饮),Dayuan Yin(达原饮),Xingren Huashi Tang(杏仁滑石汤),Sanren Tang(三仁汤)with less strength are inferior to Ganlu Xiaodu Dan in the treatment of FUO.This paper expounds the traditional Chinese medicine treatment of FUO from the characteristics of patients,treatment ideas,therapeutic method,prescription selection and other aspects,in order to provide clinical reference.