湿疫源流及治则治法主方考

中医将具有强烈传染性、流行性的疾病称之为疫病,病因为感受疫疠邪气所致,归属于温病范畴。根据疫病的临床症候及病因属性,目前主要分为湿热类和温热类疫病。文中归纳整理湿疫的相关文献,认为湿疫为感受湿邪为主的疫疠毒邪,由口鼻而入。因湿疫病因固定,具有明显的传变规律的阶段性,可以分为初期、进展期、极期、恢复期阶段。凝练了湿疫的诊断要点,提出不同阶段的治疗原则和常用方证。在治疗的不同阶段始终要围绕湿疫毒邪的祛除,同时湿疫初期,湿疫毒邪伏于膜原,虽有类似表证,但不能给予辛温发汗,必须芳香涤秽化浊、疏利气机,着眼于邪气的透达,促使湿热分消走泄,即吴又可所谓的促邪溃败之意。湿疫临床特点依然不能脱离湿热范畴,临床存在正局、变局之分,湿遏热伏,热得湿则郁遏而不宣,故愈炽,存在极易入营、逆传心包、横逆肝肾等变局,导致病情急剧加重,需要引起临床重视。因此提出治疗上,初期注重芳香涤秽化浊、疏利气机、透邪外达,湿疫化热后,要警惕变局,重视解毒凉血活血法的应用。同时湿疫治肺、着眼于祛邪的治疗思想要贯穿始终。

Origins,pathogenesis,treatment principles,methods and formulas of damp epidemic diseases: a literature review

Infectious diseases that are highly contagious and spreading quickly are named as epidemic diseases(yibing)in traditional Chinese medicine(TCM).Caused by contraction of epidemic pathogens,epidemic diseases generally fall into the category of warm diseases(wen bing).According to the characteristics of clinical manifestations and pathogenic factors,epidemic diseases are classified into either damp heat type(damp epidemics)or warm heat type(warm epidemics).This paper reviews relevant TCM statement and texts on damp epidemics from the literature.Damp toxic pathogens invade the body via the mouth and nose,leading to the development of damp epidemic disease,which is featured by stage-by-stage(from early stage,progressive stage,to advanced stage and convalesce stage)progression,as the pathogenic factors of damp epidemics are of specific nature with step-by-step transmission.The diagnostic essentials are summarized in this paper;Treatment principles and commonly-used formulas are also recommended.The key to treatment is to dispell damp toxic pathogens throughout the stages.At early stage of damp epidemics,athogens tend to lurk in the membrane source(mo yuan),which is difficult to target.Sweating method by using pungent warm medicinalsis not suitable in this indication though the manifestationresemble that of an exterior pattern.Aromatic medicinals are advised to be used to remove the filth and turbidity as well as to regulate the qi movement.The purpose is to eliminate the damp heat pathogens by dispelling,dispersing and purging from different pathways,which is also the therapeutic strategy advocated by Wu Youke,“enabling the pathogens to recede”.Damp epidemic disease is by nature a damp-heat disease.Therefore there are two possibilities(favorable or unfavorable development)when it comes to the progression and prognosis of disease.Dampness tend to constrain heat from dissipating,thus heat could easily be intensified and transmit either interiorly to the nutrient-blood aspect,reversely to the pericardium,or transversely to the liver and kidney.These are all critical conditions that needs close clinical care.By reviewing the literature,this paper proposes the following therapeutic principles at different stages.At early stage,fragrant medicinals should be used to resolve filth and turbidity,dredge and regulate qi movement,and outthrust pathogens to be expelled from the surface,in order to prevent it from progression.Once damp epidemics do transform into heat,watch for signs of unfavorable development and use toxin-removing,blood-cooling and blood-activating methods.The idea of targeting at the lung and expelling pathogens should be maintained throughout the course of damp epidemics.