浅析温病初起辛温与寒凉配伍应用的发展规律

辛温药在治疗外感病初起时其配伍应用经历了单纯使用辛温药、辛温苦寒相配、辛温与辛凉相配的3个变化过程。萌芽阶段(战国到晋唐)、成长阶段(宋金元)与形成阶段(明清)是温病学派形成过程中的3个重要时期,随着温病学派的崛起,辛温药由最初的辛温峻烈之品到后来的微辛温之品,其与寒凉药的比例也不断变化。本文对三个时期温病初起时辛温与寒凉的配伍应用进行了梳理,强调根据病机临证处方用药,注重寒温并用、性味合化的组方思路,辨治温病初起时可体现为辛温与寒凉药物配伍,意在使用辛温开郁达邪,与清热凉解祛邪相结合,根据气机郁闭与热邪炽盛的程度决定选药与用量。为临床辨治温病时辛温药与辛凉药的配伍应用提供思路。

Developing law of application of pungent-warm with cold-cool medicinal combination for treating warm diseases at initial stage

The combination of pungent-warm medicinal has experience 3 changing processes during initial stage of warm diseases:simply using pungent-warm medicinal,combination of pungent-warm with bitter-cold medicinal and combination of pungent-warm with pungent-cool medicinal.There were 3 important periods during the formation of warm disease school, which were infancy stage(period from Warring States to Jin and Tang Dynasties),growth stage(periods of Song,Jin and Yuan Dynasties)and forming stage(periods of Ming and Qing Dynasties).With the deuolopment of warm disease school, the use of pungent-warm medicinal altered from hot to slight warm, and proportion of pungent-warm medicinal and cold-cool medicinal changed continuously.The combination administration of pungent-warm and cold-cool medicinal for treating febrile diseases at the initial stage was summed up,clinical prescribing according to pathogenesis was emphasized,and thinking train of property-flavor combination was stressed.The combi-nation of pungent-warm and cold-cool medicinal aimed at releasing depression and eliminating pathogen combined with clearing heat,cooling and dispelling pathogen at the initial stage of warm diseases.The selection and dosage of medicinal should be determined according to the degree of depression of qi move -ment and intense heat toxin.The thought of combination of pungent-warm and cold-cool medicinal should be thought of when practicing and treating warm diseases in chinic.