《温热论》苦泄法与开泄法探析

分析了《温热论》苦泄法与开泄法的内涵、运用要点以及临床运用。苦泄法与开泄法是清代温病学家叶天士针对湿热病邪结胃脘所引起的胃痞病而提出的两种治法。“苦辛通降，透泄并施”是苦泄法的核心内涵；“轻苦微辛，宣透外达”是开泄法的核心内涵。苦泄法与开泄法的运用当以“邪聚中焦，胃气壅滞”为辨证关键，以“苦辛并用，给邪以出路”为治疗关键，并在此基础上正确辨析二法的区别要点，审慎运用。苦泄法与开泄法在慢性胃炎、慢性阻塞性肺疾病、结核性胸膜炎、干燥综合征、新型冠状病毒感染等疾病的治疗中均可应用。 

Exploration on the Bitterness-Purging and Dispersion-Discharge Methods in the Treatise on Warm-Heat Diseases

This study analyzes the connotation, key points, and clinical application of the bitterness-purging method and the dispersion-discharge method in the Treatise on warm-heat diseases. The bitterness-purging method and the dispersion-discharge method are two treatment methods proposed by the Qing dynasty warm-disease therapist Ye Tian-shi for the gastric distention and fullness caused by damp-heat accumulated in the stomach. The core connotation of the bitterness-purging method is "unblocking and purging with bitter-acrid medicinals, together with using acrid-cool medicinals to promote sweating combined with bitter-cold medicinals to discharge interior heat". In addition, the core connotation of the dispersion-discharge method is "diffusing the exterior with slightly bitter and acrid medicinals". The key to the application of the bitterness-purging method and the dispersion-discharge method is to identify "the damp-heat accumulated in the middle jiao and the blockage of stomach qi". Thus, the corresponding key treatment is "removing pathogenic factors with bitter and acrid medicinals". On this basis, it is critical to correctly identify the differences between the two methods and apply them judiciously. The bitterness-purging method and the dispersion-discharge method can be applied in the treatment of chronic gastritis, chronic obstructive pulmonary disease, tuberculous pleurisy, sicca syndrome, as well as novel coronavirus infection.