【作者】 张飞龙；

【导师】 马健；

【作者基本信息】 南京中医药大学 ， 中医临床基础， 2011， 博士

【摘要】 温病是由温邪引起的以发热为主症,热象偏重,易化燥伤阴的一类急性外感热病。根据温病多以外感温邪为主的病因学特点,其治疗以“温者清之”,“热者寒之”为原则,选药(方)多为寒凉。寒凉清解药(方)为主的治疗方法抓住了温病的主要矛盾方面,形成了寒凉清解为主的温病治疗学,从而广用寒凉之品,以达清解热邪,生津护阴之目的。外感温邪,并非只可寒凉清解,若不察病势,一闻温病即妄投寒凉之剂,冰遏温邪外透之机,从而使邪热难以透达。寓辛温疏散之品于寒凉清解之剂,不仅内蕴之邪热有外出之机,又能助正达邪。温病治疗经常配伍温热之品,尤湿热类温病治疗中大量温热药(方)的运用,从而更好的祛除病邪。《温病条辨》言：“温病最忌辛温,暑病不忌者,以暑必兼湿,湿为阴邪,非温不解,故此方香薷、厚朴用辛温,而余则佐以辛凉,下文湿温论中,不惟不忌辛温,且用辛热也。”“湿为阴邪,非温不解”更是后世医家治湿的准绳。文中简要论述了中药四性尤温热药性的理论沿革及温热药性的现代药理研究；梳理了自《黄帝内经》以来温病治疗温热药物(方)运用的文献理论；将收集到的温病治疗医案分为解表类、清热类、祛湿类、和解类、攻下类、温补类、开窍类等类进行频次统计、聚类分析等统计；阐述了温热药物的透散表邪、开郁散结、行气化湿、开窍醒神、通下破瘀、回阳救逆的功效在温病治疗的具体运用,总结其应用规律。就在温病治疗中什么情况下可用温热药(方),温热药(方)的作用,运用温热药(方)时的注意事项等方面进行探讨和总结。文献研究作为本课题的研究方法,检索1989--2010年CNKI--中国学术期刊库、万方数据库、校图书馆等有关温病治疗温热药(方)运用的的临床文献医案,建立Access数据库,将收集的医病案,按方剂来源,治法、药物组成、所含温热药物等录入数据库,获得医案方剂2718首(含解表类、祛湿类、和解类等)。采用频次统计、聚类分析、黄金分割法等统计方法,将通过频次统计得出各药物频率进行排序,用黄金分割法按累积频率由高到低选出常用药物；运用SPSS聚类分析将医案方剂中的药物予以聚类找出之间的差别,借以来探讨温热药(方)配伍及运用规律。综合分析,所收温病治疗运用温热药(方)的医案中,最常见配伍为寒凉药物为主,酌加温热药物。其运用规律可概括为：一、辛凉复辛温法之于温病初期：温邪犯卫,表郁较重,用辛温以疏散表邪；暑湿兼寒,肌表郁闭,非用温药表邪不解；温燥为病,辛凉宣透与生津润燥并施；伏温初发,而肾阳先亏,治当辛温解表药与温里助阳药相合。二、温散与清热之于温病中期：风寒外束,里热炽盛,宜用辛温散寒,兼清里热；湿热相合,三焦弥漫,用温热方药以芳香化湿；痰浊积滞瘀阻,气机郁滞,佐辛温以行气开泄；窍闭神昏,当投辛香开窍之品以开窍醒神。三、温阳益阴之于温病后期：阳气暴脱,急当大辛大温之剂以回阳救逆；热撤里虚,寒从中生,以温药而助阳；阳气耗伤,阴液损耗,当用温热方药以益气固脱,温阳护阴。温热之品运用于治疗温病时要注意：辨证论治；注意配伍,用量适宜；药宜精选,温宜适可。更多还原

【Abstract】 Epidemic febrile diseases with the main manifestation of fever accompanied by more warmness and easy to transform into dryness to impair yin refer to a type of acute exogenous febrile diseases caused by warm pathogen. "Treating warm syndromes with cool-natured herbs" and "treating heat syndromes with cold-natured herbs" should be considered as the therapeutic principles of epidemic febrile diseases according to their etiological characteristics mainly dominated by the exogenous warm pathogen, so herbs (formulas) are frequently cool and cold. The principal contradictions of epidemic febrile diseases are embodied in therapeutic methods, especially the cool and cold-natured herbs (formulas), and the treatment school of epidemic febrile diseases mainly with cool and cold-natured herbs is formed. Consequently, cool and cold-natured herbs are widely used to achieve purposes of clearing heat pathogen and generating fluid to protect yin. Exogenous warm pathogen cannot be necessarily treated by cool and cold-natured herbs without observing the patient’s condition. Cool and cold-natured herbs are immediately administrated as long as the disease pertains to epidemic febrile diseases, contributing to coldness obstructing the outward penetration of warm pathogen to make pathogenic heat difficult to disperse. However, adding some acrid warm-natured herbs in the cool and cold-natured herbs can not only make internal pathogenic heat go out, but also support healthy qi to eliminate pathogenic factors.In order to dispel pathogenic factors more effectively, large quantities of warm and hot-natured herbs (formulas) are usually combined in treating epidemic febrile diseases, particularly the dampness-heat category. It is said in Detailed Analysis of Epidemic Febrile Diseases that epidemic febrile diseases should avoid acrid and warm-natured herbs most. If the patient with summer-heat disease is not avoided, his summer heat has to be accompanied by dampness. Only warm-natured herbs can resolve in that the dampness belongs to yin pathogen. Hence, only acrid and warm-natured Xiangru and Houpu as well as acrid and cool-natured others are applied in this prescription. In the next context of epidemic damp-heat diseases, the acrid and warm-natured herbs are not avoided, and combined the acrid and hot-natured ones." Wu’s proposition that "only warm-natured herbs can resolve in that the dampness belongs to yin pathogen" becomes the criterion to treat the dampness for practitioners of later generations.This paper briefly discusses the four traditional Chinese medicine property, especially warm and warm herbal medicinal modern pharmacological research; combed from the " Yellow Emperor’s Canon of TCM" thermal treatment of warm diseases since the drug the use of literature theory; will be collected Medical treatment of warm disease cases were divided into relieving exterior, heat type, dampness type, settlement type, take classes, warming category, class and other classes resuscitation frequency statistics, cluster analysis; described the drug through the bulk thermal Table evil, Gloomy Sanjie, line wet gasification, resuscitation Stasis, pass under the Po Yu, Yang deficiency disease the efficacy of treatment in the temperature of the concrete used to summarize the application of drug laws and use of warm note.Literature as the subject of research methods, search 1989 - 2010 CNKI - Chinese Academic Journal Database, Wanfang Data, the school library and other related thermal treatment of warm disease drugs the use of medical records of clinical literature.By the establishment of access database and data entry of the collected medical records to the database according to formula sources, treatments, herbal compositions, herbs with warm and hot nature contained in the formulas and so forth,2718 medial formulas (including exterior-relieving type, dampness-eliminating type, harmonizing type and so on) were obtained. The statistical methods, including frequency statistics, cluster analysis and Fibonacci method, were adopted. The order was performed based on each herbal frequency achieved by frequency statistics; Fibonacci method was used to select commonly-encountered herbs from high to low according to the cumulative frequency; SPSS cluster analysis was applied to analyze the herbs in the formulas of medical records and cluster to find differences among them in order to explore the compatibility and application principles of herbs (formulas) with warm and hot nature.Comprehensive analysis, cases using warm prescriptions,compatibility is the most common cold drugs,The rules can be summarized as:1. The therapy with acrid cool-natured herbs and acrid warm-natured herbs is suitable for the initial stage of epidemic febrile diseases:the acrid warm-natured herbs are used for dispersing exterior pathogens in the case of serious exterior stagnation induced by the invasion of warm pathogen into defensive phase; Warm-natured herbs have to be employed to relieve exterior pathogens when summer-heat dampness combined with cold causes the closeness of the interstitial space; The combination of acrid cool-natured herbs with dispersing function and herbs with the function of generating fluid to moist dryness should be applied if the disease result from warm dryness.2. Warm-dispersing and heat-clearing therapy is applied in the middle stage of epidemic febrile diseases:acrid warm-natured herbs with functions of dispelling cold and clearing away internal heat are applicable to the syndrome of wind-cold obstructing the exterior and exuberance of internal heat; Herbs with warm and hot nature are used for eliminating dampness when dampness heat diffuses triple energizer; Acrid warm-natured herbs are assisted to promote qi and discharge the turbidity in the cases phlegm-turbid retention, blood stasis and qi stagnation; aromatic herbs are used to resuscitate and restore consciousness in the case of unconsciousness caused by orificial obstruction; 3.Yang-warming and yin-tonifying therapy is used in the advanced stage of epidemic febrile diseases:great acrid warm-natured herbs should be immediately applied to recuperate yang to rescue the life in the case of sudden depletion of yang qi; warm-natured herbs are used to aid yang in the cases of interior weakness and cold from the interior due to withdrawing of heat; herbs with warm and hot nature are applied to tonify qi to prevent collapse and warm yang to protect yin in the cases of yang qi impairment and yin fluid depletion.The application of herbs with warm and hot nature in treating epidemic febrile diseases should be noticed in the following points:treatment based on syndrome differentiation; noticing the compatibility and doses of medicines; selecting herbs cautiously to make sure that they have proper warm nature.更多还原