张禾棻《五疫症治辨》学术思想探析OA

[Objective]To investigate the characteristics of traditional Chinese medicine(TCM)pestilence diseases diagnosis and treatment by ZHANG Hefen,a medical practitioner in Zhejiang during the late Qing and Republican periods,based on Discussion on the Treatment of Five Pestilences,in order to enrich the academic theory of TCM epidemiology.[Methods]Taking the five pestilence diseases recorded in ZHANG Hefen's Compilation of Emergency Treatments,specifically in Discussion on the Treatment of Five Pestilences as the main research object,the literature search method was used to collect medical texts related to the five pestilence diseases since Huangdi Neijing,trace their historical origins,and explore the characteristics of diagnosis and treatment by ZHANG Hefen.The content analysis method was employed to exame the etiology,pathogenesis,syndrome differentiation and treatment strategies of the five pestilence diseases,analyze the logic of their diagnosis and treatment by ZHANG Hefen,and summarize his academic thoughts and clinical experience in managing pestilence diseases.[Results]The theory of the five pestilence diseases first appeared in Huangdi Neijing.ZHANG Hefen inherited and adapted this theory,and proposed that the five pestilence diseases arose from the excessive and unbalanced vital energy generated by the excess of the five elements,and they manifested as different seasonal pestilences with varying degrees of severity according to the different annual cycles of Yunqi(five elements and six factors).Specifically,the wood pestilence was rooted in spring wind-warmth,carrying seasonal pestilential toxins;the earth pestilence is based on summer-autumn damp-heat,combined with turbid pathogenic Qi;the fire pestilence was caused by summer drought and latent pestilence;the metal pestilence involved autumn cool-dryness with seasonal pestilence;and the water pestilence resulted from sudden severe cold accompanied by pestilence pathogens.ZHANG Hefen advocated treating wood and earth pestilences according to classical methods from past physicians.The wood pestilence was often accompanied with wind-warm syndrome,and the upper-Jiao should be treated.The earth pestilence was frequently accompanied with damp-heat syndrome,and the opening and dispersing solution should be adopted.For the fierce fire pestilence,ZHANG Hefen recommended potent prescriptions to eliminate pathogens and restore consciousness simultaneously.For the metal pestilence,he emphasized that the lung and stomach should be cleared and harmonized initially by using YU Chang's Qingzao Jiufei Decoction,while the accompanied symptoms should be treated by balancing Yin of the lung and stomach.For the water pestilence with severe cold,he highlighted the integration of internal and external treatment methods.[Conclusion]Although the theory of the five pestilence diseases has been in existence since ancient times,it lacks systematic elaboration.ZHANG Hefen's Discussion on the Treatment of Five Pestilences provides a relatively systematic and comprehensive discussion on the symptoms,pathogenesis and treatment of the five pestilence diseases and deepens the theoretical system of TCM epidemiology,which offers ideas for later generations in managing pestilences and deserves further research.