从《临证指南医案》探究叶天士从三焦论治暑湿经验OA

Summer-dampness mostly occurs in summer and falls under the category of damp-heat warm diseases,clinically characterized by intertwined dampness and heat as well as lingering disease course.Clinical Guide to Medical Records,written by Ye Tianshi,a physician of the Qing Dynasty,systematically records abundant clinical experience of diagnosing and treating summer-dampness with the triple energizer differentiation system.Taking this monograph as the core literature,this paper sys-tematically sorts out YE's theoretical system and clinical thinking for the differentiation and treatment of summer-dampness.Inheriting Liu Wansu's triple energizer theory,Ye clearly put forward the treatment principle that"Warm-heat disorders proposed by Liu Hejian must be differentiated from the perspective of triple energizer".He held that summer-heat is often ac-companied by damp pathogen;steaming of intertwined dampness and heat tends to diffuse throughout the triple energizer and block qi movement.Therefore,the fundamental therapeutic principle is to dredge and disinhibit triple energizer as well as sepa-rate and eliminate damp-heat.In specific diagnosis and treatment,YE advocated the triple energizer separation-elimination therapy:"unblock upper energizer stagnation,assist middle e nergizer transportation,and drain intestinal dampness".For the upper energizer,the therapies are lightly diffusing lung qi and resolving summer-heat with aromatic medicinals;for the mid-dle energizer,activating spleen to eliminate dampness and regulating pivot movement;for the lower energizer,percolating damp turbidity and expelling pathogenic factors outward.His academic thought can be summarized as"establish therapeutic methods based on Liu Hejian's triple energizer theory,distinguish the predominant pathogen between summer-heat and dampness,and further identify the depth of pathogenic invasion between qi and nutrient phases".Namely,locating lesions with triple energizer as the outline,judging disease nature according to the severity of dampness and heat,and assessing disease progression based on the superficial or deep invasion of nutrient and qi systems.Clinically,Ye emphasized identifying pathogenesis through syn-drome differentiation,focusing on distinguishing the preponderance of dampness or heat and lesion locations in triple energizer.He either prioritized unblocking upper energizer,smoothing middle energizer or percolating lower energizer,or combined the three therapies to separate,disperse and drain pathogens,meanwhile nourishing qi and yin,embodying a holistic view integrating eliminating pathogenic factors and strengthening healthy qi.By analyzing Ye's academic experience of treating summer-damp-ness via separate triple energizer therapies,this paper reveals his core therapeutic principle of"separating and eliminating damp-heat and guiding pathogens out according to their tendency",so as to provide theoretical reference for modern clinical diagnosis and treatment of summer-dampness and related damp-heat diseases.