基于《伤寒论》“郁热–瘀热”一体观探析急性黄疸型肝炎的分期辨治思路

Analyzing the Staging and Treatment Ideas of Acute Jaundice Hepatitis Based on the Integral View of “Depression-Heat and Stasis-Heat” in The Treatise on Typhoid Fever

摘要: 基于《伤寒论》原文“瘀热在里，身必发黄”，结合急性黄疸型肝炎临床分期症候表现，得出“郁热–瘀热”一体观理论，认为“郁热”与“瘀热”乃急性黄疸型肝炎黄疸前期与黄疸期之主要矛盾，二者一体观在此病的发生发展中至关重要；基于“郁热–瘀热”一体观理论得出本病三期病机：黄疸前期为湿热郁闭兼表证未解，黄疸期为郁热更进，延及血分，瘀热内结，恢复期则为脏腑失调为主，或兼有余邪留滞；基于“郁热–瘀热”一体观理论指导本病的分期治疗，强调因机施治，给邪气以出路：黄疸前期外散其黄，黄疸期通利二便，恢复期随证施治。三期以该理论为指导，谨守病机，辨证施治，从而治愈本病。

Abstract: Based on the original text of The Treatise on Typhoid Fever, “When stagnant heat is inside the body, the body will be yellow”, combined with the clinical staging of acute jaundice hepatitis, we have come up with the theory of “stagnant heat and stagnant heat”, and believe that “stagnant heat” and ‘stagnant heat’ are the main conflicts of acute jaundice hepatitis. Combining with the clinical staging of acute jaundice hepatitis, the theory of “depressed heat and stagnant heat” is derived, and it is believed that “depressed heat” and “stagnant heat” are the main contradictions of acute jaundice hepatitis, and the concept of integration of the two runs through the whole disease; based on the theory of “depressed heat and stagnant heat”, the three-phase mechanism of this disease is derived: In the pre-jaundice stage, dampness-heat is blocked and the surface evidence is not resolved; in the jaundice stage, the heat is more advanced, extends to the blood, and the stasis-heat is internalized; in the recovery stage, the disorder of internal organs is the main cause of the disease, or there is a stagnation of residual evils at the same time; based on the theory of the integral view of “stagnant-heat-stasis-heat”, the staged treatment of the disease emphasizes the application of treatments according to the mechanism to give an outlet to the evils: Jaundice in the first stage of jaundice, the yellow is dispersed externally; in the jaundice stage, the bowels are opened up; and in the recovery stage, the disease is treated according to the evidence. The three phases of the disease are guided by this theory, and the disease is cured by observing the mechanism of the disease and applying treatments according to the evidence.