葉天士溫病學術思想之研究

A REVIEW OF YE TIAN-SHI’S THOUHGTS ON WARM DISEASES

溫病學的內容，可分為風溫、春溫、暑溫、濕溫、秋燥等五種，衛氣營血是溫病傳變的四個證型，但也有在衛分即逆傳心包為腦中樞感染者。溫病的治療原則，清朝葉天士曾提出其有名的治病思想「衛之後方言氣，營之後方言血。在衛汗之可也，到氣才可清氣，入營猶可透熱轉氣，入血就恐耗血動血，直須涼血散血」。溫病的病程發展，可分上焦、中焦和下焦溫病，代表溫病疾病發展初期、中期和末期的表現。上焦溫病與上呼吸道感染有關，中焦溫病與腸胃道疾病有關，而下焦溫病以肝腎陰虛的體質為特點，與心臟功能受損和神經內分泌生理反饋失調有關。The contents of warm diseases school contain wind-warmth, spring-warmth, summerheat-warmth, damp-warmth and autumn-dryness. Defense, qi, construction and blood are the four-aspects pattern of warm diseases shifted from one to another. The pericardiac pattern is a cerebral nervous system infection resulted in warm-heat evils arriving directly from the defense aspect. The principles of treatment for warm diseases, a famous outline of thought is described by Ye Tian-shi in Qing Dynasty. Ye’s states: The general conception 【 of the theory of warm diseases】 is that qi is subjacent to defense and that blood is subjacent to construction. When disease affects defense, diaphoretic treatment may be given. Only when it reaches the qi aspect can qi-clearing treatment be prescribed. When it enters construction, treatment involves out-thrust of heat to the qi aspect. Finally, when it reaches blood and causes depletion and frenetic movement, blood cooling and dissipation is prescribed. These lines represent the general outline of the four-aspects pattern identification and treatment system of the theory of warm diseases. The course development of warm diseases may be divided into upper, middle and lower burner of warm diseases. The upper burner of warm disease represents the early stage of externally contracted warm-heat disease in relation with upper respiratory tract infection. The middle burner of warm disease represents the middle stage of externally contracted warm-heat disease in relation with gastro-intestinal tract infection. The lower burner of warm disease represents the last stage of externally contracted warm-heat disease, characterized by liver and kidney yin vacuity in constitution, in relation with heart function and loss derangement of neuro-endocrine regulatory mechanism in hemeostasis.