登革熱中醫辨證論治之探討

A Study on the TCM-Based Diagnosis and Treatment of Dengue Fever

登革熱是全球嚴重傳染病之一，目前尚無特效療法。近代中醫對登革熱的治療歷史已超過30年，不少病例報告和文獻顯示，中醫介入治療可縮短病程，甚至預防惡化為重症。由於登革熱起病迅速、症狀多變，因此治則、治法及用藥處方呈現多樣性。中醫辨證能有效指導臨床用藥，然而證候具有動態特性，病情可能隨疾病進展而變化，因此治療方案需相應調整。本文通過文獻搜尋與整理分析，探討登革熱病名的起源與演變、中醫對登革熱的認識，以及病因病機和證候分析，同時參考不同醫家的經驗，列出登革熱常見的證型及其出血證的論治概要，以供臨床參考。
登革熱由疫癘毒邪自肌膚侵入，病邪性質以濕熱和暑燥為主，濕熱疫毒多先犯衛氣或膜原，而暑燥疫毒則易直入臟腑。登革熱來勢迅猛，病程階段性明顯，傳變規律與溫病的衛氣營血理論相符。治則以清熱解毒、涼血化瘀為核心，常用方藥如清瘟敗毒飲；另並輔以益氣養陰、調理臟腑的辨證施治，靈活應用中醫「既病防變」的特色與優勢。

Dengue fever remains a significant global health concern, lacking a definitive antiviral treatment. For over three decades, Traditional Chinese Medicine (TCM) has been employed in managing dengue cases. Quite a number of studies and clinical reports suggest that TCM interventions may alleviate symptoms, shorten disease duration, and potentially prevent progression to severe forms. The rapid onset and diverse symptomatology of dengue fever present challenges in standardizing treatment protocols. Consequently, TCM practitioners have developed various treatment strategies and prescriptions, leading to a spectrum of approaches within the field. Central to TCM's methodology is syndrome differentiation, which effectively guides clinical medication. However, the dynamic nature of dengue's clinical manifestations necessitates continuous assessment and adjustment of treatment plans as the disease progresses. This review delves into the historical evolution of dengue fever's nomenclature, TCM's theoretical perspectives on the disease, and analyses of its etiology and pathogenesis. By synthesizing insights from diverse TCM schools of thought, the paper outlines common syndrome types associated with dengue fever and provides a treatment framework, particularly addressing hemorrhagic manifestations. This comprehensive analysis aims to serve as a valuable reference for TCM practitioners in clinical settings.
From TCM perspective, dengue fever is caused by an epidemic toxin invading through the skin, with the pathogenic nature primarily characterized by damp-heat and summer-heat dryness. Damp-heat epidemic toxins often first affect the Wei-Qi or Mo-Yuan, while summer-heat dryness toxins tend to penetrate directly into the internal organs. The disease exhibits distinct stages, progresses rapidly, and follows the transmission patterns consistent with the Wei-Qi-Ying-Xue theory in Warm Disease. The treatment principles center on clearing heat, detoxifying, cooling the blood, and resolving stasis, with commonly used prescriptions such as Qingwen Baidu Decoction. Additionally, syndrome differentiation-based treatments are employed to tonify Qi, nourish Yin, and regulate organ functions, highlighting the unique advantage of TCM in preventing disease progression while managing existing conditions.