《伤寒论》与急危重症——基于CCU重症病例及中西医结合诠释经典条文内涵、经方剂量与六经实质
投稿时间:2018-05-03  修订日期:2018-05-08  责任编辑:  点此下载全文
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熊兴江* Xiong Xingjiang 中国中医科学院 广安门医院 Guang′anmen Hospital,China Academy of Chinese Medical Sciences 5administration@163.com 
中文摘要:《伤寒论》是中医学的经典著作。针对《伤寒论》条文内涵不清,剂量存在争议,六经实质混乱及“中医是慢郎中,不能救急”的临床难题,在医院心血管重症监护病房工作中,提倡从急危重症及中西医结合角度诠释经典,深化条文内涵、澄清经方剂量,还原六经实质,提高中医药治疗急危重症疗效。认为:(1)基于病机推演及文字考证解读条文内涵,虽能传承经典,但终因其在中医学概念术语中反复推导、循环论证及诊断预后不清晰而很难满足当前临床需求,很难在《伤寒论》的学术传承上产生重大突破;(2)“伤寒”为狭义伤寒,其本质可能为急性热性传染性疾病;(3)《伤寒论》是一部治疗急危重症的专著,急危重症的临床表现就是《伤寒论》条文的经典再现,“古方今病,必相能也”;(4)《伤寒论》与《金匮要略》不以外感与内伤划分,而以是否为传染性疾病为划分标准;(5)《伤寒论》中用药以大剂量为主,“四两只能拨四两”,“千斤才能拨千斤”;(6)《伤寒论》六经实质是重症感染,是人体对重症感染后不同阶段的描述,包括重症感染炎性反应为主的三阳阶段,以及重症感染后的脏器功能衰竭为主的三阴阶段;六经是看出来的,而不是辨出来的;历代伤寒与温病学派之争在本质上统一的;(7)基于急危重症及中西医结合角度破译经典条文内涵是研究《伤寒论》最直接、最根本方法;(8)《伤寒论》现代研究及现今中医临床强烈呼唤基于中西医结合概念的“病机结合病理,药性结合药理”治疗理念;(9)《伤寒论》及经方传承亟需强化急危重症和中西医结合能力的训练与培养。
中文关键词:伤寒论  经方  六经  急危重症  中西医结合
 
Treatise on Febrile Diseases and critical care medicine: exploring the connotation of the original, dosage, and the essence of the six meridians from the perspective of critical care medicine and integrative medicine
Abstract:Treatise on Febrile Diseases is one of the greatest classics in traditional Chinese medicine. Currently, so many key scientific problems including unclear connotation of the original, dosage of Chinese herbal medicine, and the essence of the six meridians were identified. On the basis of years of clinical experience in critical care medicine, it was advocated that the connotation of Treatise on Febrile Diseases should be explored from the perspective of critical care medicine and integrative medicine. It was identified that, the traditional study from the perspective of pathogenesis and textual research couldn’t meet the current clinical needs due to its repeated deduction and circular argument in conceptual terms and unclear diagnosis and prognosis of modern diseases. The?concept?of exogenous febrile disease is the?narrow?sense, the essence of which may be acute febrile infectious diseases. Treatise on Febrile Diseases is a monographs for critical care medicine. The clinical manifestation of so many critical care medicine can be identified in Treatise on Febrile Diseases. The distinction standard of Treatise on Febrile Diseases and Synopsis of Golden Chamber is not external injury but contagious disease. The dosage problem in Treatise on Febrile Diseases mainly refers to large dose. The essence of six meridians in Treatise on Febrile Diseases is severe infection. Six meridians are different stages of severe infection, including the inflammation-based three Yang stages and deficiency-based three Yin stages. Additionally, the six meridians could be recognized by look, while not speculation. The struggle between cold and warm schools could be unified based on our research. The most direct and fundamental methods in studying Treatise on Febrile Diseases lies in critical care medicine and integrative medicine. The modern research of Treatise on Febrile Diseases is intensely calling for new treatment principle based on pathogenesis combined with pathology and property combined with pharmacology. Therefore, cultivation of ability in critical care medicine and integrative medicine should be emphasized in future studies.
keywords:Treatise on Febrile Diseases  Chinese classical formulas  six meridians  critical care medicine  integrative medicine
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