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1、山西中醫(yī)2010年3月第26卷第3期SHANXIJOFTCMMar12010Vol126No13·1··學(xué)術(shù)探討·葉天士《臨證指南醫(yī)案》辨治咳嗽經(jīng)驗(yàn)探析張建華摘要:葉天士《臨證指南醫(yī)案·咳嗽》中匯集了有關(guān)診治咳嗽的醫(yī)案142例,歸納為風(fēng)寒襲肺、風(fēng)熱犯肺、肺燥津傷、肝火灼肺、脾虛肺弱和肺腎虛衰6型。通過分析,可以看出葉天士治療咳嗽,并非見咳治咳,而是善于掌握病因病機(jī)。邪在表者予輕劑宣解,邪在里者或不治肺而治脾腎,注重顧護(hù)胃氣和津液。充分體現(xiàn)了葉天士辨治咳嗽精深的學(xué)術(shù)見解與博通豐富的臨證經(jīng)驗(yàn)。關(guān)鍵詞:葉天士;臨
2、證指南醫(yī)案;咳嗽;治法中圖分類號(hào):R24912R256111文獻(xiàn)標(biāo)識(shí)碼:A文章編號(hào):1000-7156(2010)03-0001-03AnalysisonCharacteristicsofYETian2shiTreatingCoughinClinicalGuidetoMedicalRe2cardsZHANGJian2hua(DaliCountyHospitalinShanxi,Dali,715100,China)Abstract:ClinicalGuidetoMedicalRecordsisacollect
3、ionofYETian2shipssucceedingcasesandprescriptionsonvariousdiseasesofinternalmedicine,gynecologicalandpediatricdiseases.Itcontainedatotalof142casesre2latedtodiagnosisandtreatmentofcough,whichwereroughlydividedintosixtypes,wind2coldpulmonarystheni2a,wind2heat
4、pulmonarysthenia,consumptionofbodyfluidduetolung2dryness,liverheatinvadinglung,hypo2functionofspleenleadingtoweaknessoflung,anddeficiencyoflungandkidney.Bytheprescriptionsineverycase,wecanseethatYETian2shididnotliketokillthesymptomofcough,butgraspedthecaus
5、eandpathogene2sisofcoughtokillcoughwhilehetreatedit.Whenevilwasintheexterior,hewouldselecttheprescriptionforexpellingwind2eviltoopentheinhibitedlung2energy.Butwhenevilwasintheinterior,hewouldnottreatlungbuttreatspleenandkidney,focusingonprotectinggastricqi
6、andbodyfluid.AllthosefullyreflectYETian2shi'streatmentcharacteristics,meticulousdifferentiationofsymptomsandsignsandgoodatseizingtheprincipalsyn2drome.Keywords:YETian2shi,ClinicalGuidetoMedicalRecords,cough,treatingmethod清代著名醫(yī)家葉天士《臨證指南醫(yī)案·咳112風(fēng)寒郁肺,清竅失和:本證計(jì)5
7、案。風(fēng)為陽[1]嗽》中共收載142例醫(yī)案,其中有關(guān)咳嗽病因病邪,善行數(shù)變,寒為陰邪,凝滯郁閉,兩者交困,易使機(jī)、治療法則及遣方用藥的論述,多有創(chuàng)見,現(xiàn)歸清竅失和。證見頭痛,鼻塞流涕,咳嗽聲重,四肢酸納分析如下。痛,舌苔薄白,脈浮等。葉氏遇此等證,常用“辛以1風(fēng)寒襲肺散邪,佐微苦以降氣”,方取杏蘇散出入,藥用蘇111衛(wèi)陽受傷,阻遏氣機(jī):本證計(jì)有8案。均系風(fēng)葉、杏仁、前胡、桔梗、陳皮、牛蒡子、薄荷、甘草等,寒所致。其證多見咳嗽,纏綿不已,形寒,頭痛,舌或加半夏、貝母以祛痰,枳殼以理氣,加茯苓、通草苔白,脈浮緩或
8、沉細(xì),用桂枝湯調(diào)和營衛(wèi),或加杏以滲濕,總以疏風(fēng)散寒,化痰宣肺為治。仁苦以降肺,茯苓、薏苡仁淡以除飲,半夏燥以祛113寒郁肺衛(wèi),郁久化熱:本證計(jì)4案。風(fēng)寒外痰;如陽虛較甚,則去芍藥之酸寒,生姜之辛散;痰束,伏熱內(nèi)蘊(yùn),出現(xiàn)惡寒發(fā)熱,或身熱出汗,咳嗽不濕較盛,則去大棗之甘膩;若因衛(wèi)陽受損,遇風(fēng)則已,音聲漸窒,氣急而喘,脈右寸獨(dú)堅(jiān)。當(dāng)散寒清咳者,則加黃芪、防風(fēng)、白術(shù)(玉屏風(fēng)散)以護(hù)陽,佐熱,用麻杏石甘湯主治,或加入半夏祛
