摘要
[目的]拓展“六经病欲解时”和“升降相因”理论在咳嗽病治疗中的临床应用。[方法]通过临床5则医案,阐明“六经病欲解时”与“升降相因”理论在咳嗽病中的运用思路与方法,并观察临床疗效。[结果]5则医案均具有反复出现的时间性特征,表现为一个或者数个时段症状突出,符合“欲解时”理论。六经传变有三阳传变、三阴递进的特点,太阴、少阴、厥阴及少阳四经在时辰上有重叠,需仔细鉴别。阴阳气消长变化导致脏腑气机升降失调是咳嗽的基本病机,例如少阳病欲解时案肝火冲逆犯肺,以小柴胡汤合从龙汤疏利少阳、降逆平肝;厥阴病欲解时案厥阴风动,以乌梅丸缓肝调中、敛肺止咳;太阳病欲解时案肺气郁闭,予麻黄汤开宣肺气;少阳、阳明欲解时案三焦气机失调,蕴为痰湿,以柴胡桂枝干姜汤加减通利三焦,药后腹泻数次,肺气得降;少阴、厥阴病欲解时案阴虚火旺,予连梅饮加减养阴清热、肃肺止咳。“六经病欲解时”与“升降相因”理论的基础是阴阳气之升降,结合两者治疗咳嗽病能明显提高临床疗效。[结论]洞悉六经病欲解时之象,调节阴阳气之升降于六经当旺之时,在辨治咳嗽中屡获良效。该理论为判断疾病的传变、拟定治则以及给药时间提供了理论依据,值得临床推广与应用。
[Objective]To expand the application of theories of“six meridians diseases to be cured”and“interdependence of Qi between ascending and descending”in the differentiation and treatment of cough.[Methods]Through summarizing five clinical medical cases,the ideas and methods of the theories of“six meridians diseases to be cured”and“interdependence of Qi between ascending and descending”used in differentiation and treatment of cough were illustrated and the clinical effects were observed.[Results]The five medical records all had the time feature of repetition and manifested as one or more typical symptoms in a certain time,which accorded with the theory of"time to be cured".The six meridians were characterized by transformation and development of three Yang meridians and progression of three Yin meridians.The four meridians of Taiyin,Shaoyin,Jueyin and Shaoyang are overlapped intime and should be carefully identified.It is the basic pathogenesis of cough that the fluctuation of Yin and Yang Qi leads to the ascending and descending disorder of viscera and Qi.For example,when Shaoyang disease was about to be cured,the liver fire impinged on the lung and Xiaochaihu decoction and Conglong decoction were used to purge the adverse flow of Qi,calm the liver and regulate Shaoyang meridian.When Jueyin disease was about to be cured,the patient was treated with Wumei pill to soothe the liver,regulate the stomach,astringe the lung to relieve cough.When the Taiyang disease was about to be cured,Mahuang decoction was used to relieve the stagnation of lung Qi activity.When Shaoyang and Yangming disease was about to cured,the basic pathogenesis was disorder of Qi activity of tri-Jiao and accumulation of phlegm dampness,Chaihu Guizhi Ganjiang decoction was used to regulate Qi activity of tri-Jiao,and after several times of diarrhea,the depressed lung Qi was descended.When Shaoyin and Jueyin disease was about to be cured,the pathogenesis was fire excess from Yin deficiency,Lianmei decoction was used to nourish Yin and clear heat,clear the lung and relieve cough.The theory of“six meridians diseases to be cured”and“interdependence of Qi between ascending and descending”is based on the ascending and descending of Qi of Yin and Yang,which can improve clinical curative effect remarkably.[Conclusion]It is worthy of clinical promotion and application to understand thoroughly the symptoms of the six meridians diseases to be cured,and regulating the ascending and descending of Yin and Yang Qi under the circumstances of six meridians,which has achieved good results in the treatment of cough and provided theoretical basis for the transformation and development of diseases,principle of treatment as well as time of medication administration.
作者
朱黎红
潘俊杰
ZHU Lihong;PAN Junjie(Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou(310007),China;Hangzhou Dingqiao Hospital)
出处
《浙江中医药大学学报》
CAS
2021年第1期46-50,共5页
Journal of Zhejiang Chinese Medical University
基金
浙江省自然科学基金青年基金项目(LQ20H290004)
浙江省中医药优秀青年人才基金项目(2020ZQ039)
浙江省中医药传承与创新“十千百”人才工程(杏林工程)省级中青年名中医项目(浙卫发[2017]65号)。
关键词
六经病欲解时
升降相因
咳嗽病
临床运用
病机
天人相应
医案
six meridians diseases to be cured
interdependence of Qi between ascending and descending
cough
clinical application
pathogenesis
correspondence between man and universe
medical cases
