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1、山西中医2010年3月第26卷第3期SHANXIJOFTCMMar12010Vol126No13·1··学术探讨·叶天士《临证指南医案》辨治咳嗽经验探析张建华摘要:叶天士《临证指南医案·咳嗽》中汇集了有关诊治咳嗽的医案142例,归纳为风寒袭肺、风热犯肺、肺燥津伤、肝火灼肺、脾虚肺弱和肺肾虚衰6型。通过分析,可以看出叶天士治疗咳嗽,并非见咳治咳,而是善于掌握病因病机。邪在表者予轻剂宣解,邪在里者或不治肺而治脾肾,注重顾护胃气和津液。充分体现了叶天士辨治咳嗽精深的学术见解与博通丰富的临证经验。关键词:叶天士;临
2、证指南医案;咳嗽;治法中图分类号:R24912R256111文献标识码:A文章编号: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清代著名医家叶天士《临证指南医案·咳112风寒郁肺,清窍失和:本证计5
7、案。风为阳[1]嗽》中共收载142例医案,其中有关咳嗽病因病邪,善行数变,寒为阴邪,凝滞郁闭,两者交困,易使机、治疗法则及遣方用药的论述,多有创见,现归清窍失和。证见头痛,鼻塞流涕,咳嗽声重,四肢酸纳分析如下。痛,舌苔薄白,脉浮等。叶氏遇此等证,常用“辛以1风寒袭肺散邪,佐微苦以降气”,方取杏苏散出入,药用苏111卫阳受伤,阻遏气机:本证计有8案。均系风叶、杏仁、前胡、桔梗、陈皮、牛蒡子、薄荷、甘草等,寒所致。其证多见咳嗽,缠绵不已,形寒,头痛,舌或加半夏、贝母以祛痰,枳壳以理气,加茯苓、通草苔白,脉浮缓或
8、沉细,用桂枝汤调和营卫,或加杏以渗湿,总以疏风散寒,化痰宣肺为治。仁苦以降肺,茯苓、薏苡仁淡以除饮,半夏燥以祛113寒郁肺卫,郁久化热:本证计4案。风寒外痰;如阳虚较甚,则去芍药之酸寒,生姜之辛散;痰束,伏热内蕴,出现恶寒发热,或身热出汗,咳嗽不湿较盛,则去大枣之甘腻;若因卫阳受损,遇风则已,音声渐窒,气急而喘,脉右寸独坚。当散寒清咳者,则加黄芪、防风、白术(玉屏风散)以护阳,佐热,用麻杏石甘汤主治,或加入半夏祛
