基于膏方医案探析秦伯未从脾胃论治肺病思想  

QIN Bowei’s Thoughts on Treating Lung Diseases from Spleen and Stomach Based on Medical Cases of Herbal Extracts

作　　者：黄廷轩 吕思缘 张悦 李雁[3] 刘通 于会勇 王成祥 HUANG Tingxuan;LYU Siyuan;ZHANG Yue;LI Yan;LIU Tong;YU Huiyong;WANG Chengxiang(Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China;Beijing Hospital of Integrated Chinese and Western Medicine,Beijing 100039,China;Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学第三附属医院,北京100029 [2]北京中西医结合医院,北京100039 [3]北京中医药大学东直门医院,北京100700

出　　处：《山东中医药大学学报》2024年第4期416-421,共6页Journal of Shandong University of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(编号:2018YFC1704100、2018YFC1704101);北京中医药薪火传承“3+3”工程项目(编号:2020-SZ-A-47);北京中医药文化资源调查项目(编号:WHZX-2020-94)。

摘　　要：秦伯未先生遵《灵枢·本脏》“脾坚则脏安难伤”之旨,重视肺与脾胃在生理、病理上的相互关联,善于从调理脾胃的角度治疗肺系疾病。秦老在膏方的运用上颇具心得,反对膏方一味蛮补,认为膏方包含救偏却病之义,应做到补正必兼泻邪,邪去补自得力。秦老临证善用膏方治疗肺系疾病,并将中药膏方与从脾胃论治肺病的思想相结合。在膏方医案中,秦老依病机不同而有针对性地运用滋胃阴、温脾阳、补中气、益消导、助统血、降胃气等法治疗肺系诸病,同时寓泻于补、攻补兼施,并非单纯以补益脾胃之法治疗肺病。对于肺痨、痰饮、体虚外感、外感热病瘥后、咯血、咳嗽等常见肺系疾病,秦老蕴从脾胃论治肺病思想于膏方之中,对疾病预防、发展及瘥后全过程进行综合干预,取得良好疗效。QIN Bowei adhered to the principle of“a strong spleen ensures the organs are safe from harm”from the Spiritual Pioot·Origin of Viscera.He emphasized the physiological and pathological interrelation between the lungs and the spleen-stomach,skillfully treating lung-related diseases by focusing on regulating the spleen-stomach.He had unique expertise in the application of herbal ointments,opposing the indiscriminate reinforcement approach and instead advocating for the dual purpose of herbal ointments,which included expelling pathogenic factors.He believed that it was easier to reinforce after eliminating pathogenic factors.In clinical practice,he integrated the use of herbal ointments with the concept of treating lung diseases from the perspective of the spleen and stomach.In his herbal ointment medical cases,he tailored treatments for various lung diseases based on different pathogenic mechanisms,employing methods such as nourishing stomach yin,warming spleen yang,reinforcing central qi,promoting digestion and elimination,assisting in governing the blood,and descending stomach qi.He simultaneously incorporated purging into tonifying,combining tonification and purging rather than solely relying on tonification to benefit the spleen and stomach in treating lung diseases.For common lung-related ailments such as pulmonary tuberculosis,phlegm dampness,susceptibility to colds,post-cold recovery,hemoptysis,and cough,he infused the concept of treating lung diseases from the perspective of the spleen and stomach into his herbal ointment formulations.He comprehensively intervened in the entire process of disease prevention,progression,and recovery,achieving favorable therapeutic outcomes.

关 键 词：秦伯未 膏方 医案 肺系疾病 脾胃学说 

分 类 号：R256.1[医药卫生—中医内科学]