王孟英辨治咳嗽特色阐微  

WANG Mengying′s Unique Approaches to Cough Treatment

作　　者：王淞[1] 赵晓旻 宫胜贤 张树剑[2] WANG Song;ZHAO Xiaomin;GONG Shengxian;ZHANG Shujian(Shandong College of Traditional Chinese Medicine,Yantai,Shandong,China,264199;Institute of Acupuncture and Moxibustion of Chinese Academy of Traditional Chinese Medicine,Beijing,China,100700)

机构地区：[1]山东中医药高等专科学校,山东烟台264199 [2]中国中医科学院针灸研究所,北京100700

出　　处：《河南中医》2024年第11期1683-1687,共5页Henan Traditional Chinese Medicine

基　　金：2023年山东省中医药科技发展计划项目(M-2023278);2023年山东省卫生健康委员会中医药重点学科建设项目{鲁卫中医药科教字[2022]4号}。

摘　　要：清代医家王孟英认为咳嗽的病因有外感、内伤、药误三个方面,亦有外感兼内伤者,如痰火内伏兼湿热外侵、冬温挟痰阻肺,治节不伸、阴虚兼有伏痰等,阴亏、痰阻、郁热是主要病理因素,肺失宣肃,枢机不利,上逆而咳。王孟英诊察疾病重视观察胃气的盛衰、二便的通利、舌脉的变化,治疗咳嗽用药排在前五位的药物是竹茹、冬瓜子、旋覆花、枇杷叶、天花粉,用药以甘寒清热、斡旋枢机为主,同时重视顾护肺阴,保护胃气,给邪气以出路。对于阴虚劳嗽则予以滋阴降气,加以镇摄,需要注意的是,有外邪者,当散邪为先。王孟英治疗咳嗽时,根据病因的不同,采用不同的疏瀹枢机、调其愆滞的方法,痰阻枢机者,治以开胸祛痰,常用竹茹、半夏、陈皮、冬瓜子、旋覆花、薏苡仁、瓜蒌、枳壳、枇杷叶、浙贝母、石菖蒲、黄连;邪热壅滞气机者,治以清热疏利,兼以养阴,常用芦根、石膏、知母、滑石、天花粉、麦冬、黄芩、西洋参、石斛、沙参等药。王孟英常分段论治咳嗽,根据患者症状、病机的变化采用不同的治疗方法,还重视因人制宜,强调体质因素对发病的影响,重视食治,反对滥用温补。Wang Mengying,a physician of the Qing Dynasty,identified three main causes of cough:external pathogens,internal injuries,and medication errors.He also recognized cases where external and internal factors coexist,such as latent phlegm-fire combined with external dampness-heat invasion,or winter warmth with phlegm obstructing the lung,difficulty in joint flexion and extension,yin deficiency accompanied by latent phlegm,etc.The primary pathological factors include yin deficiency,phlegm obstruction,and stagnant heat,leading to impaired lung function and cough.In his diagnosis,Wang emphasized observing the state of the stomach qi,the regularity of urination and bowel movements,and changes in the tongue and pulse.The top five Chinese medicinals used for cough treatment include Zhuru(Caulis Bambusae in Taenia),Dongguazi(Semen Benincasae),Xuanfuhua(Flos Inulae),Pipaye(Folium Eriobotryae),and Tianhuafen(Radix Trichosanthis),focusing on sweet,cold,and clearing properties while also protecting lung yin and stomach qi,allowing the expulsion of pathogenic factors.For cough due to yin deficiency,he advocated nourishing yin and descending qi,and calming the mind,noting that when external pathogens are present,dispersing them should be prioritized.His treatment methods varied according to the underlying causes,utilizing different strategies to clear obstructions and regulate qi.For phlegm obstruction,he often employed Zhuru(Caulis Bambusae in Taenia),Banxia(Rhizoma Pinelliae),Chenpi(Pericarpium Citri Reticulatae),Dongguazi(Semen Benincasae),Xuanfuhua(Flos Inulae),Yiyiren(Semen Coicis),Gualou(Fructus Trichosanthis),Zhiqiao(Fructus Aurantii),Pipaye(Folium Eriobotryae),Zhebeimu(Bulbus Fritillariae Thunbergii),Shichangpu(Rhizoma Acori Tatarinowii)and Huanglian(Rhizoma Coptidis)to open the chest and eliminate phlegm.For pathogenic heat obstructing the qi movement,he favored clearing heat and nourishing yin,so Lugen(Rhizoma Phragmitis),Shigao(Gypsum Fibrosum),Zhimu(Rhizoma Anemarrhenae),Huashi(Talcum),Tianhuafen(Radix Trichosanthis),M

关 键 词：咳嗽 外感 内伤 药误 王孟英 

分 类 号：R256.11[医药卫生—中医内科学]