周平安教授辨治呼吸系统疾病临证验案举隅

Professor ZHOU Ping’an’s clinical successful cases of respiratory diseases based on TCM differentiation and treatment

周平安教授,北京中医药大学教授、主任医师,第四批全国老中医专家学术经验继承工作指导老师,第三届首都国医名师。周教授是我国著名的呼吸病学、传染病学专家,多年临证实践中,坚持辨证与辨病相结合诊治疾病,同时用药结合中药药理学知识,治疗上主张“和法”思想,对呼吸系统疾病、消化系统疾病及疑难病积累了丰富的临证经验。文章介绍周老辨治呼吸系统疾病的思辨过程,主要选取4个呼吸系统常见医案,医案中有四诊详细分析及周老独特的用药经验,每则医案后都有周老用药按语。周老认为生理上肺为娇脏,清虚而居高位,主气司呼吸,开窍于鼻,外合皮毛,与卫气相通,主一身之表,临证以咳嗽、发热、喘息等肺系病证多见,肺之气机升降失常为肺病总的病机纲领,因此,临床选方用药应顺乎肺的生理特性,以通调肺气为核心,以恢复肺之宣降为基本原则,用药当遵吴瑭《温病条辨》所述的“治上焦如羽,非轻不举”,用药宜轻灵,药味宜辛苦,药性宜平,对于外感急性发热、咳喘,治宜以祛邪为主;慢性咳喘,首辨外感内伤及虚实,在此基础上祛除痰饮、瘀血等内生病邪,注重调补中焦脾胃,培土生金,并对临床医案进行思辨分析,希望对后学者中医临床有所帮助。

Professor ZHOU Ping’an,is a professor and chief physician from Beijing University of Traditional Chinese Medicine,one of the fourth groups of National Senior Chinese Medicine Experts,one of the Third National Famous Doctors in the Capital.Professor ZHOU is also a famous expert on respiratory and infectious disease in China.During many years of clinical practice,he insists on the combination of diagnosis and treatment of diseases and disease differentiation,combined medication with traditional Chinese medicine pharmacology.Professor ZHOU advocates the idea of“harmony”and has accumulated rich clinical experience in the treatment of respiratory diseases,digestive diseases and difficult diseases.This paper introduces the dialectical process of Professor ZHOU’s treatment of respiratory diseases.Four common medical cases of respiratory system are selected,in which detailed analysis of four diagnoses and his unique medication experience are included.Each medical case is followed by Professor ZHOU’s medication instructions.Professor ZHOU believes that the lung is delicate physically,and that it is clear and empty,so it is in a high position.The lung is responsible for breathing,it is opening in the nose,combining skin and hair,and it is connected with defensive Qi(气),and it is the main manifestation of the whole body.Cough,fever,wheezing and other lung diseases and syndromes are common in clinical symptoms.The abnormal rise and fall of lung Qi is the general pathogenesis of lung diseases.Therefore,the clinical prescription should be selected according to the physiological characteristics of the lung,with regulating lung Qi as the core,and the basic principle of restoring the ascending and descending of the lung Qi.The drug should be used according to WU Tang’s medication rule of treating febrile diseases in Wenbing Tiaobian(《温病条辨》),which complies with the characteristic of lung,“it is as light as a feather”.The drug should be light and flexible,the drug taste should be pungent and bitter,and the drug property should be moderate.For exogenous acute fever,cough and asthma,treatment should give priority to dispelling pathogenic factors;With chronic cough and asthma,priority is to distinguish external and internal injuries as well as deficiency and excess.On this basis,it can eliminate internal diseases such as phlegm and blood stasis,while paying attention to regulating and tonifying the spleen and stomach in the middle energizer,and cultivating the earth to generate gold.Through the analysis of clinical medical cases,it is hoped that it will be helpful to the clinical thinking of later scholars in TCM.