《金匮要略》麦门冬汤治咳之辨

Cough Treatment Based on Syndrome Differentiation of Maimendong Decoction in Synopsis Golden Chamber

麦门冬汤出自张仲景《伤寒杂病论》,仲景原将其载于咳嗽上气篇目中,然历代医家多认为本方用于治疗虚热肺痿,并在实践中证实确有疗效,故沈目南定本方为治疗虚热肺痿之主方,沿用至今。笔者于临床跟师随诊,导师王苹教授临证善用麦门冬汤治疗咳嗽,无论卒病、痼疾,外感、内伤,只要辨证准确,随症加减,效如桴鼓。笔者认为无论肺痿、咳嗽上气之病,只要善辨其脉证,皆可引而用之;尤为咳嗽一证,若能探其机括,审慎辨析,疗效立竿见影。咳嗽一证,病机复杂,常致迁延,缠绵难愈,为病者所苦。咳嗽的病名、成因、证候等首见于《内经》,仲景勤求古训,阐发经旨,将《内经》理论应用于临床实践,创立了咳嗽辨证论治思想。麦门冬汤组方精炼,方中仅半夏一味具有化痰止咳之功,其治疗咳嗽机理何在?笔者将其归纳为:基本病机为肺胃阴虚;病变脏腑在肺、脾、胃;用药刚柔并济,辛开苦降,调补中焦。

Maimendong decoction originates from the Treatise on Cold Damage and Miscellaneous Disease of Zhang Zhongjing,which fisrt recorded in Cough and lnspiratory Dyspnea article. However, past generations doctors believed that it can be used in yin-deficiency Pulmonary Asthenia and confirmed that has curative effect for the treatment in clinical practice. Therefore, Shen mu nan set the Maimendong decoction as the first formula curing the yin-deficiency Pulmonary Asthenia, continued to use it up today. The author learns from professor Wang ping in clinic, Dr.Wang is skilled in using Maimendong decoction curing cough in clinic. Regardless of chronic or acute disease, external causes or internal causes,as long as the accurate syndrome differentiation and addition and subtraction with the disease, the significant effect will arise, l privately consider that whether Cough and Inspiratory Dysp- nea or Pulmonary Asthenia,so long as good at differentiating on pulse syndrome, it can be cited and used; particularly in cough syndrome. The cough syndrome, widely suffering, even prolonged, hard to be recovered, becomes a misery of patient. The name, pathogenic factors, syndromes of cough were first seen in the Huangdi＇s Canon of Medicine. Zhong Jing elucidated and developed classic theory, and used it in clinical practice, founded the cough syndrome differentiation and treatment theory. Maimendong decoction has a refined formula, only one herb Rhizoma Pinelliae can expel phlegm and relieve a cough, what the mechanism of treatment the cough is ？ The author summarized as： the basic pathogenesis is fin-deficiency of lung and stomach,the le- sions viscera are in lung, spleen and stomach, medication treatment is coupling hardness with softness,pungen-exiting and bitter-descending,tonifying middle-jiao.