《医学正旨择要》咳嗽证治规律浅析

Principles of Syndrome Differentiation and Treatment of Cough in Essentials of Gist of Medicine

目的:探讨《医学正旨择要》中咳嗽的证治规律。方法:将《医学正旨择要》中所论述的咳嗽证治等内容逐句分解为586条,依据其各自所论的病因、病机、病位、诊断、治疗等不同,以八纲、脏腑等为据,逐条进行归类分析。结果:经计数统计,《医学正旨择要》论及咳嗽病因病性,属于热者有59条,属于寒者有59条,属于虚者48条,属于实者10条,因于水湿痰饮者共有119条(水25条,湿36条,痰45条,饮13条),因于燥者14条,病位在肺者共140条,在脾者35条,在肾者34条,在肝者13条,在胃者8条;论及治疗该病的方剂113首,其中只出现过一次的方剂有70首,出现过两次的方剂有25首,平均出现频次1.8次,出现次数最多的方剂是小青龙汤(11次)和小柴胡汤(11次),出现频次较多的方剂还有二陈汤(9次)、真武汤(6次)。结论:《医学正旨择要》认为咳嗽主要分为风寒外袭、风热侵袭、痰湿困阻、燥邪侵袭、肺脾气虚、肺肾阴虚六种证型。诊治咳嗽,在病位上除肺脏外,强调脾肾两脏的重要性;在病因上,强调咳嗽与痰湿关系最为密切。

Objective： To investigate the principles of syndrome differentiation and treatment of cough in Essentials of Gist of Medicine.Methods： Contents about syndrome differentiation and treatment of cough in Essentials of Gist of Medicine were decomposed sentence by sentence into 586 items,which were classified and analyzed one by one according to the etiology,pathogenesis,diagnosis and treatment on the basis of eight principles and viscera and so on.Results： According to the counting statistics,causes and nature of cough are discussed in Essentials of Gist of Medicine,59 items belong to the nature of hot,59 to the cold,48 to the deficiency,10 to the excess,a total of 119 to the water-dampness and phlegm-retention,（25 to water,36 to wet,45 to phlegm,13 to retention）,14 to the dryness;140 items are about disease location in the lung,35 in the spleen,34 in the kidney and 13 in liver and 8 in the stomach;and 113 prescriptions are mentioned for the treatment of cough,among which 70 prescriptions only appear once,25 appear twice,the average frequency of occurrence is 1.8 times,Xiaoqinglong Decoction and Xiaochaihu Decotion have the largest number of occurrence（11 times）,there are also two frequently-occurred prescriptions： Erchen Decoction（9 times）,Zhenwu Decoction（6 times）.Conclusion： Essentials of Gist of Medicine believes that the cough is mainly divided into 6 types of syndromes： exopathogenic wind and cold,wind-heat invasion,resistant phlegm and dampness,invasion of dryness,qi deficiency of the lung and spleen,yin deficiency of the lung and kidney.In the diagnosis and treatment of cough,the importance of the spleen and kidney should be emphasized except the lung;the close relationship between cough and dampness and phlegm should be emphasized in the causes of cough.