王檀教授从火论治哮病一则

One case of Professor Wang Tan in the treatment of asthma disease from the “fire”

王檀教授认为,哮病具有迁延难治且反复发作的特点,在北方严寒之地其发病率更为突出。引起哮病发作的原因错综复杂,其病因无外乎外感及内因。提出"哮病主于火"及"五脏六腑皆令人哮"为哮病的病机关键。从脏腑相干理论出发提出哮病因火、热而哮,因痰而作。治疗时,当辨清五脏六腑的寒热虚实,调整脏腑功能,尤其脾胃的功能的健运。从火、热论治哮病,发则治其标,缓则治其本。本病例,由于患者久病,久病及肾,长期应用苦寒清肺之药物,过度耗散命门之火,温煦无力,脾阳升发无力,无力运化水湿则内停;同时外侵体表,体表营阴瘀滞;命门火衰,肺阳不足,无力宣发卫气,卫阳内郁,郁而化火,火性炎上,冲逆妄行;由于体表营卫瘀滞,火邪相对宣发无路,奔冲于上,搏击气道,发为哮病。结合症、舌、脉,初诊时以标证为主,即:营卫瘀滞,火邪内生,肺气奔迫之证候群为主,治疗上当以"急则治其标"为主;予身痛逐瘀汤加减,以解除其体表郁滞,使人体阳气宣散有路,则喘促、气短等症状,自然得到缓解;复诊后,标证得缓,本证渐显,以命门火衰,肾阳不足,肾不纳气之症候群为主;治疗上当"缓则治其本",金匮肾气丸加减,以善其后;整个治疗经过充分体现了吾师王檀教授从火论治哮病辨证思路,值得分享。

Professor Wang Tan believes that asthma has the characteristics of being difficult to cure and recurrent attacks, the incidence of the disease is more prominent in the northern cold regions. Etiology and pathogenesis of asthma are complex, which include exogenous or internal injury. He holds the point of view that “fre is to asthma” and “zang fu（ 脏腑 ）dysfunction starts the onset of asthma”, which are the keys to the etiology and pathogenesis of asthma. According to the theory of zang fu（ 脏腑 ）, professor WANG puts forward the idea that asthma is caused by the fire, heat and phlegm. At the time of treatment, the cold, hot, deficiency or strong of zang fu（ 脏腑 ） should be distinguished and adjusted their function, especially for the function of the spleen and stomach. In short, professor Wang’s view of the treatment of asthma is from the fre and heat, when diseases attack we need make choice depending on the target symptoms, when the disease eases, we take the etiological treatment. In this case, a long illness, defciency of kidney, a long-term application of bitter cold and clearing lung medicine lead to excessive dissipation of fre, mild weakness, weakness of Spleen Yang and inability to transport the water and moisture; at the same time, due to external invasion of body surface, Wei Yang internal stagnation, fre defciency of lung Yang, weakness of lung Yang, the fre will go up and go backward. Because of the body surface, Ying, Wei, stasis and stagnation, the fre pathogen will have no way of dispersing and rushing upward. Combined with symptoms, tongue and pulse, the frst diagnosis was based on the standard syndrome, that is Stagnation and stagnation of camp and guard, the internal heat of the fre, the syndrome group of lung qi, and the treatment followed the “urgent rule”. After the return of the diagnosis, the standard syndrome was slow, the syndrome gradually manifested itself with the fre failure of the life gate, the defciency of the kidney yang, the syndrome of kidney qi, and the treatment followed “the slow rule”, Modifed Jingui Shenqi Pill （金匮肾气丸 ）was given and the whole treatment was fully refected in the dialectic thought of Professor Wang Tan from the fre theory of asthma, which was worth sharing.