张之文“从气治痰”学术思想浅析

On Zhang Zhiwen′s Academic Thought of "Treating Phlegm from Qi"

气病可生痰饮,痰病亦可阻碍气机,两者互为因果。对外感或内伤所致的夹痰之疾,张之文教授皆主张"从气治痰"。治痰之法,运用补气、化气、宣气、理气、降气、行气等手段,以增强脏腑的运化功能,消痰之本,才是治痰之大法。张老在临床上诊治气虚不足兼痰证,每于化痰之中佐以补气之品,以增强痰液的消散和化解;肾阳不足,水饮内停证在真武汤基础上,加入枳壳、桔梗、陈皮等,配合附片、干姜温肾化气,行水消痰;肺气失宣,水津不布而生痰者,常用药如麻黄、枳壳、枳实、桔梗、杏仁、紫苏子等,主轻浮,不用重浊厚味,是所谓微辛则开,微苦则降,合乎轻清娇脏之治;肝气抑郁、气机不畅者,以柴胡和枳实为君药,随症加青皮、佛手、木香、半夏、陈皮、川芎、白芍、香附、茯苓、炙甘草等;痰涎壅盛、喘嗽短气、气逆痰多之证,在苏子降气汤的基础上加用镇逆之品。

Qi disease can produce phlegm and fluid,and phlegm disease can also hinder qi movement,and the two are cause and effect each other. For the disease of phlegm entrapment caused by external or internal injury,Zhang Zhiwen advocates to " treat phlegm from qi". The main method of phlegm treatment is to use the methods of invigorating qi,transforming qi,ventilating qi,regulating qi,reducing qi,and promoting qi,so as to enhance the function of zang-fu viscera and eliminate phlegm. In the clinical diagnosis and treatment of qi deficiency and phlegm syndrome,Zhang Lao often used qi tonifying medicine when removing phlegm to enhance the dissipation and resolution of phlegm;in the treatment of kidney yang deficiency and fluid retention syndrome,on the basis of Zhenwu Decoction,he added Fructus aurantii,Platycodon grandiflorum,tangerine peel,etc. to cooperate with epileptiform and dried ginger to warm the kidney to transform qi,circulate fluid and remove phlegm. For the patients with phlegm due to lung qi loss of ventilating and fluid loss of being distributed,commonly used drugs such as ephedra,Fructus aurantii,Fructus aurantii,Platycodon grandiflorum,almond,perilla,etc. Medicine should be light and frivolous,without the invitation of thick taste,mainly because micro pungent is open,micro bitter is descending,suitable for the treatment of light,clean and delicate viscera. If the liver qi is depressed and the qi movement is not smooth,bupleurum and Fructus aurantii are used as the monarch drugs,and Qingpi,bergamot,woody fragrance,pinellia,tangerine peel,Ligusticum chuanxiong,white peony,Xiangfu,Poria cocos,roasted licorice are added along with the symptoms. In the treatment of congestion of the lung,asthma and cough,shortness of breath,and qi reverse,we can use suppressing adverse qi medicine on the basis of Suzi Jiangqi Decoction.