“寒咳”证治概要

Review of pattern and treatment of“cold cough”

咳嗽是临床常见病症,若治不得法,容易发展成慢性咳嗽。感受寒邪是导致咳嗽的重要病因,“形寒饮冷则伤肺”是寒邪致病的高度概括,“寒咳”证治一直以来散在于中医典籍和临床实践中,但缺乏系统的梳理。我们提出从三焦脏腑论治“寒咳”的思路与架构:①寒邪伤肺,当依寒邪之轻重,分别选用止嗽散、金沸草散和麻黄汤为主方加减,而寒兼饮者,以小青龙汤、苓桂剂为佳;②中焦脾胃宜细分,寒伤脾而咳者用理中汤类;胃咳以小半夏加茯苓汤、半夏泻心汤加减;胆热脾寒者,可选柴胡桂枝干姜汤;③下焦肾寒致咳,温肾散寒是治疗大法,二仙汤、真武汤及金水六君煎是有效方剂。“寒咳”治疗当依病情轻重、病变病位以及脏腑之不同,用药选方亦有所区别,详加辨证。

As a commonly encountered clinical symptom,cough may easily develop into chronic cough if treated in an inappropriate way.Pathogenic cold is one of the important causes of cough as is well summarized in the quote“the invasion of cold into the body and drinking cold water impair the lung”from Nanjing(The Classic of Difficult Issues).Descriptions of the pattern and treatment of“cold cough”have been scattered in classics of traditional Chinese medicine and records of clinical practice,but a systematic review is lacking.Therefore,we put forward the following ideas and framework of treating cold cough from the perspective of triple energizer and zang-fu organs.(1)When cold pathogen attacks the lung,Zhisou San(Cough-Stopping Powder),Jinfeicao San(Inula Powder),Mahuang Tang(Ephedra Decoction)and relevant modified formulas should be used according to the severity of the cold pathogen.As for cough caused by cold with fluid retention,Xiaoqinglong Tang(Minor Green Dragon Decoction)and Linggui Zhugan Tang(Poria,Cinnamon Twig,Atractylodes Macrocephala and Licorice Decoction)are preferred.(2)If cold pathogen invades the spleen or stomach in the middle energizer,treatment should be tailored to the spleen,stomach and gallbladder respectively.For cough as a result of attack on the spleen from cold,Lizhong Tang(Center-Regulating Decoction)and similar formulas are suitable.For cough resulting from attack on the stomach by cold,Xiaobanxia Jia Fuling Tang(Minor Pinellia Decoction Plus Poria),Banxia Xiexin Tang(Pinellia Heart-Draining Decoction)and relevant modified formulas should be adopted.For cough with gallbladder heat and spleen cold,we could choose Chaihu Guizhi Ganjiang Tang(Bupleurum,Cinnamon Twig and Dried Ginger Decoction).(3)As for cough due to cold attack on the kidney in the lower energizer,it is key to warm the kidney and dissipate cold with effective formulas such as Erxian Tang(Two Immortals Decoction),Zhenwu Tang(True Warrior Decoction)and Jinshui Liujun Jian(Gold Water Six Gentlemen Decoction).In conclusion,when treating cold cough,we should choose formulas and medicinals based on careful pattern differentiation according to the severity and location of the disease and the affected zang-fu organs.