外感咳嗽治则及治法探究

A study on the treatment principles and therapies of exogenous cough

外感咳嗽是以咳嗽、咳痰为主要表现的一类常见肺系病证,治法宜"宣",用药宜"轻"。立法选方的关键重在宣肺,因四时节气之不同,选方用药亦有所不同,大致如下:春时受风,宜桑菊饮疏风清热、宣肺止咳;夏时受暑,宜清肺汤清暑利湿、宣肺止咳;秋时外感凉燥,宜杏苏散轻宣温润、化痰止咳,温燥则宜桑杏汤轻宣凉润、化痰止咳;冬时,外受寒邪者,则宜三拗汤宣肺散寒;寒热错杂者,则宜麻杏石甘汤宣肺散寒、清解里热;外寒内饮者,则宜小青龙汤宣肺散寒、温化内饮。新感久治不瘥者,有肺阴不足、寒热错杂、湿热阻肺、风寒束肺、少阳胆咳、咽喉源性咳嗽诸情形,大致如下:久咳肺阴不足者,宜二母散润肺清热、化痰止咳;寒热错杂者,宜麻杏石甘汤表里两解、宣肺清热;湿热阻肺者,宜甘露消毒饮宣肺利湿、化痰止咳;外受风寒、久咳不愈,宜宁嗽散宣肺散寒、化痰止咳;外邪不解,邪传少阳,宜小柴胡汤和解少阳、化痰止咳;咽喉源性咳嗽,则宜清喉利咽汤清喉利咽、轻宣肺气。

Exogenous cough is a common type of lung diseases with cough and sputum as the main manifestations. The therapy should be dispersible and the medication should be light. The key to prescriptions selection is to disperse lung Qi ( 肺 气 ). The prescriptions and medications were selected according to four seasons and solar terms. When patients were swept by the cold wind in spring, it was advisable to drink Sangju Yin( 桑菊饮) in order to resist Fengxie( 风邪) and cough. In summer, the Qingfei decoction should be applied to play the role of Qingshu Lishi( 清暑利湿) and Xuanfei Zhike( 宣肺止咳). Xingsu San( 杏苏散) was used to drive out Liangzao( 凉燥), or the Sangxing decoction( 桑杏汤) was used to drive out Wenzao( 温燥) in autumn. In winter, treating cold with the San’ao decoction( 三拗汤) could gain the effect of Xuanfei Sanhan( 宣肺散寒), or treating cough caused by Hanre Cuoza( 寒热错杂) with the Maxing Shigan decoction( 麻杏石甘汤) gained the effects of Xuanfei Sanhan( 宣肺散寒) and Qingjie Lire( 清解里热), etc..The etiology of the new cold that did not heal for a long time included Feiyin-deficiency( 肺阴不足), Hanre Cuoza( 寒热错杂), damp and heat block lung, wind-cold bundle lung, Shaoyang Danke( 少阳胆咳), laryngeal cough and so on. Ermu San( 二母散), the Maxing Shigan decoction, Ganlu Xiaodu Yin( 甘露消毒饮), Ningsou San( 宁嗽散), the Xiaochaihu decoction( 小柴胡汤) and the Qinghou Liyan decoction( 清喉利咽汤) were applied respectively to treat cough caused by the above reasons.