基于“病痰饮者,当以温药和之”探讨恶性胸腔积液治疗思路

Discussion on the Treatment Ideas of Malignant Pleural Effusion Based on“Patients Suffered from Phlegm and Retained Fluid Should be Treated by Warm Medicine”

“病痰饮者,当以温药和之”源于医圣张仲景《金匮要略·痰饮咳嗽病脉证并治》,后世论治痰饮病皆以此为宗。恶性胸腔积液的病因病机、临床表现、疾病演变与痰饮致病均有关联。故拟从释义、内涵、遣药组方等方面对“痰饮致病,温药和之”治则进行剖析,探讨此治则在论治恶性胸腔积液中的以“缓者温运阳气,通调脏腑治其本;急者和其不和,速排水饮治其标”为治疗纲领,阐释“温药和之”思想在治疗恶性胸腔积液中的应用,活用古方,遵古而不囿古,以期为临床治疗恶性胸腔积液提供思路。

“Patients suffered from phlegm and retained fluid should be treated by warm medicine”originated from Synopsis of the Golden Chamber written by the medical sage Zhang Zhongjing,which was regarded as the canon to resist the phlegm and retained fluid.The etiology,pathogenesis,clinical manifestations and disease evolution of malignant pleural effusion are related to phlegm and retained fluid.Therefore,it is proposed to analyze the treatment principle of“patients suffered from drink pathogen should be treated by warm medicine”from the interpretation,connotation,dispatching medicine prescription and other aspects,and to explore the application of this treatment principle in the treatment of malignant pleural effusion,taking“the slow one warms and transports Yang Qi,dredges and regulates the Zang-fu organs to treat the root;the urgent one reconciles its discord,and the quick drainage drink to treat the treetop”as the treatment program,so as to expound the application of the thought of“reconcile with warm medicine”in the treatment of malignant pleural effusion,and to apply the ancient prescriptions flexibly,follow the ancient but not limit the ancient to the treatment of malignant pleural effusion,in order to provide ideas for clinical treatment of malignant pleural effusion.