清代名医张璐治痰经验探析

Analysis of Famous Doctor Zhang Lu’s Experience in Treating Phlegm in Qing Dynasty

张璐治痰强调求本,认为脾胃在痰邪的生成过程中起到关键作用。其遣方用药遵循“由胃而上胸胁心肺之分者,驱其还胃,或下从肠出,或上从呕出,而不至于伏匿”的原则。治疗上明辨痰邪侵犯的部位,根据不同病机分别采用探吐痰涎、健脾化痰、补肾豁痰等方法,顾护脾胃的思想贯穿其中。痰在上焦,可吐可消,需防探吐损伤脾胃;痰在中焦,脾胃为生痰之源,更宜调理脾胃;痰在下焦,多因肾虚痰邪下注,治宜固肾为主;痰邪每随脾失健运而渗灌于经隧,久之而成顽痰,故需借温药为导。本文通过梳理《张氏医通》中关于痰证辨治的论述,分析其病因病机,总结其治法规律及特点,以期挖掘古代名医思想,指导临床合理选方用药。

Zhang Lu’s treatment of phlegm emphasizes seeking roots and believes that the spleen and stomach play a key role in the formation of phlegm.According to the principle of"vomiting,not to hide",the treatment is to identify the part of the invasion of phlegm evil.According to different pathogenesis,respectively adopt methods such as spitting and salivation,strengthening the spleen and eliminating phlegm,and invigorating the kidney and eliminating phlegm.The thought of protecting the spleen and stomach runs through it.Phlegm is located in the upper Jiao,which can be vomited and eliminated.It is necessary to prevent vomiting and damage the spleen and stomach;the spleen and stomach are the source of phlegm.phlegm is in the middle Jiao,which is more suitable for regulating the spleen and stomach.Betting on evil is the main cure for strengthening the kidney;every time the phlegm is infiltrated into the channel with the failure of the spleen,it will become stubborn phlegm over time,so it needs to be guided by warm drug.This article combs the expositions on phlegm syndrome in"Zhang's medical treatment",analyzes its exact etiology and pathogenesis,summarizes its treatment rules and characteristics,and hopes to excavate the ancient thoughts of famous doctors to guide the rational selection of prescriptions and medications.