新安医家吴楚运用温补思想辨治痰证经验探析

Exploration on Experience of Wu Chu's Warming and Supplementing Thought on Phlegm Syndrome Differentiation and Treatment in Xin'an Medical School

吴楚是清代著名新安医家,通过对其《吴氏医验录》中痰证相关病案进行总结分析,归纳其温补思想在痰证辨治中的运用。吴氏认为,痰之所生主要归责于脾肾两脏。脾虚则水湿不能运化,从而停聚为痰;肾虚则肾水无以牵制,上犯为痰。临证之时以脉为重,滑脉为脾虚生痰之象,脉沉主肾虚生痰之象,不同兼脉象意有不同。痰、涎二证有异有同。涎证属虚,而痰证有虚有实,然均施以温法,但二者温补之时有所差别。涎证温补多以甘温之品补肾健脾,痰证温补或用苦温之品温燥湿痰,或用辛温之品温散寒痰,或用甘温之品温运虚痰。吴氏确定了以大补温剂治疗痰证的治疗原则以及燥脾土、培肾阳的治疗方法,临床形成六君子汤、八味丸为代表性方剂的温补治疗体系。

Wu Chu is a famous Xin'an physician in the Qing Dynasty,and through the summary and analysis of the sputum-related cases in his Wu Shi Yi Yan Lu,he summarized the application of his warm tonic idea in the differentiation and treatment of phlegm.Wu believes that phlegm is mainly attributed to the spleen and kidneys.If the spleen is deficient,the water dampness cannot be transported,so that it stops agglomerating into phlegm;If the kidney is deficient,the kidney water cannot be contained,and the offense is phlegm.The slippery pulse is the image of spleen deficiency and phlegm,and the pulse sinking indicates kidney deficiency and phlegm,and the meaning of different pulses is different.There are similarities and differences between phlegm and salivation.Saliva evidence is deficiency,while phlegm evidence is deficiency and excess,both can apply warm methods,but there is a difference between the two when warming up.Saliva supplement is mostly to use sweet and warm drugs to supplement the kidney and spleen,phlegm warm supplement or use bitter drugs to warm dry and wet phlegm,or use spicy and warm drugs to warm cold phlegm,or use sweet and warm drugs to warm and transport deficiency phlegm.Wu determined the treatment principle of using large warming agents to treat phlegm,as well as the treatment methods of dry spleen and kidney Yang,and clinically formed a warm tonic treatment system with Liujunzi decoction and Bawei pills as representative formulas.