基于“土郁夺之”理论探讨痰湿型慢性咳嗽的治疗

Treatment of Chronic Cough of Phlegm-Dampness Syndrome Based on the Theory of“Removing the Earth Stagnation”

基于“土郁夺之”理论探讨痰湿型慢性咳嗽的治疗。认为中焦气机郁滞引起人体水液代谢失常是导致痰湿咳嗽发生的关键病机。寒湿犯脾、湿热中阻,及中焦虚弱、清阳不升、阴火内炽等病机均可导致“土郁”,从而引发痰湿咳嗽。治疗主张“夺其壅滞”以运转中焦气机,祛除郁滞,根据不同病因病机采用温运和中、流气化湿、培土生金、补土升阳、降泻阴火等治法,达到疏调中气、化痰祛湿而平咳喘的目的。偏寒湿者选用姜苓半夏汤,偏湿热者选用半夏泻心汤合香苏散,脾胃虚弱者根据其病情程度特点可选用补中益气汤、调中益气汤、升阳益胃汤、补脾胃泻阴火升阳汤。

This paper discussed the treatment of chronic cough of phlegm-dampness type based on the theory of“removing the earth stagnation”.It is believed that stagnation of qi in the middle energizer caused malfunction of water metabolism in the human body,which is the key pathogenetic mechanism leading to phlegm-dampness cough.Pathogenesis like cold and dampness attacking the spleen,dampness-heat obstruction,weakness of the middle energizer,failure to ascend clear yang,and internal blazing of yin fire may lead to“earth stagnation”,which triggered phlegm-dampness cough.The treatment advocated“removing the stagnation”to improve qi transformation in the middle energizer,eliminate stagnation,and use different treatment methods such as warming the middle,circulating qi,transforming phlegm and dampness based on different disease cause and mechanism to calm cough.As for prescriptions,Jiangling Banxia Decoction(姜苓半夏汤)could be used for cold-dampness syndrome,Banxia Xiexin Decoction(半夏泻心汤)plus Xiangsu Powder(香苏散)used for damp-heat syndrome,and Buzhong Yiqi Decoction(补中益气汤),Tiaozhong Yiqi Decoction(调中益气汤),Shengyang Yiwei Decoction(升阳益胃汤)and Bupiwei Xieyinhuo Shengyang Decoction(补脾胃泻阴火升阳汤)could be selected for spleen-stomach weakness syndrome according to different characteristics and pathogenesis.