张之文运用温病三焦理论辨治慢性阻塞性肺疾病经验

Experience of ZHANG Zhiwen using the theory of sanjiao of warm diseases in differentiation and treatment of chronic obstructive pulmonary disease

咳、痰、喘为慢性阻塞性肺疾病的三大主症,全国名中医张之文教授基于叶天士辨治久咳思想“久咳不已,则三焦受之,是病不独在肺矣”,认为本病治疗重在调治肺、脾、肾三脏,提出“开上、运中、奠下”治疗原则。病在上焦,肺失清肃,气易壅滞,治宜开宣肺气;病在中焦,脾失健运,痰浊内阻,治宜温运脾气;病在下焦,肾失摄纳,气促而喘,治宜补纳肾气。急性加重期开上为主;稳定期运中、奠下为主,或三法同用,同时兼顾兼夹证治疗。

Cough,phlegm and asthma are the three main symptoms of chronic obstructive pulmonary disease.Based on thought of YE Tianshi,the location of long time cough is not only in lung,but also in sanjiao,ZHANG Zhiwen believes that the lesion of this disease involves the lung,spleen and kidney.He put forward the therapeutic principle of this disease,which is opening the upperjiao,promoting the middle-jiao and laying the down-jiao.When the disease lies in the upper-jiao,the lungs would defeated to govern depurative downbearing,and qi would be obstructed.It is advisable to open and promote lung qi for treatment.When the disease lies in the middle-jiao,the spleen would lose governing transportation and transformation.It is advisable to treat it by warming the spleen and promoting spleen qi.When the disease lies in the down-jiao,the kidney would lose receiving respiratory qi.It is advisable to tonifying kidney qi.During the acute exacerbation phase,it is mainly focused on promoting lung qi;During the stable period,the main treatment is to transforming spleen qi or tonifying kidney qi,or to use the three methods together,while also considering the treatment of mixed symptoms.