文章摘要
盛祎,钱静华,宓伟毅.《医学衷中参西录》治肺法浅析[J].浙江中医药大学学报,2021,(1):103-106.
《医学衷中参西录》治肺法浅析
Analysis of the Treatment of Lung Diseases in “Integrating Chinese and Western Medicine”
投稿时间:2020-04-30  
DOI:10.16466/j.issn1005-5509.2021.01.021
中文关键词: 医学衷中参西录  张锡纯  肺痈  肺痨  喘证  异病同治  瘟疫  肺系危重症
英文关键词: Integrating Chinese and Western Medicine  ZHANG Xichun  pulmonary abscess  consumption  asthma  homotherapy for heteropathy  pestilence  critical lung diseases
基金项目:
作者单位E-mail
盛祎 浙江中医药大学 杭州 310053  
钱静华 嘉兴市中医医院 qianjinghua2006@163.com 
宓伟毅 平湖市第一人民医院  
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中文摘要:
      [目的]学习张锡纯治肺的方法和理念,为现代呼吸系统疾病的治疗提供参考。[方法]通过文献检索,从病因病机、处方用药特点等方面对《医学衷中参西录》中有关肺痈、肺痨、喘证等章节及医案进行研读分析,归纳总结张氏治疗肺系疾病的基本治法和方药,分析张氏治病的基本理念及其对后世的指导意义。[结果]张氏认为肺痈、肺痨同有肺体损伤、血败肉腐之病机,疾病初期善用生石膏、金银花等清热解毒,中期善用生山药、白术等培土生金,后期善用熟地黄、麦冬等滋阴润肺,三棱、莪术等活血化瘀,常用资生汤、参麦汤、清金解毒汤等方,并主张用徐服法缓解生石膏寒凉之性引起的副作用。喘证病因在于外邪侵袭、痰湿内生、大气下陷、肾不纳气、元气欲脱,张氏以宣肺利水法、理气化痰法、益气升提法、补肾纳气法、敛气固脱法治疗喘证,善用赭石、半夏、陈皮降胃气,芡实敛肾气,龙骨、牡蛎、山萸肉敛元气,生黄芪、升麻、柴胡升提大气,常用薯蓣纳气汤、参赭镇气汤、理痰汤、升陷汤等方。张氏主张整体观念和异病同治的辨证思维,在肺系危重症的治疗上颇有建树,提出了“兼以解毒”的瘟疫治疗理念,可为新型冠状病毒肺炎的治疗提供经验借鉴。[结论]张氏重视肺痨、肺痈、喘证的病机演变过程,运用脏腑五行生克、气机升降理论立法用药,注重异病同治,擅长运用清热解毒法、敛气固脱法等治疗肺系危重症,这些方法在当今肺系相关疾病治疗中仍有指导意义。
英文摘要:
      [Objective]To learn ZHANG Xichun's methods and concepts of treating pulmonary diseases and provide reference for the treatment of modern respiratory diseases.[Methods]Through literature searching and reading, the treatment of pulmonary abscess, consumption, asthma, etc. in“Integrating Chinese and Western Medicine” was analyzed from etiology, pathogenesis, prescription medication rules and other aspects, and the basic therapy and prescription were summarized.The basic idea of treating disease and its guiding significance to later generations were concluded. [Results] ZHANG believed that pulmonary abscess and consumption had the same pathogenesis of lung damage and blood decay and treated by clearing away heat and toxic material, and Gypsum fibrosum and Lonicer japonica were used in the early stage of the disease. In addition, he made use of Rhizoma dioscoreae and Atractylodes macrocephala for strengthening earth to support metal in the medium stage. In the later stage,Radix Rehmanniae Preparata and Ophiopogon japonicus were used to nourish Yin and moisture the lung,and Rhizoma sparganii and Curcuma zedoaria were used to promote blood circulation and remove blood stasis. Besides, ZHANG often used Zisheng decoction,Shenmai decoction,Qingjin Jiedu decoction, etc and took it slowly to relieve the side effects caused by the cold nature of Gypsum fibrosum. The causes of asthma were external evil invasion, phlegm and dampness endogenous, pectoral Qi collapse, failure of the kidney in absorbing Qi, and vitality about to be removed, ZHANG treated this disease through ventilating the lung Qi for promoting diuresis, regulating Qi and eliminating phlegm, invigorating Qi for ascending, nourishing the kidney and absorbing Qi, astringing Qi for relieving desertion. ZHANG was good at using Haematitum,Rhizoma Pinellia and Pericarpium Citri Reticulatae to reduce stomach Qi,Euryale ferox Salisb to astringe kidney Qi, Os Draconis, Ostreae Concha and Fructus Corni astringe promordial Qi,and Astragalus membranaceus,Cimicifugae Rhizoma and Bupleuri Radix to lift pectoral Qi.ZHANG often used Shuyu Naqi decoction,Shenzhe Zhenqi decoction,Litan decoction,Shengxian decoction, etc. ZHANG advocated the holistic concept and the syndromedifferentiation thinking of homotherapy for heteropathy, and made considerable achievements in the treatment of critical lung diseases. He put forward the concept of treating pestilence with “detoxification”,which provided experience and reference for the treatment of Corona Virus Disease 2019(COVID-19).[Conclusion]ZHANG attached great importance to the pathogenesis of pulmonary abscess,consumption and asthma. He used the five elements generation-inhibition of viscera, and ascending and descending theories of functional activity of Qi for prescription medication, and paid attention to homotherapy for heteropathy, and was good at using methods of clearing away heat and toxic material,astringing Qi for relieving desertion to treat critical lung diseases.These methods are still instructive in the treatment of pulmonary diseases.
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