陆家龙名老中医治疗咳嗽临证思想探赜.docVIP

陆家龙名老中医治疗咳嗽临证思想探赜 2012年全国名老中医药专家传承工作室建设项目国中医药人教函〔2012〕149号xploring on the experience of prominent TCM doctor LU Jia-long in treating cough CHEN Bin, WEI Dan-xia, GU Li-hua, Lu Jia-long (Kunming Hospital of Traditional Chinese Medicine, Kunming 650011, China) Abstract LU Jia-long founded “dry cough” theory, Which Based on the Treating Disease according to Syndrome Differentiation. It was used in the treatment of cough in Kunming area having rich clinical experience and satisfactory therapeutic effects. In clinic, that used methods including The Opening the Inhibited Lung-Qi by Cooling Dryness, Normalizing the Stomach and Keeping Lung-Qi Pure and Descend-ant, Resolving Dampness for Assisting Qi movement, Invigorating Stomach and Spleen for effects of Transportation and Transformation. The method based on the experience of predecessors, forming a unique view, prescription steady and refining. Therefore, it is very important to sum up experience by Lu Jia-long therapeutics of cough in Kunming area and to promote the clinical level of diagnosis and therapy. Keywords cough, LU Jia-long, Famous doctor experience 陆家龙主任医师是全国第五批名中医药专家学术经验继承人导师，全国名中医工作室指导老师，云南省荣誉名中医。恩师从医40余年，医德醇厚，学验俱丰。临床运用中医中药治疗咳嗽病，取疗效显著。笔者从师侍诊有年，受益良多，现不揣浅陋，将其治疗咳嗽的临证思想介绍如下： （一）咳嗽论治首重燥 燥邪，为六淫邪气之一。《素问?至真要大论》有病机十九条，在六气病机中独少秋感于燥一条，陆老认为这对燥邪的认识是有一定道理的。六淫理论，论燥固少，自清代?喻昌提出：“秋伤于燥”之说，后世不少医家递相倡论，虽在一定程度上深化发展了外感燥邪理论，但也难免一隅之囿。遵循《素问?阴阳应象大论》：“燥胜则干”的燥邪为病的特点。燥邪致病是与地理环境、气候因素、人体体质三者相互影响的一种病理表现结果，正如《婺源余先生医案》所说：冬、春、夏三季若天干大旱，气候干燥，亦能形成燥邪为患。燥邪伤人并非独见于秋季，其他季节也可因燥而致病。昆明地处低纬高原地区，为亚热带季风气候，除夏季外、春秋冬三季雨少，且终年日照充沛，蒸发作用强烈，昼夜温差大，空气对流作用明显，形成昆明空气湿度低，气候温和，寒温不显，风高劲急的地理气候特点[1]。加之当地民俗所尚，饮食多香燥辛辣炙煿之品。故燥邪为此地常见主要致病因素，且冬无酷寒、夏无酷热，气候温和，因寒而燥之证，并不多见，亦难过极化火。外燥恒见，因饮食不节，七情所伤导致素体阴虚津伤，感邪后同气相召致内外合燥也不少见。即《内经》所谓正化、从化、兼化之理。 燥邪致病，多见咳嗽。陆师常说肺为燥金之脏，同气相求。正如清?叶天士亦言:“燥气上受，先干于肺,令人咳嗽”(叶天士医案?咳嗽门)。肺气为燥所伤，治节不周，宣降失调；肺之阴津受损，津液枯涸，清肃不利。治节失司，脏腑气化失常；津液枯涸，气血运行艰涩。五脏六腑皆受累及。因此陆师分析认为昆明地区咳嗽的临床特点凡四：①燥咳多见，发无定时，非独秋有；②燥常兼温，寒热不甚；③内外合燥，脏腑皆干；④临床中表现常为干咳呛咳，咽痒嗌干,痰少而粘、鼻燥口渴症状。在治疗现代医学之