《金匮要略》湿病、痰饮、水气病辨治规律
|
摘要
湿病、痰饮和水气病皆是由于人体或感受外邪、或饮食不节、或劳倦过度,影响肺、脾、肾、三焦正常功能,而使水液代谢失调所致。三者性质相近,病变脏腑相关,随病情发展既可相互转化,又可以合并为病,故治则治法具有一定的相通之处,"发汗、利小便、攻下逐水"为祛邪之常法。脏腑功能失调是疾病发生的前提要素,故扶正是治本之关键,"以温药和之"是扶正之根本。"发汗、利小便、攻下逐水"虽是祛邪常法,但有助于阳气得复,祛邪以安正;"以温药和之"虽重在温阳化气,扶助肺脾肾气化功能,但气化功能恢复可利于祛除水湿之邪。所以,扶正即是祛邪,祛邪亦是为了安正,两者是不可完全割裂的。三证初期均是因正气虚弱或邪气壅盛所致,若病情迁延,日久不愈,将转变为虚实夹杂之证,"虚虚实实"延误病情,故辨清虚实是治疗疾病的关键。湿病、痰饮、水气病由于病程迁延,病情常常复杂多变,故临床上需要学会变通,根据症状表现而随证治之。
Damp disease,phlegm-fluid retention,and disease with fluid-retention syndrome are caused by the disorder of water metabolism resulting from the impairment of normal function of lung,spleen,kidney and sanjiao due to either exogenous pathogens,or poor diet,or excessive fatigue. The three are similar in nature and are related to diseased viscera. With the development of the disease,they can not only transform each other,but also can be merged into a disease,so the treatment has some similarities,and the commonly-used treatment focuses on " sweating,promoting urination,elimination of fluid retention by purgation". Dysfunction of viscera and is the precondition factor of disease occurrence,so strengthening healthy qi is the key to cure the disease,and " warming medicine to harmonize it " is the basis of strengthening healthy qi. " Sweating,promoting urination,elimination of fluid retention by purgation" the commonly-used treatment methods,but they can recover yang qi,removing pathogenic factors. " Warming medicine to harmonize it " pays attention to warming yang and transforming qi to help lung,spleen and kidney qi function,but recovery of qi function is helpful to eliminate fluid retention,so strengthening healthy qi means eliminating pathogenic factors,and vice versa. The two must not be completely separated. The initial stage of any disease is due to weakness of vital qi or excessive evil qi. If the disease is prolonged,it will be transformed into a mixed syndrome of deficiency and excess,and " mixed deficiency and excess" will delay the disease,so the key to the treatment is to distinguish deficiency and excess. Damp disease,phlegm-fluid retention,and disease with fluid-retention syndrome are often complicated and changeable due to the protracted course of disease.Therefore,it is necessary to learn to be flexible in clinical practice and treat based on syndrome differentiation.
Damp disease,phlegm-fluid retention,and disease with fluid-retention syndrome are caused by the disorder of water metabolism resulting from the impairment of normal function of lung,spleen,kidney and sanjiao due to either exogenous pathogens,or poor diet,or excessive fatigue. The three are similar in nature and are related to diseased viscera. With the development of the disease,they can not only transform each other,but also can be merged into a disease,so the treatment has some similarities,and the commonly-used treatment focuses on " sweating,promoting urination,elimination of fluid retention by purgation". Dysfunction of viscera and is the precondition factor of disease occurrence,so strengthening healthy qi is the key to cure the disease,and " warming medicine to harmonize it " is the basis of strengthening healthy qi. " Sweating,promoting urination,elimination of fluid retention by purgation" the commonly-used treatment methods,but they can recover yang qi,removing pathogenic factors. " Warming medicine to harmonize it " pays attention to warming yang and transforming qi to help lung,spleen and kidney qi function,but recovery of qi function is helpful to eliminate fluid retention,so strengthening healthy qi means eliminating pathogenic factors,and vice versa. The two must not be completely separated. The initial stage of any disease is due to weakness of vital qi or excessive evil qi. If the disease is prolonged,it will be transformed into a mixed syndrome of deficiency and excess,and " mixed deficiency and excess" will delay the disease,so the key to the treatment is to distinguish deficiency and excess. Damp disease,phlegm-fluid retention,and disease with fluid-retention syndrome are often complicated and changeable due to the protracted course of disease.Therefore,it is necessary to learn to be flexible in clinical practice and treat based on syndrome differentiation.
引文
[1]杨精华,王俊峰.基于“肺为水之上源”理论辨治水病体会[J].光明中医,2017,32(19):2772-2773.
[2]孟庆岩,张庆祥,高思华.肺通调水道作用及其临床意义[J].中国中医基础医学杂志,2014,20(2):160-161.
[3]董秀文.谈脾胃为水液代谢之中枢[J].中医药研究,1992(1):28-29.
[4]邵命海,周圆,詹恬恬,等.彭培初教授辨治肾性水肿学术思想[J].上海中医药大学学报,2016,30(6):1-5.
[5]李大林.水肿病从三焦论治探讨[J].内蒙古中医药,2013,32(4):138-139.
[6]张丽瑛,蔡树河,李来泽.三焦运化水湿除痰消饮功能的探讨[J].中国中医药现代远程教育,2013,11(23):4-6.
[7]李宁.《金匮要略》水液代谢障碍类疾病证治规律探讨[J].环球中医药,2014,7(10):790-792.
[8]房明明,王新佩.浅析《金匮要略》中湿病、痰饮、水气病之异同[J].河南中医,2016,36(4):559-561.
[9]张振南,谢利民,于潼.《金匮要略》中湿病治法与方药探究[J].吉林中医药,2015,35(1):6-8.
[10]伊丽古玛,刘梅.仲景水肿治法浅析[J].河南中医,2017,37(3):378-380.
[11]王国力,赵琰,王庆国,等.浅议《伤寒杂病论》和《临证指南医案》对通阳祛湿法的运用[J].环球中医药,2016,9(6):712-714.
[12]吴潜智.《金匮要略》痰饮、水气和湿病的辨证论治特色[J].辽宁中医药大学学报,2013,15(11):165-168.
[13]蔡丽威,李景华.中医气血水关系在肝硬变腹水治疗中的应用[J].中国社区医师,2014,30(11):105-106.
[14]刘静,傅杰,丁舸.试论麻黄、石膏核心药组在方剂配伍中的意义[J].中医研究,2013,26(10):50-51.
[15]邓虎,崔长虹,陈彩丽,等.叶天士运用杏仁治疗肺系疾病规律初探[J].世界中西医结合杂志,2012,7(10):837-838,853.
[2]孟庆岩,张庆祥,高思华.肺通调水道作用及其临床意义[J].中国中医基础医学杂志,2014,20(2):160-161.
[3]董秀文.谈脾胃为水液代谢之中枢[J].中医药研究,1992(1):28-29.
[4]邵命海,周圆,詹恬恬,等.彭培初教授辨治肾性水肿学术思想[J].上海中医药大学学报,2016,30(6):1-5.
[5]李大林.水肿病从三焦论治探讨[J].内蒙古中医药,2013,32(4):138-139.
[6]张丽瑛,蔡树河,李来泽.三焦运化水湿除痰消饮功能的探讨[J].中国中医药现代远程教育,2013,11(23):4-6.
[7]李宁.《金匮要略》水液代谢障碍类疾病证治规律探讨[J].环球中医药,2014,7(10):790-792.
[8]房明明,王新佩.浅析《金匮要略》中湿病、痰饮、水气病之异同[J].河南中医,2016,36(4):559-561.
[9]张振南,谢利民,于潼.《金匮要略》中湿病治法与方药探究[J].吉林中医药,2015,35(1):6-8.
[10]伊丽古玛,刘梅.仲景水肿治法浅析[J].河南中医,2017,37(3):378-380.
[11]王国力,赵琰,王庆国,等.浅议《伤寒杂病论》和《临证指南医案》对通阳祛湿法的运用[J].环球中医药,2016,9(6):712-714.
[12]吴潜智.《金匮要略》痰饮、水气和湿病的辨证论治特色[J].辽宁中医药大学学报,2013,15(11):165-168.
[13]蔡丽威,李景华.中医气血水关系在肝硬变腹水治疗中的应用[J].中国社区医师,2014,30(11):105-106.
[14]刘静,傅杰,丁舸.试论麻黄、石膏核心药组在方剂配伍中的意义[J].中医研究,2013,26(10):50-51.
[15]邓虎,崔长虹,陈彩丽,等.叶天士运用杏仁治疗肺系疾病规律初探[J].世界中西医结合杂志,2012,7(10):837-838,853.