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黄昏咳之探析及验案2则

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黄昏咳散见于中医经典著作中,但未见专篇论述.黄昏咳,即黄昏时分咳嗽,余时不咳或偶咳,是为本病最为显著的特征,时间特点十分鲜明.但由于历史原因,"黄昏"所指代的具体时间段一直模糊不清.本研究分析《黄帝内经》所载的计时方法,结合历史学家考证结果及临床观察,明确了"黄昏"对应于现代24小时制的17~20点.黄昏咳的病因病机,多数古代医籍均认为其属肾病及肺,肾水不足,虚火失制上浮而扰肺金所致,推荐采用二五饮治疗,即五味子、五倍子两味,意在敛降虚火,但该方偏重于治标.石强教授临床善治咳嗽,患者数量较多且依从性较好,获得较好的临床疗效,形成了独特的宝贵经验.石强教授临床诊治黄昏咳时紧扣肾阴虚这一关键前因,解决了前因,则后果自然可消除,且补虚需久久为功,故常选用六味地黄丸作为底方予以治疗.六味地黄丸被誉为滋肾阴之祖方,奏标本兼治之功.本病的临床表现与一般肾阴不足之证候有较大出入,不易通过伴随症状加以鉴别,且临床对此病症报道亦鲜见,故特选2则验案供同道借鉴.
An analysis of 2 empirical cases of cough in the dusk
Cough in the dusk is scattered in various TCM classics in ancient times,but has not been discussed in a special sections and chapters.Cough in the dusk,and no cough at other times or occasional cough at rest,which is the most significant feature of the disease,and the time characteristic is very distinct.However,due to historical reasons,the specific time period referred to dusk has been ambiguous.Based on the analysis of the timing method contained in Huangdi Neijing(《黄帝内经》),combined with the textual research results of historians and clinical observation,this paper clarifies that dusk corresponds to 17 to 20 o'clock of modern 24-hour system.Regarding the etiology and pathogenesis of cough in the dusk,most ancient doctors believe that the disease is caused by kidney disease involving lung,that is,insufficient kidney water causes deficiency fire to float up and then disturb lung gold.Erwu Yin(二五饮)has always been recommended for the treatment.This prescription is composed of Wuweizi(Fructus Schisandrae Chinensis)and Wubeizi(Galla Chinensis),which is intended to suppress and reduce deficiency fire,but focuses on the treatment of superficial symptoms.Professor SHI Qiang is good at treating cough clinically,with a large number of patients with good compliance,and good clinical efficacy,forming unique valuable experience of the professor.In the clinical diagnosis and treatment of cough in the dusk,Professor SHI Qiang closely focuses on the key cause of kidney Yin(阴)deficiency to solve antecedent for eliminating the consequences naturally.Because it takes a long time to make up for the deficiency,Liuwei Dihuang Wan(六味地黄 丸)is often used as the base prescription for the treatment.Liuwei Dihuang Wan has always been known as the ancestral prescription of nourishing kidney Yin,and plays the role of addressing both symptoms and root causes.The clinical manifestations of this disease are quite different from the general syndromes of kidney Yin deficiency,which are not easy to be identified by accompanying symptoms,and the clinical reports of this disease are also rare,so 2 empirical cases are chose below for more reference.

Cough in the duskLiuwei Dihuang WanEmpirical case

周继业、石强

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江西中医药大学岐黄国医书院,江西 南昌,330004

黄昏咳 六味地黄丸 验案

2024

中医临床研究
中华中医药学会

中医临床研究

影响因子:0.839
ISSN:1674-7860
年,卷(期):2024.16(31)