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中醫聞診之聞聲--陰吹

祝由網(wang) 2023-11-12 19:39:36

【聞診】陰吹的(de)特征是:婦女陰道(dao)(dao)中出氣(qi)簌簌有聲(sheng),有如失(shi)氣(qi)。如大便秘結不通,則氣(qi)體從陰道(dao)(dao)中排(pai)出更為明顯。《金匱要略》說:“胃氣(qi)下(xia)泄,陰吹而(er)下(xia)喧,此谷(gu)氣(qi)之實也,膏(gao)發煎導(dao)之。”

【臨床意義】陰(yin)(yin)吹(chui)(chui)(chui)為(wei)胃(wei)(wei)(wei)中(zhong)正(zheng)氣(qi)(qi)(qi)(qi)衰弱,致胃(wei)(wei)(wei)氣(qi)(qi)(qi)(qi)下(xia)泄,不(bu)(bu)由(you)(you)大腸(chang)出(chu),而(er)(er)(er)(er)由(you)(you)陰(yin)(yin)道而(er)(er)(er)(er)出(chu)所(suo)(suo)致。魏(wei)荔彤(tong)說:“胃(wei)(wei)(wei)氣(qi)(qi)(qi)(qi)下(xia)泄,不(bu)(bu)由(you)(you)大腸(chang)而(er)(er)(er)(er)出(chu)濁(zhuo)道,乃由(you)(you)小腸(chang)而(er)(er)(er)(er)出(chu)清道,則(ze)(ze)氣(qi)(qi)(qi)(qi)不(bu)(bu)足(zu)而(er)(er)(er)(er)無所(suo)(suo)收攝也,故令下(xia)陰(yin)(yin)作吹(chui)(chui)(chui),而(er)(er)(er)(er)其聲(sheng)且喧(xuan)(xuan)聞于(yu)外(wai)。此(ci)雖為(wei)胃(wei)(wei)(wei)中(zhong)谷氣(qi)(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)實(shi)(shi),而(er)(er)(er)(er)其實(shi)(shi)胃(wei)(wei)(wei)中(zhong)正(zheng)氣(qi)(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)衰。”《會心錄》說:“陰(yin)(yin)吹(chui)(chui)(chui)一證,古(gu)書不(bu)(bu)多(duo)(duo),唯《金匱》云:胃(wei)(wei)(wei)氣(qi)(qi)(qi)(qi)下(xia)泄,陰(yin)(yin)吹(chui)(chui)(chui)而(er)(er)(er)(er)正(zheng)喧(xuan)(xuan),此(ci)谷氣(qi)(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)實(shi)(shi)也,膏發煎(jian)導之(zhi)(zhi)(zhi)(zhi)(zhi)。夫(fu)陰(yin)(yin)器(qi)厥陰(yin)(yin)部位,精竅通沖(chong)任之(zhi)(zhi)(zhi)(zhi)(zhi)脈,尿竅通小腸(chang)之(zhi)(zhi)(zhi)(zhi)(zhi)路(lu),氣(qi)(qi)(qi)(qi)道不(bu)(bu)從此(ci)出(chu),安(an)得有(you)(you)聲(sheng)而(er)(er)(er)(er)喧(xuan)(xuan)?蓋由(you)(you)肝腎虧(kui)于(yu)下(xia),肺氣(qi)(qi)(qi)(qi)虧(kui)于(yu)上(shang),致陽(yang)明胃(wei)(wei)(wei)氣(qi)(qi)(qi)(qi)不(bu)(bu)能鼓(gu)舞(wu)上(shang)行,而(er)(er)(er)(er)虧(kui)于(yu)中(zhong),不(bu)(bu)走陰(yin)(yin)器(qi),直入精竅而(er)(er)(er)(er)出(chu),豈同大腸(chang)矢(shi)氣(qi)(qi)(qi)(qi),《經(jing)》謂濁(zhuo)陰(yin)(yin)出(chu)下(xia)竅者可比耶?常見虛損之(zhi)(zhi)(zhi)(zhi)(zhi)輩,久咳(ke)經(jing)阻,胃(wei)(wei)(wei)氣(qi)(qi)(qi)(qi)不(bu)(bu)升(sheng),往往多(duo)(duo)有(you)(you)此(ci)患。言(yan)乎(hu)腎,則(ze)(ze)氣(qi)(qi)(qi)(qi)不(bu)(bu)攝可知;言(yan)乎(hu)肝,則(ze)(ze)氣(qi)(qi)(qi)(qi)不(bu)(bu)平(ping)可知;言(yan)乎(hu)肺,則(ze)(ze)氣(qi)(qi)(qi)(qi)不(bu)(bu)主可知。是以(yi)上(shang)咳(ke)下(xia)吹(chui)(chui)(chui),氣(qi)(qi)(qi)(qi)竅相(xiang)通,陰(yin)(yin)器(qi)隱(yin)(yin)隱(yin)(yin)有(you)(you)聲(sheng)。足(zu)見精血(xue)(xue)之(zhi)(zhi)(zhi)(zhi)(zhi)虧(kui),元氣(qi)(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)弱,根本搖搖矣。夫(fu)陽(yang)明為(wei)多(duo)(duo)氣(qi)(qi)(qi)(qi)多(duo)(duo)血(xue)(xue)之(zhi)(zhi)(zhi)(zhi)(zhi)海(hai),與沖(chong)任血(xue)(xue)海(hai)之(zhi)(zhi)(zhi)(zhi)(zhi)脈同聲(sheng)相(xiang)應,下(xia)為(wei)經(jing)而(er)(er)(er)(er)上(shang)為(wei)乳,變化取汁,血(xue)(xue)氣(qi)(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)實(shi)(shi)也。喧(xuan)(xuan)聞戶外(wai),胃(wei)(wei)(wei)氣(qi)(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)虛也。”

【治(zhi)(zhi)法】扶(fu)正祛邪,《金匱要略》用(yong)豬膏發煎治(zhi)(zhi)療,后(hou)世多(duo)結合其他兼癥予以辨證處理。《會心錄》說:“今胃氣下走,豈尋(xun)常之(zhi)藥可(ke)(ke)以奏功?必須培補(bu)肝腎(shen)以固肺金,生精(jing)益(yi)血以助真氣。若陽分(fen)多(duo)虧(kui),補(bu)中、歸(gui)(gui)脾(pi)之(zhi)屬(shu)可(ke)(ke)投;陰(yin)分(fen)多(duo)虧(kui),六味、左歸(gui)(gui)之(zhi)屬(shu)可(ke)(ke)用(yong);陰(yin)陽兩虧(kui),八(ba)味、右歸(gui)(gui)之(zhi)屬(shu)可(ke)(ke)服。耗氣敗血之(zhi)藥,非治(zhi)(zhi)也(ye)。倘不咳而竅有聲者(zhe),較咳而竅有聲者(zhe)為稍輕,逍遙、六味皆合法也(ye)。”

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