關(guan)鍵詞：痰證 雜病 溫(wen)病 病因病機
摘要：本文從(cong)痰證(zheng)理論(lun)的(de)(de)歷(li)(li)史發(fa)展(zhan)(zhan)角度，探(tan)討了(le)各歷(li)(li)史時期痰證(zheng)論(lun)治的(de)(de)特點和成(cheng)就，經歷(li)(li)了(le)從(cong)痰飲(yin)論(lun)治發(fa)展(zhan)(zhan)到雜病(bing)治痰，再(zai)到溫病(bing)治痰；從(cong)水、飲(yin)、濕(shi)的(de)(de)論(lun)治到百病(bing)治痰，再(zai)到從(cong)痰論(lun)治急性熱病(bing)等不斷發(fa)展(zhan)(zhan)的(de)(de)過程；反映了(le)中醫“痰”的(de)(de)內涵逐漸豐(feng)富，痰證(zheng)理論(lun)的(de)(de)不斷發(fa)展(zhan)(zhan)和成(cheng)熟。
痰(tan)(tan)證的(de)治(zhi)療實踐(jian)歷史悠久(jiu)，我國公元前五世紀作品《詩經·鄘(yong)風》就有“陟彼(bi)阿(a)丘，言采其虻(meng)”的(de)詩句，“虻(meng)”就是現今常用的(de)化痰(tan)(tan)藥物(wu)貝母。《五十二病方(fang)》中亦記(ji)載(zai)有常用的(de)化痰(tan)(tan)藥物(wu)如半(ban)夏、服零(茯苓)、白附(白附子(zi))等。漢以前無“痰(tan)(tan)”字(zi)，而(er)有“淡(dan)”字(zi)之用，《文字(zi)集略》曰：“淡(dan)為胸中液”，說(shuo)明了痰(tan)(tan)與人體內水(shui)液相(xiang)(xiang)關。《內經》中水(shui)、濕、飲病證的(de)論(lun)(lun)(lun)述相(xiang)(xiang)當詳盡(jin)，奠定了痰(tan)(tan)證論(lun)(lun)(lun)治(zhi)的(de)理(li)論(lun)(lun)(lun)基礎。此后，痰(tan)(tan)證理(li)論(lun)(lun)(lun)在此基礎上不斷發(fa)展，代有闡(chan)發(fa)，形(xing)成了獨具特色的(de)中醫痰(tan)(tan)證理(li)論(lun)(lun)(lun)。本文就痰(tan)(tan)證理(li)論(lun)(lun)(lun)的(de)起源與發(fa)展作如下(xia)論(lun)(lun)(lun)述。
仲景四飲體(ti)系的形成與痰(tan)飲治則的確立
《內(nei)(nei)經》對(dui)水(shui)(shui)(shui)(shui)液(ye)在人體(ti)的(de)(de)(de)正常生理(li)代(dai)(dai)謝及(ji)病理(li)過程已有(you)理(li)論(lun)(lun)的(de)(de)(de)概(gai)括，提(ti)出了(le)以(yi)肺、脾(pi)(胃)、腎(膀胱)為樞軸的(de)(de)(de)水(shui)(shui)(shui)(shui)液(ye)代(dai)(dai)謝重要理(li)論(lun)(lun)。將有(you)關水(shui)(shui)(shui)(shui)液(ye)代(dai)(dai)謝的(de)(de)(de)病證多概(gai)括為水(shui)(shui)(shui)(shui)飲、水(shui)(shui)(shui)(shui)濕、積(ji)(ji)飲，并提(ti)出相(xiang)應的(de)(de)(de)治(zhi)則治(zhi)法，如“治(zhi)之以(yi)蘭，除陳氣也”(《素(su)問(wen)·奇病論(lun)(lun)》)就有(you)芳香(xiang)化濕之義(yi)，“去(qu)宛(wan)陳莝”(《素(su)問(wen)·湯(tang)液(ye)醪醴論(lun)(lun)》)有(you)逐飲之義(yi)，論(lun)(lun)述了(le)驅逐淤積(ji)(ji)于體(ti)內(nei)(nei)的(de)(de)(de)水(shui)(shui)(shui)(shui)濕的(de)(de)(de)各種方法。此外，在《靈樞·邪客》篇中，尚記載(zai)有(you)“半(ban)夏湯(tang)”，用以(yi)決瀆壅塞，治(zhi)療水(shui)(shui)(shui)(shui)濕停聚(ju)于體(ti)內(nei)(nei)之病。以(yi)上均為痰(tan)飲論(lun)(lun)治(zhi)的(de)(de)(de)最早理(li)論(lun)(lun)文獻(xian)。
最早(zao)建立水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)證治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)方(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)體系的(de)(de)(de)(de)(de)(de)是漢(han)代的(de)(de)(de)(de)(de)(de)張仲景。對(dui)于(yu)(yu)水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)的(de)(de)(de)(de)(de)(de)分(fen)(fen)(fen)類(lei)、治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)則(ze)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)法、方(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)配伍(wu)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療已形(xing)成完(wan)整體系，對(dui)后(hou)世(shi)痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)的(de)(de)(de)(de)(de)(de)論(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)影響深(shen)遠。張仲景在《金匱(kui)要(yao)略(lve)·痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)咳嗽病》篇(pian)論(lun)(lun)(lun)(lun)述了(le)水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)病證的(de)(de)(de)(de)(de)(de)分(fen)(fen)(fen)類(lei)、癥候(hou)、治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)則(ze)及(ji)(ji)方(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)，該(gai)篇(pian)共(gong)有論(lun)(lun)(lun)(lun)1首，脈證21條(tiao)，方(fang)(fang)(fang)(fang)19首，說明當時水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)論(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)方(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)體系已形(xing)成。按(an)水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)停滯部位的(de)(de)(de)(de)(de)(de)不同(tong)將其(qi)(qi)分(fen)(fen)(fen)為四(si)(si)(si)類(lei)，即痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)、懸(xuan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)、溢(yi)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)、支飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)，從概念上界定了(le)四(si)(si)(si)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)的(de)(de)(de)(de)(de)(de)具體定義，較之《內經》水(shui)(shui)(shui)(shui)(shui)、濕的(de)(de)(de)(de)(de)(de)論(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)更加清晰明確。水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)停滯部位的(de)(de)(de)(de)(de)(de)辨證是四(si)(si)(si)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)分(fen)(fen)(fen)類(lei)的(de)(de)(de)(de)(de)(de)基礎，但《金匱(kui)要(yao)略(lve)》的(de)(de)(de)(de)(de)(de)“痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)”僅為四(si)(si)(si)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)之一，其(qi)(qi)共(gong)同(tong)的(de)(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療原則(ze)為“病痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)者，當以溫(wen)(wen)(wen)藥(yao)(yao)(yao)和之”，代表方(fang)(fang)(fang)(fang)劑是苓(ling)桂(gui)術(shu)甘湯(tang)(tang)。《傷寒論(lun)(lun)(lun)(lun)》中(zhong)關于(yu)(yu)結胸(xiong)等病證的(de)(de)(de)(de)(de)(de)論(lun)(lun)(lun)(lun)述，實(shi)際也屬于(yu)(yu)后(hou)世(shi)所(suo)論(lun)(lun)(lun)(lun)痰(tan)(tan)(tan)(tan)證的(de)(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療范疇。如“寒實(shi)結胸(xiong)，無熱(re)證者，與三物白散”，藥(yao)(yao)(yao)物組成為桔(jie)梗、巴豆、貝母。“傷寒六七日，結胸(xiong)熱(re)實(shi)，脈沉而(er)緊，心下(xia)痛，按(an)之石硬(ying)者，大(da)陷胸(xiong)湯(tang)(tang)主之”，該(gai)方(fang)(fang)(fang)(fang)由大(da)黃(huang)、芒硝(xiao)、甘遂(sui)三味(wei)藥(yao)(yao)(yao)物組成。由此可知，仲景的(de)(de)(de)(de)(de)(de)《傷寒論(lun)(lun)(lun)(lun)》、《金匱(kui)要(yao)略(lve)》對(dui)包括“痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)”在內的(de)(de)(de)(de)(de)(de)四(si)(si)(si)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)論(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)相當完(wan)備。其(qi)(qi)論(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理論(lun)(lun)(lun)(lun)及(ji)(ji)臨床方(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)應(ying)用主要(yao)有以下(xia)特點(dian)：一是側(ce)重(zhong)(zhong)溫(wen)(wen)(wen)化水(shui)(shui)(shui)(shui)(shui)濕的(de)(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)則(ze)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)法，以苓(ling)桂(gui)術(shu)甘湯(tang)(tang)、大(da)青龍湯(tang)(tang)、小青龍湯(tang)(tang)等為代表方(fang)(fang)(fang)(fang)劑，常用溫(wen)(wen)(wen)化水(shui)(shui)(shui)(shui)(shui)濕之類(lei)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)物有干姜、生(sheng)姜、桂(gui)枝、半夏(xia)、栝(gua)蔞等。一是側(ce)重(zhong)(zhong)攻逐(zhu)水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)的(de)(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)則(ze)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)法，如大(da)陷胸(xiong)湯(tang)(tang)、十棗湯(tang)(tang)等方(fang)(fang)(fang)(fang)劑，用藥(yao)(yao)(yao)亦(yi)多(duo)集(ji)中(zhong)在攻逐(zhu)、涌吐之類(lei)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)物，如大(da)黃(huang)、芒硝(xiao)、甘遂(sui)、芫花、葶藶子、巴豆、瓜(gua)蒂等。但仲景所(suo)論(lun)(lun)(lun)(lun)的(de)(de)(de)(de)(de)(de)“痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)”是痰(tan)(tan)(tan)(tan)、飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)并列，治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療上仍偏重(zhong)(zhong)于(yu)(yu)水(shui)(shui)(shui)(shui)(shui)、飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)，以水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)的(de)(de)(de)(de)(de)(de)病機為主，痰(tan)(tan)(tan)(tan)只是推類(lei)而(er)及(ji)(ji)。［1］其(qi)(qi)水(shui)(shui)(shui)(shui)(shui)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)的(de)(de)(de)(de)(de)(de)分(fen)(fen)(fen)類(lei)法及(ji)(ji)痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)的(de)(de)(de)(de)(de)(de)溫(wen)(wen)(wen)化與攻逐(zhu)的(de)(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)則(ze)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)法對(dui)后(hou)世(shi)影響甚廣，隋(sui)·巢元方(fang)(fang)(fang)(fang)所(suo)撰《諸病源候(hou)論(lun)(lun)(lun)(lun)》中(zhong)的(de)(de)(de)(de)(de)(de)“痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)病諸候(hou)”就有“痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)候(hou)”、“溢(yi)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)候(hou)”、“懸(xuan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)候(hou)”的(de)(de)(de)(de)(de)(de)記(ji)載，直到明清醫籍亦(yi)多(duo)用仲景四(si)(si)(si)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)分(fen)(fen)(fen)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)體系作為“痰(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)(yin)”門病證論(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)臨床分(fen)(fen)(fen)類(lei)。
宋金(jin)元時(shi)期(qi)雜病治(zhi)痰及(ji)痰治(zhi)范(fan)圍的拓(tuo)展
宋代之前，痰(tan)飲門是(shi)相(xiang)當狹窄的(de)(de)一個病種，地位(wei)一般，從(cong)《圣濟總(zong)錄》、《太平(ping)圣惠(hui)方(fang)》中(zhong)僅占極小的(de)(de)篇幅即(ji)可推(tui)知其在中(zhong)醫臨床的(de)(de)地位(wei)。至宋金元時期，尤其是(shi)朱(zhu)丹溪之后，痰(tan)證成(cheng)為雜病論治的(de)(de)主(zhu)要(yao)門類。開創了雜病治痰(tan)的(de)(de)新篇章。
仲(zhong)景(jing)(jing)所(suo)論(lun)(lun)(lun)(lun)之(zhi)(zhi)“痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)”是(shi)(shi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)與(yu)飲(yin)(yin)(yin)(yin)合(he)稱，治(zhi)(zhi)療上側重(zhong)于(yu)飲(yin)(yin)(yin)(yin)，至巢氏《病(bing)(bing)源》始(shi)將(jiang)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)與(yu)飲(yin)(yin)(yin)(yin)分(fen)論(lun)(lun)(lun)(lun)，而(er)其(qi)論(lun)(lun)(lun)(lun)述(shu)仍(reng)以(yi)(yi)飲(yin)(yin)(yin)(yin)為(wei)(wei)主(zhu)，“痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)病(bing)(bing)諸候(hou)”共(gong)16候(hou)，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)候(hou)僅5種(zhong)，飲(yin)(yin)(yin)(yin)候(hou)9種(zhong)，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)候(hou)2種(zhong)，宋·楊仁齋(zhai)在(zai)《直指(zhi)(zhi)方(fang)(fang)(fang)》中首次(ci)從(cong)形態、性質上將(jiang)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)、飲(yin)(yin)(yin)(yin)區分(fen)，“稠濁為(wei)(wei)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)，清稀為(wei)(wei)飲(yin)(yin)(yin)(yin)”，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)分(fen)論(lun)(lun)(lun)(lun)、分(fen)治(zhi)(zhi)之(zhi)(zhi)趨勢(shi)逐(zhu)漸顯現，在(zai)此(ci)基礎上，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)的(de)(de)(de)概念逐(zhu)漸擺脫(tuo)“水濕(shi)(shi)”的(de)(de)(de)束縛，不再(zai)單指(zhi)(zhi)實體(ti)(ti)(ti)的(de)(de)(de)概念，［2］形成(cheng)了(le)(le)(le)與(yu)仲(zhong)景(jing)(jing)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)論(lun)(lun)(lun)(lun)治(zhi)(zhi)理(li)(li)論(lun)(lun)(lun)(lun)有較(jiao)大差異的(de)(de)(de)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)理(li)(li)論(lun)(lun)(lun)(lun)體(ti)(ti)(ti)系(xi)。宋代官方(fang)(fang)(fang)修(xiu)訂的(de)(de)(de)著名(ming)方(fang)(fang)(fang)書《太平惠民和(he)劑(ji)(ji)局方(fang)(fang)(fang)》(簡(jian)稱《局方(fang)(fang)(fang)》，共(gong)載方(fang)(fang)(fang)788首)，而(er)且在(zai)卷一(yi)“治(zhi)(zhi)諸風(feng)”門(men)89首方(fang)(fang)(fang)中，從(cong)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)論(lun)(lun)(lun)(lun)治(zhi)(zhi)共(gong)有35首方(fang)(fang)(fang)；卷二(er)“治(zhi)(zhi)傷寒”門(men)及(ji)卷三“治(zhi)(zhi)一(yi)切氣(qi)(qi)(qi)(qi)(qi)(qi)”門(men)亦有不少是(shi)(shi)從(cong)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)而(er)治(zhi)(zhi)的(de)(de)(de)。所(suo)論(lun)(lun)(lun)(lun)臨(lin)床(chuang)表(biao)現涉(she)及(ji)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)熱(re)咳嗽、風(feng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)頭(tou)痛、風(feng)壅痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)盛(sheng)、神志昏憒、多(duo)(duo)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)好(hao)睡、痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)逆等，擴大了(le)(le)(le)以(yi)(yi)往(wang)“痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)飲(yin)(yin)(yin)(yin)”僅僅治(zhi)(zhi)飲(yin)(yin)(yin)(yin)的(de)(de)(de)狹窄的(de)(de)(de)臨(lin)床(chuang)應(ying)用(yong)(yong)范圍。其(qi)所(suo)載二(er)陳(chen)(chen)湯(tang)、平胃散(san)、參苓白術散(san)至今仍(reng)是(shi)(shi)臨(lin)床(chuang)治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)常用(yong)(yong)方(fang)(fang)(fang)劑(ji)(ji)。朱(zhu)丹(dan)(dan)溪(xi)(xi)(xi)正是(shi)(shi)繼承(cheng)《局方(fang)(fang)(fang)》治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)成(cheng)就的(de)(de)(de)基礎上發(fa)展了(le)(le)(le)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)理(li)(li)論(lun)(lun)(lun)(lun)。他認(ren)為(wei)(wei)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)隨(sui)氣(qi)(qi)(qi)(qi)(qi)(qi)升降，無處(chu)不到(dao)，可聚集在(zai)機體(ti)(ti)(ti)的(de)(de)(de)任何(he)部(bu)位(wei)而(er)致多(duo)(duo)種(zhong)病(bing)(bing)證(zheng)(zheng)(zheng)，故“百病(bing)(bing)兼痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)”，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)論(lun)(lun)(lun)(lun)治(zhi)(zhi)由(you)一(yi)證(zheng)(zheng)(zheng)突(tu)(tu)破(po)(po)到(dao)百病(bing)(bing)。其(qi)次(ci)，丹(dan)(dan)溪(xi)(xi)(xi)創(chuang)立“四傷學說”，以(yi)(yi)氣(qi)(qi)(qi)(qi)(qi)(qi)、血(xue)、痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)、郁為(wei)(wei)綱論(lun)(lun)(lun)(lun)治(zhi)(zhi)雜(za)病(bing)(bing)，形成(cheng)了(le)(le)(le)特點鮮明的(de)(de)(de)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)論(lun)(lun)(lun)(lun)治(zhi)(zhi)體(ti)(ti)(ti)系(xi)。從(cong)氣(qi)(qi)(qi)(qi)(qi)(qi)血(xue)的(de)(de)(de)角度闡釋了(le)(le)(le)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)郁形成(cheng)的(de)(de)(de)機理(li)(li)，“氣(qi)(qi)(qi)(qi)(qi)(qi)血(xue)沖(chong)和(he)，萬病(bing)(bing)不生，一(yi)有怫郁，諸病(bing)(bing)生焉”，“人之(zhi)(zhi)一(yi)身，血(xue)脈(mo)貫通如乾(qian)坤之(zhi)(zhi)旋(xuan)轉，江(jiang)河之(zhi)(zhi)流(liu)注(zhu)，一(yi)有不通則成(cheng)病(bing)(bing)”，說明氣(qi)(qi)(qi)(qi)(qi)(qi)血(xue)逆亂瘀滯是(shi)(shi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)郁產生的(de)(de)(de)根本，故治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)以(yi)(yi)行氣(qi)(qi)(qi)(qi)(qi)(qi)、調(diao)(diao)血(xue)為(wei)(wei)要。并(bing)在(zai)此(ci)基礎上形成(cheng)治(zhi)(zhi)氣(qi)(qi)(qi)(qi)(qi)(qi)用(yong)(yong)四君(jun)，治(zhi)(zhi)血(xue)用(yong)(yong)四物(wu)(wu)，治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)用(yong)(yong)二(er)陳(chen)(chen)，治(zhi)(zhi)郁用(yong)(yong)越鞠丸(wan)的(de)(de)(de)雜(za)病(bing)(bing)論(lun)(lun)(lun)(lun)治(zhi)(zhi)特色(se)。同時(shi)注(zhu)重(zhong)脾(pi)(pi)(pi)胃、肺胃等臟(zang)(zang)(zang)腑(fu)(fu)和(he)氣(qi)(qi)(qi)(qi)(qi)(qi)機的(de)(de)(de)調(diao)(diao)理(li)(li)，改(gai)變了(le)(le)(le)以(yi)(yi)往(wang)治(zhi)(zhi)飲(yin)(yin)(yin)(yin)只注(zhu)重(zhong)辨胸(xiong)膈、脅下、腸間等體(ti)(ti)(ti)位(wei)而(er)不及(ji)臟(zang)(zang)(zang)腑(fu)(fu)的(de)(de)(de)簡(jian)單方(fang)(fang)(fang)法。并(bing)總結了(le)(le)(le)“善治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)者，不治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)而(er)治(zhi)(zhi)氣(qi)(qi)(qi)(qi)(qi)(qi)，氣(qi)(qi)(qi)(qi)(qi)(qi)順則一(yi)身之(zhi)(zhi)津液亦隨(sui)氣(qi)(qi)(qi)(qi)(qi)(qi)而(er)順”的(de)(de)(de)理(li)(li)論(lun)(lun)(lun)(lun)，突(tu)(tu)破(po)(po)了(le)(le)(le)仲(zhong)景(jing)(jing)治(zhi)(zhi)飲(yin)(yin)(yin)(yin)單從(cong)溫化原則立法遣(qian)方(fang)(fang)(fang)用(yong)(yong)藥的(de)(de)(de)束縛。開創(chuang)了(le)(le)(le)以(yi)(yi)氣(qi)(qi)(qi)(qi)(qi)(qi)、血(xue)、痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)、郁雜(za)病(bing)(bing)證(zheng)(zheng)(zheng)治(zhi)(zhi)體(ti)(ti)(ti)系(xi)為(wei)(wei)理(li)(li)論(lun)(lun)(lun)(lun)特色(se)的(de)(de)(de)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)治(zhi)(zhi)理(li)(li)論(lun)(lun)(lun)(lun)。再(zai)者，作(zuo)為(wei)(wei)病(bing)(bing)理(li)(li)產物(wu)(wu)的(de)(de)(de)“痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)”，丹(dan)(dan)溪(xi)(xi)(xi)已將(jiang)其(qi)明確地概括為(wei)(wei)致病(bing)(bing)因素。指(zhi)(zhi)出“諸病(bing)(bing)多(duo)(duo)因痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)而(er)生”，“無痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)不作(zuo)眩”，表(biao)明痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)與(yu)六淫一(yi)樣是(shi)(shi)一(yi)種(zhong)致病(bing)(bing)因素，可以(yi)(yi)隨(sui)氣(qi)(qi)(qi)(qi)(qi)(qi)流(liu)動，停滯于(yu)不同部(bu)位(wei)為(wei)(wei)患，這正是(shi)(shi)“百病(bing)(bing)兼痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)”的(de)(de)(de)機理(li)(li)所(suo)在(zai)。從(cong)而(er)完成(cheng)了(le)(le)(le)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)從(cong)病(bing)(bing)證(zheng)(zheng)(zheng)概念到(dao)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)邪概念的(de)(de)(de)轉變。治(zhi)(zhi)療上，注(zhu)重(zhong)臟(zang)(zang)(zang)腑(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)(qi)機的(de)(de)(de)調(diao)(diao)理(li)(li)，主(zhu)張“實脾(pi)(pi)(pi)土，燥脾(pi)(pi)(pi)濕(shi)(shi)”，如《丹(dan)(dan)溪(xi)(xi)(xi)心法》中指(zhi)(zhi)出：“大凡治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)，用(yong)(yong)利(li)藥過多(duo)(duo)，致脾(pi)(pi)(pi)氣(qi)(qi)(qi)(qi)(qi)(qi)虛，則痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)易(yi)生而(er)多(duo)(duo)。”常用(yong)(yong)具(ju)有理(li)(li)氣(qi)(qi)(qi)(qi)(qi)(qi)健脾(pi)(pi)(pi)、燥濕(shi)(shi)化痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)功效的(de)(de)(de)二(er)陳(chen)(chen)湯(tang)，并(bing)稱之(zhi)(zhi)能治(zhi)(zhi)管一(yi)身之(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)。［3］臨(lin)證(zheng)(zheng)(zheng)上，二(er)陳(chen)(chen)湯(tang)既為(wei)(wei)治(zhi)(zhi)療濕(shi)(shi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)主(zhu)方(fang)(fang)(fang)，隨(sui)癥加減，亦廣泛應(ying)用(yong)(yong)于(yu)其(qi)他類型的(de)(de)(de)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)。至此(ci)，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)論(lun)(lun)(lun)(lun)治(zhi)(zhi)由(you)治(zhi)(zhi)飲(yin)(yin)(yin)(yin)為(wei)(wei)主(zhu)轉變為(wei)(wei)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)與(yu)飲(yin)(yin)(yin)(yin)的(de)(de)(de)分(fen)論(lun)(lun)(lun)(lun)、分(fen)治(zhi)(zhi)，到(dao)以(yi)(yi)治(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)為(wei)(wei)主(zhu)，從(cong)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)論(lun)(lun)(lun)(lun)治(zhi)(zhi)從(cong)一(yi)證(zheng)(zheng)(zheng)突(tu)(tu)破(po)(po)到(dao)百病(bing)(bing)，從(cong)注(zhu)重(zhong)體(ti)(ti)(ti)位(wei)辨證(zheng)(zheng)(zheng)發(fa)展到(dao)臟(zang)(zang)(zang)腑(fu)(fu)及(ji)氣(qi)(qi)(qi)(qi)(qi)(qi)血(xue)的(de)(de)(de)辨證(zheng)(zheng)(zheng)，形成(cheng)了(le)(le)(le)獨具(ju)特色(se)的(de)(de)(de)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)論(lun)(lun)(lun)(lun)治(zhi)(zhi)體(ti)(ti)(ti)系(xi)，是(shi)(shi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證(zheng)(zheng)(zheng)理(li)(li)論(lun)(lun)(lun)(lun)臨(lin)床(chuang)上的(de)(de)(de)一(yi)次(ci)重(zhong)大突(tu)(tu)破(po)(po)。
明(ming)清時(shi)期溫病(bing)治(zhi)痰臨床理論的成熟
明清醫家對痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)論(lun)(lun)(lun)(lun)(lun)的(de)(de)(de)(de)(de)論(lun)(lun)(lun)(lun)(lun)述(shu)亦頗多(duo)(duo)發(fa)揮，如(ru)(ru)明·張景(jing)岳指出(chu)，元氣(qi)虛損(sun)是(shi)(shi)生(sheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)(zhi)(zhi)根本，“若化(hua)失其正(zheng)(zheng)，則(ze)臟腑病(bing)(bing)(bing)，津(jin)(jin)(jin)液(ye)敗，而(er)血氣(qi)即成(cheng)(cheng)(cheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)涎(xian)……”，臨床注重(zhong)(zhong)(zhong)辨痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)(zhi)(zhi)虛實，治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療(liao)(liao)主(zhu)張應當溫(wen)(wen)(wen)(wen)(wen)(wen)脾強腎。喻昌(chang)在《醫門法律(lv)》中(zhong)提出(chu)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)四(si)法：實脾、燥(zao)濕(shi)、降火(huo)、行氣(qi)，從不(bu)同角度豐富(fu)了(le)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)論(lun)(lun)(lun)(lun)(lun)。隨著溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)學(xue)派的(de)(de)(de)(de)(de)興起(qi)，逐(zhu)漸(jian)認識到(dao)溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)挾痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)的(de)(de)(de)(de)(de)普遍性(xing)(xing)和重(zhong)(zhong)(zhong)要性(xing)(xing)，從痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)論(lun)(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)的(de)(de)(de)(de)(de)論(lun)(lun)(lun)(lun)(lun)述(shu)亦逐(zhu)漸(jian)增(zeng)多(duo)(duo)，并不(bu)斷(duan)成(cheng)(cheng)(cheng)熟和完善，形(xing)成(cheng)(cheng)(cheng)了(le)與(yu)雜(za)病(bing)(bing)(bing)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)截然不(bu)同的(de)(de)(de)(de)(de)論(lun)(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)論(lun)(lun)(lun)(lun)(lun)。痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證論(lun)(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)范疇也(ye)由(you)雜(za)病(bing)(bing)(bing)突破到(dao)外感溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證理(li)論(lun)(lun)(lun)(lun)(lun)得(de)到(dao)進一步發(fa)展。溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)是(shi)(shi)由(you)溫(wen)(wen)(wen)(wen)(wen)(wen)熱(re)(re)病(bing)(bing)(bing)邪引起(qi)以發(fa)熱(re)(re)為(wei)(wei)(wei)主(zhu)癥，具有熱(re)(re)象(xiang)偏重(zhong)(zhong)(zhong)、易化(hua)燥(zao)傷(shang)陰(yin)等(deng)(deng)特點的(de)(de)(de)(de)(de)一類急(ji)性(xing)(xing)外感熱(re)(re)。因此，陰(yin)津(jin)(jin)(jin)損(sun)傷(shang)貫(guan)穿于溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)的(de)(de)(de)(de)(de)始終(zhong)，治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療(liao)(liao)上注重(zhong)(zhong)(zhong)護陰(yin)、養陰(yin)是(shi)(shi)溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)的(de)(de)(de)(de)(de)臨床特點。然而(er)熱(re)(re)灼(zhuo)(zhuo)津(jin)(jin)(jin)液(ye)易煉(lian)液(ye)為(wei)(wei)(wei)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)；溫(wen)(wen)(wen)(wen)(wen)(wen)邪入(ru)侵(qin)(qin)易致(zhi)氣(qi)機郁滯(zhi)，津(jin)(jin)(jin)液(ye)不(bu)能正(zheng)(zheng)常布散，停(ting)滯(zhi)為(wei)(wei)(wei)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)；且又有平素(su)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)盛體(ti)質者(zhe)(zhe)，則(ze)多(duo)(duo)挾痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)為(wei)(wei)(wei)病(bing)(bing)(bing)。故痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證的(de)(de)(de)(de)(de)論(lun)(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)為(wei)(wei)(wei)溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)學(xue)家所(suo)重(zhong)(zhong)(zhong)視。溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)大致(zhi)有三個方面，一為(wei)(wei)(wei)患者(zhe)(zhe)素(su)有停(ting)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)伏飲，溫(wen)(wen)(wen)(wen)(wen)(wen)邪侵(qin)(qin)入(ru)與(yu)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)互結，形(xing)成(cheng)(cheng)(cheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證。如(ru)(ru)葉天士《溫(wen)(wen)(wen)(wen)(wen)(wen)熱(re)(re)論(lun)(lun)(lun)(lun)(lun)》云“平素(su)心虛有痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)，外熱(re)(re)一陷(xian)，里絡就閉。”二為(wei)(wei)(wei)留連(lian)氣(qi)分，三焦氣(qi)化(hua)失司，津(jin)(jin)(jin)液(ye)失去正(zheng)(zheng)常布化(hua)，聚而(er)成(cheng)(cheng)(cheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)。三為(wei)(wei)(wei)感受溫(wen)(wen)(wen)(wen)(wen)(wen)熱(re)(re)之(zhi)(zhi)(zhi)(zhi)(zhi)邪后，熱(re)(re)邪內熾(chi)，煎熬(ao)津(jin)(jin)(jin)液(ye)而(er)成(cheng)(cheng)(cheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)。溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)根據病(bing)(bing)(bing)因及臨床表現(xian)的(de)(de)(de)(de)(de)不(bu)同，可分為(wei)(wei)(wei)熱(re)(re)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)、燥(zao)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)、風痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)、濕(shi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)等(deng)(deng)，但溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)的(de)(de)(de)(de)(de)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證并非(fei)都以痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)為(wei)(wei)(wei)主(zhu)，而(er)往(wang)往(wang)是(shi)(shi)其他(ta)證型(xing)的(de)(de)(de)(de)(de)兼夾證。［4］正(zheng)(zheng)如(ru)(ru)《臨證指南醫案》所(suo)謂：“痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)乃病(bing)(bing)(bing)之(zhi)(zhi)(zhi)(zhi)(zhi)標，非(fei)病(bing)(bing)(bing)之(zhi)(zhi)(zhi)(zhi)(zhi)本也(ye)，善治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)者(zhe)(zhe)，治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)其所(suo)以生(sheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)(zhi)(zhi)源，則(ze)不(bu)消痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)而(er)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)自無(wu)矣。”故在治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療(liao)(liao)溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)挾痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)時(shi)，常以他(ta)法為(wei)(wei)(wei)主(zhu)而(er)配合化(hua)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)(zhi)(zhi)法，或(huo)直治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)其成(cheng)(cheng)(cheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)(zhi)(zhi)因，其用(yong)藥(yao)大多(duo)(duo)選用(yong)輕靈流動之(zhi)(zhi)(zhi)(zhi)(zhi)品，且用(yong)量宜小，如(ru)(ru)此才有助于正(zheng)(zheng)氣(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)流行，氣(qi)機之(zhi)(zhi)(zhi)(zhi)(zhi)宣散，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)濁(zhuo)之(zhi)(zhi)(zhi)(zhi)(zhi)漸(jian)消。常用(yong)的(de)(de)(de)(de)(de)藥(yao)物(wu)有瓜(gua)蔞、杏仁、冬瓜(gua)子、絲瓜(gua)絡、天花粉、竹茹、天竺黃、菖蒲、貝母(mu)等(deng)(deng)，這些藥(yao)物(wu)大都有清熱(re)(re)滌(di)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)(zhi)(zhi)功，確為(wei)(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)挾痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)(zhi)(zhi)常用(yong)藥(yao)物(wu)。在溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)的(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療(liao)(liao)中(zhong)，從痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)論(lun)(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)急(ji)性(xing)(xing)熱(re)(re)病(bing)(bing)(bing)及重(zhong)(zhong)(zhong)癥，是(shi)(shi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證理(li)論(lun)(lun)(lun)(lun)(lun)的(de)(de)(de)(de)(de)重(zhong)(zhong)(zhong)要突破。如(ru)(ru)熱(re)(re)陷(xian)心包證，邪熱(re)(re)熾(chi)盛，發(fa)病(bing)(bing)(bing)急(ji)驟，耗血傷(shang)津(jin)(jin)(jin)，灼(zhuo)(zhuo)津(jin)(jin)(jin)成(cheng)(cheng)(cheng)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)，痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)熱(re)(re)蒙蔽(bi)心包，癥見神(shen)昏譫語或(huo)昏憒(kui)不(bu)語、痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)壅氣(qi)阻、身灼(zhuo)(zhuo)熱(re)(re)等(deng)(deng)急(ji)癥，治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療(liao)(liao)常用(yong)清心滌(di)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)開竅之(zhi)(zhi)(zhi)(zhi)(zhi)法，方用(yong)安宮牛黃丸或(huo)至寶丹、紫雪丹等(deng)(deng)，無(wu)不(bu)體(ti)現(xian)了(le)從痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)而(er)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)特色(se)，突破了(le)僅從痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)論(lun)(lun)(lun)(lun)(lun)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)雜(za)病(bing)(bing)(bing)的(de)(de)(de)(de)(de)局限(xian)。治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)法上亦有了(le)進一步的(de)(de)(de)(de)(de)拓(tuo)展，如(ru)(ru)熱(re)(re)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)清之(zhi)(zhi)(zhi)(zhi)(zhi)，燥(zao)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)潤之(zhi)(zhi)(zhi)(zhi)(zhi)，風痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)散之(zhi)(zhi)(zhi)(zhi)(zhi)，濕(shi)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)燥(zao)之(zhi)(zhi)(zhi)(zhi)(zhi)等(deng)(deng)，顯示了(le)溫(wen)(wen)(wen)(wen)(wen)(wen)病(bing)(bing)(bing)痰(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)(tan)證獨特的(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)療(liao)(liao)特色(se)。
參考文獻
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廣西中(zhong)醫學院(yuan)(南寧，530001)秦生發(fa) 指導 蔣應時
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