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冬病夏治,養陽防病

醫(yi)案日記 2023-04-30 18:54:10

董瑞 北京康(kang)益德中西醫結合醫院

“冬(dong)病(bing)(bing)夏治”是指冬(dong)天易發生的疾(ji)病(bing)(bing)或(huo)冬(dong)天癥狀加重的疾(ji)病(bing)(bing),在病(bing)(bing)情相對緩解的夏季進行調治補(bu)養以(yi)達到減緩發作乃至控制的一(yi)種(zhong)特殊療法(fa)。

“冬(dong)病”包括(kuo)呼吸(xi)、循(xun)環、消化、免疫等(deng)多(duo)種疾病,它的病機特點是(shi)陽氣不足,“夏(xia)治(zhi)”是(shi)在(zai)夏(xia)天或長夏(xia)炎熱的時間選用(yong)適宜(yi)的中(zhong)醫(yi)方(fang)術(shu)加以預防與治(zhi)療,包括(kuo)內(nei)服中(zhong)藥、中(zhong)藥外(wai)敷、中(zhong)藥外(wai)治(zhi),食(shi)療、艾灸等(deng)多(duo)種綜(zong)合手段。在(zai)我國使用(yong)冬(dong)病夏(xia)治(zhi)已(yi)有2000多(duo)年(nian)的歷史,從1973年(nian)在(zai)長沙馬王堆漢墓出土(tu)的《五十二病方(fang)》,漢代(dai)(dai)張仲景《傷寒(han)雜病論》,唐代(dai)(dai)孫思邈《千金(jin)要(yao)方(fang)》,宋(song)代(dai)(dai)劉(liu)翰《開寶本草》,明(ming)代(dai)(dai)李時珍《本草綱目(mu)》,清代(dai)(dai)的吳(wu)尚先《理瀹(yue)駢文》對中(zhong)醫(yi)“冬(dong)病夏(xia)治(zhi)”都有不同的描述(shu)和記載(zai),只是(shi)沒有提及“冬(dong)病夏(xia)治(zhi)”這一詞。

真正“冬(dong)病夏治(zhi)”的(de)(de)高峰到來是在新中(zhong)國成立(li)后(hou),在黨的(de)(de)中(zhong)醫(yi)(yi)政策(ce)扶持下,我國各級中(zhong)醫(yi)(yi)醫(yi)(yi)療機構、民間(jian)(jian)診所均(jun)已開展(zhan)了此項工作,并形成了“冬(dong)病夏治(zhi)”防治(zhi)體系(xi),中(zhong)醫(yi)(yi)“冬(dong)病夏治(zhi)”工作逐步走向(xiang)正規化、標準化、規范化的(de)(de)道(dao)路(lu),該療法已由民間(jian)(jian)走向(xiang)正統。

冬病夏治的理論基礎

“冬病夏治“的理論觀點以《黃帝內經》為基礎,有三方面學說是總(zong)的指導思想。其一“春夏養陽(yang)、秋(qiu)冬養陰(yin)”的平衡(heng)觀(guan)點;其二不治已(yi)病(bing)治未病(bing)的“正氣內存(cun),邪(xie)不可(ke)干”正氣學說觀(guan)點;其三“人(ren)以天(tian)地之氣生,四時之法(fa)成”的天(tian)人(ren)相應觀(guan)點。

“陽(yang)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)者,若天(tian)日(ri)”《內經》將陽(yang)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)喻為天(tian)上的太陽(yang),天(tian)上的光明依(yi)賴于太陽(yang),人體的安康依(yi)賴于陽(yang)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi),“陽(yang)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)”推(tui)動(dong)人體生(sheng)(sheng)命運(yun)動(dong),保持溫度,推(tui)動(dong)水谷(gu)之(zhi)運(yun)化(hua)(hua),推(tui)動(dong)大小便排(pai)泄,像(xiang)衛士(shi)一樣防(fang)御體外之(zhi)邪(xie)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)、邪(xie)風,一旦陽(yang)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)受損,就會百病(bing)(bing)叢生(sheng)(sheng)。因此(ci)無論(lun)“慢(man)支、哮(xiao)喘、肺氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)腫、肺纖維化(hua)(hua)”等呼吸(xi)病(bing)(bing)及循環(huan)、消化(hua)(hua)、免疫(yi)系統疾(ji)病(bing)(bing),還是其他系統疾(ji)病(bing)(bing),陽(yang)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)虛損為之(zhi)根本,“冬病(bing)(bing)夏治”目的就是,選用適(shi)宜方術在春、夏使得陽(yang)氣(qi)(qi)(qi)(qi)(qi)(qi)(qi)(qi)充實,而達陰平陽(yang)秘(mi)之(zhi)目的。

陽(yang)(yang)(yang)(yang)指人體(ti)(ti)之(zhi)(zhi)(zhi)(zhi)(zhi)陽(yang)(yang)(yang)(yang)氣(qi)(qi),“陽(yang)(yang)(yang)(yang)氣(qi)(qi)”之(zhi)(zhi)(zhi)(zhi)(zhi)根是(shi)(shi)(shi)(shi)指元(yuan)陽(yang)(yang)(yang)(yang),是(shi)(shi)(shi)(shi)一(yi)身之(zhi)(zhi)(zhi)(zhi)(zhi)陽(yang)(yang)(yang)(yang)之(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)。另(ling)有衛(wei)(wei)陽(yang)(yang)(yang)(yang)、肺(fei)陽(yang)(yang)(yang)(yang)、脾陽(yang)(yang)(yang)(yang)、腎陽(yang)(yang)(yang)(yang)等(deng)陽(yang)(yang)(yang)(yang)氣(qi)(qi)”。“元(yuan)陽(yang)(yang)(yang)(yang)”與“衛(wei)(wei)陽(yang)(yang)(yang)(yang)”之(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)又是(shi)(shi)(shi)(shi)陽(yang)(yang)(yang)(yang)之(zhi)(zhi)(zhi)(zhi)(zhi)根本,疾(ji)病的(de)發生,纏綿不(bu)愈均是(shi)(shi)(shi)(shi)二陽(yang)(yang)(yang)(yang)之(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)生化(hua)(hua)(hua)不(bu)足(zu)而(er)致(zhi)。二陽(yang)(yang)(yang)(yang)的(de)來(lai)源,“元(yuan)陽(yang)(yang)(yang)(yang)”是(shi)(shi)(shi)(shi)為先天(tian)之(zhi)(zhi)(zhi)(zhi)(zhi)腎精而(er)化(hua)(hua)(hua)生,為腎之(zhi)(zhi)(zhi)(zhi)(zhi)本;“衛(wei)(wei)陽(yang)(yang)(yang)(yang)”是(shi)(shi)(shi)(shi)脾胃運化(hua)(hua)(hua)水谷精微而(er)化(hua)(hua)(hua)生之(zhi)(zhi)(zhi)(zhi)(zhi),行于脈外(wai)。前者(zhe)統(tong)領一(yi)身純陽(yang)(yang)(yang)(yang)之(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi),后者(zhe)防御、護(hu)衛(wei)(wei)人之(zhi)(zhi)(zhi)(zhi)(zhi)人體(ti)(ti)。所(suo)以(yi)“春(chun)(chun)夏養陽(yang)(yang)(yang)(yang)”目(mu)的(de)就(jiu)是(shi)(shi)(shi)(shi)讓元(yuan)陽(yang)(yang)(yang)(yang)化(hua)(hua)(hua)之(zhi)(zhi)(zhi)(zhi)(zhi)充足(zu);“衛(wei)(wei)陽(yang)(yang)(yang)(yang)”之(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)充盛;而(er)達到預防和治療呼吸及(ji)其他系(xi)統(tong)疾(ji)病。這(zhe)乃為“春(chun)(chun)夏養陽(yang)(yang)(yang)(yang)”之(zhi)(zhi)(zhi)(zhi)(zhi)“道”也(ye),春(chun)(chun)夏養陽(yang)(yang)(yang)(yang)”重點在化(hua)(hua)(hua)生“衛(wei)(wei)陽(yang)(yang)(yang)(yang)”和“元(yuan)陽(yang)(yang)(yang)(yang)”之(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)。

冬病夏治的適應癥(zheng)與禁忌癥(zheng)

冬病夏(xia)治效(xiao)果最為(wei)理(li)想(xiang)的是呼吸(xi)系統(tong)(tong)疾病,還有(you)循環(huan)、消化(hua)、免疫系統(tong)(tong)疾病。其適應癥(zheng)主(zhu)要有(you)慢性支氣(qi)管炎(yan)(yan)、支氣(qi)管哮喘(chuan)、肺氣(qi)腫、慢性阻(zu)塞性肺疾病、過敏性鼻炎(yan)(yan)、變異性咳(ke)(ke)嗽、類風濕性關(guan)節炎(yan)(yan)、胃炎(yan)(yan)等中醫辨證屬(shu)陽虛為(wei)主(zhu),或(huo)寒(han)(han)(han)熱(re)錯雜以寒(han)(han)(han)為(wei)主(zhu)的患(huan)(huan)者;也適用(yong)于怕(pa)(pa)冷、怕(pa)(pa)風、平素易感(gan)冒(mao)或(huo)冬季(ji)反復感(gan)冒(mao)的虛寒(han)(han)(han)體(ti)質(zhi)的患(huan)(huan)者。此類患(huan)(huan)者常見癥(zheng)狀(zhuang)(zhuang)有(you):咳(ke)(ke)、喘(chuan)反復發(fa)作(zuo),鼻涕、痰(tan)液(ye)清稀(xi)而白,背部怕(pa)(pa)寒(han)(han)(han),冬季(ji)及受寒(han)(han)(han)后癥(zheng)狀(zhuang)(zhuang)明顯加重(zhong),舌質(zhi)淡紅,苔薄(bo)白或(huo)薄(bo)黃,脈弦、緊或(huo)滑。需要注意的是,支氣(qi)管擴張(zhang)、活(huo)動(dong)性肺結核咳(ke)(ke)血患(huan)(huan)者、孕(yun)婦禁(jin)用(yong)冬病夏(xia)治膏藥;糖尿病患(huan)(huan)者血糖控制不佳(jia)者、瘢痕體(ti)質(zhi)者、皮膚過敏者要慎(shen)用(yong)冬病夏(xia)治膏藥。

冬病夏治的時間

我國從公(gong)元(yuan)前776年至今,流行“干支紀日(ri)(ri)(ri)(ri)(ri)(ri)(ri)法(fa)(fa)”,即是把天(tian)(tian)(tian)干的(de)(de)甲乙(yi)丙(bing)丁戊己庚(geng)辛壬(ren)癸、地支的(de)(de)子(zi)丑(chou)寅(yin)卯辰巳午未申酉戌(xu)亥各取(qu)一(yi)(yi)個字(zi)結合而(er)得甲子(zi)、乙(yi)丑(chou)、丙(bing)寅(yin)……等六十組的(de)(de)不同名稱(cheng)來記(ji)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)子(zi),每逢有(you)(you)(you)“庚(geng)”字(zi)的(de)(de)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)子(zi)叫“庚(geng)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)”。秦漢時盛行“五(wu)行生克(ke)”的(de)(de)說法(fa)(fa),認為(wei)最熱的(de)(de)夏(xia)(xia)天(tian)(tian)(tian)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)子(zi)屬火(huo)(huo),而(er)庚(geng)屬金,火(huo)(huo)克(ke)金(金怕火(huo)(huo)燒(shao)融),所以到庚(geng)日(ri)(ri)(ri)(ri)(ri)(ri)(ri),金必伏(fu)藏。于是就(jiu)規定從夏(xia)(xia)至日(ri)(ri)(ri)(ri)(ri)(ri)(ri)(陽歷6月(yue)21日(ri)(ri)(ri)(ri)(ri)(ri)(ri)或22日(ri)(ri)(ri)(ri)(ri)(ri)(ri))后第三(san)(san)庚(geng)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)為(wei)初伏(fu)(有(you)(you)(you)十天(tian)(tian)(tian)),第四庚(geng)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)為(wei)中(zhong)伏(fu)(有(you)(you)(you)的(de)(de)年是十天(tian)(tian)(tian),有(you)(you)(you)的(de)(de)年是二(er)十天(tian)(tian)(tian)),立秋(陽歷8月(yue)7日(ri)(ri)(ri)(ri)(ri)(ri)(ri)或8日(ri)(ri)(ri)(ri)(ri)(ri)(ri))后第一(yi)(yi)庚(geng)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)為(wei)三(san)(san)伏(fu),有(you)(you)(you)十天(tian)(tian)(tian)。這樣,三(san)(san)伏(fu)就(jiu)有(you)(you)(you)固定的(de)(de)日(ri)(ri)(ri)(ri)(ri)(ri)(ri)期了。從此(ci)推斷出2011年冬病夏(xia)(xia)治(zhi)治(zhi)療最佳日(ri)(ri)(ri)(ri)(ri)(ri)(ri)期為(wei):7月(yue)14日(ri)(ri)(ri)(ri)(ri)(ri)(ri),7月(yue)24日(ri)(ri)(ri)(ri)(ri)(ri)(ri),8月(yue)13日(ri)(ri)(ri)(ri)(ri)(ri)(ri)。

冬病夏治治療方法

“冬(dong)病(bing)(bing)(bing)夏(xia)治”是(shi)指冬(dong)天(tian)易(yi)發生的(de)疾(ji)病(bing)(bing)(bing)或冬(dong)天(tian)癥狀加重的(de)疾(ji)病(bing)(bing)(bing),在(zai)病(bing)(bing)(bing)情相對緩(huan)解的(de)夏(xia)季,尤其(qi)是(shi)酷暑(shu)三伏(fu)天(tian)選以大(da)新大(da)熱之藥,配以任(ren)督二脈為(wei)主經(jing),選足太陽膀(bang)胱經(jing),足陽明胃經(jing),足少陰(yin)腎經(jing),手太陽肺經(jing)為(wei)輔經(jing),施(shi)以治療的(de)一種方(fang)法。自國家衛生部、中(zhong)醫(yi)藥管理(li)局推廣的(de)十年百項(xiang)適宜技術“FBP”方(fang)案防治呼(hu)吸病(bing)(bing)(bing)實(shi)施(shi)以來(lai)更(geng)規范了冬(dong)病(bing)(bing)(bing)夏(xia)治在(zai)治療呼(hu)吸病(bing)(bing)(bing)中(zhong)的(de)應用,“F”是(shi)指穴位敷膏;“B”是(shi)指穴位拔罐;“P”是(shi)指辨證(zheng)口(kou)服中(zhong)藥。

冬病夏治注意事項

一是慎用辛燥之品,以(yi)防傷陰(yin)。夏季氣候炎熱(re),易傷陰(yin)液,而(er)辛溫香(xiang)(xiang)燥之品容(rong)易導致(zhi)燥熱(re)內盛,暗耗(hao)津精,所以(yi)應慎食肉(rou)桂(gui)、花椒(jiao)、大茴香(xiang)(xiang)、小茴香(xiang)(xiang)、狗肉(rou)、羊肉(rou)和新鮮桂(gui)圓或荔(li)枝等等。

二是忌(ji)大(da)量服用寒涼(liang)(liang)之品。夏季炎熱,往往易(yi)貪涼(liang)(liang)飲冷,若大(da)量進食寒涼(liang)(liang)之品,則易(yi)致中陽(yang)受損,脾胃虛弱(ruo),甚至損及(ji)一(yi)身(shen)之陽(yang)氣,輕則泄瀉腹(fu)痛、惡心嘔吐,重(zhong)則造成陽(yang)虛宿疾。

三(san)是慎(shen)食大量肥甘(gan)滋膩之(zhi)(zhi)(zhi)品。夏季(ji)易(yi)生暑濕,濕熱(re)之(zhi)(zhi)(zhi)邪易(yi)侵襲人體,若服用(yong)大量肥甘(gan)之(zhi)(zhi)(zhi)品,則易(yi)導致內外濕熱(re)之(zhi)(zhi)(zhi)邪合擊人體。

四是忌過量運動。以免汗出(chu)過多,導(dao)致氣陰兩虛(xu)。

治療后最好不(bu)要去空調房,因為遇(yu)冷會(hui)使毛孔收(shou)縮,影響(xiang)藥物吸收(shou);也不(bu)要劇烈活動。還要注(zhu)意的是(shi)飲(yin)食,貼(tie)敷(fu)的當(dang)天最好不(bu)要吃冷飲(yin)以及冰(bing)鎮的食品。如果貼(tie)敷(fu)部位出現水(shui)泡了,盡量不(bu)要揭(jie)皮,也不(bu)要包扎,可到(dao)治療科室進行相(xiang)應的治療,穿干凈、柔軟(ruan)、透氣的全棉衣(yi)服,一般3~5天就會(hui)痊愈。

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