咳痰（三）

姜淑香@秋日雏菊

三、病机论外感或内伤所致的咳嗽，均累及肺脏受病，由肺气不清失于宣肃所致，故《景岳全书•咳嗽》说：“咳证虽多，无非肺病。”《医学心悟》指出：“肺体属金，譬若钟然，钟非叩不鸣，风寒暑湿燥火六淫之邪，自外击之则鸣，劳欲情志，饮食炙搏之火自内攻之则亦鸣。”提示咳嗽是内、外病邪犯肺，肺脏为了祛邪外达所产生的一种病理反应。 外感咳嗽属于邪实，为外邪犯肺，肺气壅遏不畅所致，若不能及时使邪外达，可进一步发生演变转化，表现风寒化热、风热化燥，或肺热蒸液成痰等情况。(风寒袭肺，风热犯肺，风燥伤肺，燥热伤肺) 内伤咳嗽多属邪实与正虚并见。病理因素主要为“痰”与“火”。但痰有寒热之别，火有虚实之分；痰可郁而化火，火能炼液灼津为痰。他脏及肺者，多因邪实导致正虚，如肝火犯肺每见气火耗伤肺津，炼液为痰。痰湿犯肺者，多因脾失健运，水谷不能化为精微上输以养肺，反而聚为痰浊，上贮于肺，肺气窒塞，上逆为咳。若病久，肺脾两虚，气不化津，则痰浊更易滋生，此即“脾为生痰之源，肺为贮痰之器”的道理。甚者病延及肾，由咳至喘。如痰湿蕴肺，遇外感而引触，转从热化，则可表现为痰热咳嗽；若转从寒化，则可表现为寒痰咳嗽。至于肺脏自病的咳嗽则多因虚致实。如肺阴不足每致阴虚火旺，灼津为痰，肺失濡润，气逆作咳，或肺气亏虚，肃降无权，气不化津，津聚成痰，气逆于上，引起咳嗽。（痰温蕴肺、痰热郁肺、肝火犯肺、肺阴亏耗、肺气虚寒、寒饮犯肺） 外感咳嗽与内伤咳嗽还可相互影响为病，病久则邪实转为正虚。外感咳嗽如迁延失治，邪伤肺气，更易反复感邪，而致咳嗽屡作，转为内伤咳嗽；肺脏有病，卫外不固，易受外邪引发或加重，特别在气候变化时尤为明显。久则从实转虚，肺脏虚弱，阴伤气耗。由此可知，咳嗽虽有外感、内伤之分，但有时两者又可互为因果。 四、辨症：辨外感内伤外感咳嗽，多为新病，起病急，病程短，常伴肺卫表证。内伤咳嗽，多为久病，常反复发作，病程长，可伴见它脏见证。 辨证候虚实外感咳嗽以风寒、风热、风燥为主均属实，而内伤咳嗽中的痰湿、痰热、肝火多为邪实正应。阴津亏耗咳嗽则属虚，或虚中夹实。 五、治疗原则咳嗽的治疗应分清邪正虚实。外感咳嗽，多为实证，应祛邪利肺，按病邪性质分风寒、风热、风燥论治。内伤咳嗽，多属邪实正虚，治以祛邪止咳，扶正补虚，标本兼顾，分清虚实主次处理。 咳嗽的治疗，除直接治肺外，还应从整体出发注意治脾、治肝、治肾等。外感咳嗽一般均忌敛涩留邪，当因势利导，候肺气宣扬则咳嗽自止；内伤咳嗽应防宣散伤正，从调护正气着眼。咳嗽是人体祛邪外达的一种病理表现，治疗决不能单纯见咳止咳，必须按照不同的病因分别处理。 青岛环语翻译公司业务联系电话：15588617120 联系人：姜淑香QQ邮箱：634363114@qq.com微信：qq634363114 Expectoration（3）Pathogenesis: on the cough caused by exogenous factors or endogenous injury, all involve lung disease, caused by lung qi losing in dispersing and descending, so “Complete Book of Jing Yue on Cough, said: “ Although there are many cough syndromes, nothing but lung disease. ” In modern traditional Chinese medicine, it points out that lung belongs to metal, like a bell, which doesn’t ring, until six exogenous pathogenic factors, such as wind, cold, heat, dampness, dryness, and fire, beat from the outside, it can ring, and endogenous pathogenic factors, such as fatigue, desire, emotions and fire from eating, attack from the inside, it can ring. It is suggested that cough is a pathological reaction caused by exogenous and endogenous pathogenic factors invading lung and the lungs bring the pathogenic factors outward. Exogenous cough belongs to the predominance of pathogenic factor due to external evils invading lung, causing the obstruction and unsmooth lung-qi, and if the external evils cannot be dispelled timely, it can further evolved and transformed, manifested by the wind and cold transforming into heat, the wind and heat transforming into dryness, or lung heat steaming liquid into phlegm and other conditions. Endogenous injury cough belongs to the combination of pathogenic factor and causative factor. The main pathological factors were “phlegm” and “fire”, but phlegm can be cold or hot, and fire can be false or real, because phlegm can be depressed and transformed into fire, fire can condense liquid and burn fluid into phlegm. Other internal organs involve lung, mainly because pathogenic factor leads to the deficiency of anti-pathogenic ability. For example, if liver fire invading lung, it is frequently seen in lung saliva exhausted and damaged by qi and fire, and the saliva condensed into phlegm. If phlegm and dampness attack lung, it is mostly due to spleen failing in transportation, and failing to digest food and absorb food essence and distribute nutrients to the lungs, causing accumulation of phlegm and turbidity instead, which store in the lung, causing obstruction of lung qi and adverse rising of lung-qi to cough. If disease lingers, deficiency of the lung and spleen, and failure of qi transforming fluid, are more likely to breed phlegm and turbidity, and this is the truth that “the spleen is the source of phlegm, and the lung is the reservoir of phlegm”. Even more, if the disease extends to the kidney, the cough is becoming into asthma. If phlegm and dampness accumulate in the lung, for the exogenous sensation of heat or cold which can be transformed into the cough, it is manifested by either phlegm heat or cold phlegm, and for the cough caused by the lung disease itself, the pathogenic factors are frequently due to excess syndromes by deficiency. For example, the deficiency of lung-yin leads to fire-hyperactivity due to Yin deficiency, because the formation of phlegm is condensed by liquid, and for the lungs failing in moistening, qi reverse causes cough, or for the deficiency of lung qi, lung qi failing in purification and in transforming fluid, accumulated fluid into phlegm, and lung qi upward reversal, it causes cough. Exogenous cough and Endogenous injury cough can also affect each other as a pathogenic factor, the disease for a long time will make a change from excessive pathogen to deficiency of anti-pathogenic ability. If exogenous cough extends and not be treated in time, the pathogenic factor impairs lung qi, and it can also be easier to recurrently attack, causing cough repeatedly, and exogenous cough transforming into internal injury cough. Lung disease is due to unstable protection outside, easy to be induced by external evil or aggravated, especially when climate change is particularly obvious. Transforming from excessive pathogenic factor into deficiency of anti-pathogenic ability after prolonged illness, the lungs become weak, accompanied by yin-impairment and qi-exhausting. It can be seen that although cough has exogenous sensation and endogenous injury, the two sometimes can be cause and effect each other. Symptom differentiation:Differentiation of exogenous factors and endogenous injury: exogenous cough is mostly a new disease with acute onset and short course, often accompanied by exogenous pathogenic factors attacking lung. Endogenous injury cough is mostly seen in a prolonged illness, often repeated attacks, with a long duration, and accompanied by other organs symptoms. Differentiation of actual situation: exogenous cough is mainly wind-cold, wind-heat, and wind-dryness, which belongs to excessive pathogenic factor, but, endogenous injury cough with phlegm-dampness, phlegm-heat, and liver-fire mostly belongs to deficiency of anti-pathogenic ability. Beside, cough caused by yin-body fluid deficiency and exhausting belongs to deficiency of anti-pathogenic ability, or deficiency of anti-pathogenic ability mixed with excessive pathogenic factor. Therapeutic principle: the treatment of cough should distinguish between pathogenic factor and deficiency of anti-pathogenic ability. Exogenous cough is mostly pathogenic factors and should remove pathogenic factors for benefiting lung, according to the nature of pathogenic factors to treat, such as, wind-cold, wind-heat, and wind-dryness. Endogenous injury cough is with both pathogenic factor and deficiency of anti-pathogenic ability, can be treated by eliminating pathogenic factors and relieving a cough, supporting the anti-pathogenic ability and supplementing deficiency, giving consideration to address both symptoms and root causes , distinguish the primary and secondary treatment of deficiency and reality. Treatment of cough, in addition to direct treatment of lung, should integrally consider to the treatment of spleen, liver, kidney and so on. Exogenous cough should avoid a delayed disease and staying evils. It is advisable to help dispersing and promoting of lung qi according to the actual situations. Endogenous injury cough should avoid the impairment of anti-pathogenic ability by dispersing and scattering and it is advisable to focus on the adjusting and supporting of the anti-pathogenic ability. Cough is a pathological manifestation of human body to remove pathogens. So the treatment should not only relief cough after have a cough, but also be treated according to different causes. Qingdao Global language translation CompanyBusiness Call: 15588617120Contact person: Jiang ShuxiangQQ E-mail: 634363114@qq.comWeChat:qq634363114