淺談外感咳嗽的中醫臨床研究進展

Clinical Research and Development of Chinese Medicine in Coughing

10.30127/BTWZYYXZZ.201006.0004

吳忠儒(Chung-Ju Wu)

咳嗽 ； 病因病機 ； 辨證論治 ； Coughing ； Etiology and Pathogenesis ； Treatment according to Syndrome Differentiation

北台灣中醫醫學雜誌

2卷1期（2010 / 06 / 01）

65 - 86

繁體中文

咳嗽是指肺失宣降，肺氣上逆，發出咳聲，或咳吐痰液的一種肺系病證。《素問‧宣明五氣篇》云：“五氣所病……肺為咳。”咳嗽既是肺系疾病的主要症狀之一，也是獨立性的疾病。俗諺：“水泥匠怕補屋漏，醫生怕治咳嗽。”這是由於咳嗽的病因不一，容易施治誤治傳變，影響診斷的正確性。引起咳嗽的病因可分為外感和內傷兩類，外感咳嗽起病急，病程短，由風、寒、暑、濕、燥、火等六淫外邪犯肺所致；內傷咳嗽則因飲食不節、情志內傷使肺臟虛損或其他臟腑病變累及肺臟所致。現代醫家對於咳嗽的治療積累了大量的臨床經驗，根據咳嗽的病因病機、四時主氣不同，進行了辨證治療。外邪干肺咳嗽，治療上多以宣通肺氣，疏散外邪為法，使用宣肺清肺止咳，兼以疏風、散寒、清熱、瀉火、潤燥、化痰等藥物；內邪傷肺咳嗽，治療上多以祛邪扶正，標本兼顧為法，常用清火、去痰、益氣、養血、滋陰、補陽等藥物。

Couching is one of major pulmonary symptom with mechanisms of pulmonary dysfunction of expiration and inspiration and air uprising from the lungs with sound of coughing, which stimulates the reaction of couching or excretion of phlegm. As the saying goes in the Chapter of Explanations of Five Qi in the Chinese Medical Classic ”Su-Wen” (Plain Questions of the Yellow Emperor's Classics of Internal Medicine): ”The pathological Qi of lung is coughing in the diseases of five Qi”. Coughing is one of main symptoms in the presentation of pulmonary disease, and also an independent disease. As the saying goes: ”Cement craftsmen fear to mend house leaks, while doctors dread treating in couching.” This is because coughing is caused by various etiologies, which may constantly influence the exactness of diagnose due to complications of disease progression caused by malpractice. The etiologies of coughing can be classified as exogenous and endogenous pathogenic factors. The exogenous pathogenic factors of coughing would arouse acute pulmonary syndromes with rapid progression, and are caused by wind, coldness, heat, humidity, drought, internal temper (heat)-known as the six major obscene pathogenic factors; while the endogenous pathogenic factors of coughing are usually related to immoderate diet or endogenous emotional affliction that lead to the pulmonary vacuity or the complications caused by other repeated visceral damage.Modern medical professionals have accumulated a plethora of clinical experiences with regard to the treatment of coughing. They apply treatment of coughing according to syndrome differentiation based upon the etiology and pathogenesis as well as main energy flow (qi in Chinese) in different seasons. The treatment of coughing caused by exogenous pathogenic factors involves ventilation of qi in lungs and emissions of outer sources of irritation. It aims at suppression of coughing symptoms by ”cleaning” the lungs and with medications that expel the wind, scatter the coldness, clear the hotness, cool down the internal temper (heat), moisten the drought and reduce phlegm. To treat coughing agitated internally, the treatment is expected to target at strengthening the body resistance to eliminate pathogenic factors and taking care of both tip and root by clearing the internal heat, reducing phlegm, toning qi, nurturing blood, procreating for yin and enriching for yang.