黄雪梅 丁兆辉 何军 万丽玲

【摘 要】 慢性咳嗽是常见且病因复杂的呼吸系统疾病。《内经》云：“五脏六腑皆令人咳，非独肺也。”已明确指出了咳嗽病因病机的复杂性，临床不乏从肺脾肾论治慢性咳嗽。万丽玲教授在临床实践中，对部分慢性咳嗽从肝肺气机失调论治。认为此类慢性咳嗽病机关键是肺失宣降、肝气郁滞，重视肝肺同调，宣降肺气，疏达肝气，以疏肝达肺汤治疗获得良效。文章结合万丽玲教授临床经验，深入探讨从肝肺不调论治慢性咳嗽的理论依据及万丽玲教授处方用药特点，以为临床提供参考。

【关键词】 慢性咳嗽;肝肺不调;疏肝达肺

【中图分类号】R249.2/.7 【文献标志码】 A 【文章编号】1007-8517（2021）14-0099-03

Abstract：Chronic cough is a common and complicated respiratory disease. The "five internal organs" of "cough" are not "internal organs" The complexity of the etiology and pathogenesis of cough has been clearly pointed out. There is no lack of clinical treatment of chronic cough from lung， spleen and kidney. In clinical practice， Professor Wan Liling treats part of chronic cough from the imbalance of liver， lung and Qi. It is considered that the key to the pathogenesis of this kind of chronic cough is lung failure and stagnation of liver qi. Attention should be paid to the harmony of liver and lung， and the lung qi can be released and reduced， and the liver qi can be released. The good effect can be obtained by Shugan Dafei Decoction. Therefore， this article will combine with Professor Wan Liling's clinical experience， in-depth study of the theoretical basis of the treatment of chronic cough from the liver and lung imbalance and the characteristics of Professor Wan Liling's prescription medication， so as to provide reference for clinical practice.

Keywords：Chronic Cough;Disharmony of Liver and Lung;Soothe the Liver and Reach the Lung

慢性咳嗽是以咳嗽為唯一或主要症状、持续时间超过8周、胸部X线检查无明显异常的咳嗽[1]。慢性咳嗽属于中医学上“久咳”“顽咳”等范畴。在呼吸科门诊是常见的一种疾病，在国内专科门诊中，慢性咳嗽就诊患者约占三分之一以上[2]。慢性咳嗽病因繁多且涉及面广，尤其是胸部影像学检查无明显异常的慢性咳嗽，极易被误诊误治，或因诊断不明重复接受各种检查，或者长期使用多种抗菌药物和镇咳药物，收效甚微并产生诸多不良反应[3-4]。

中医对咳嗽的认识，源自《内经》，《内经》论述“肺主咳”“五脏六腑皆令人咳，非独肺也”。临床上众医家多从肺脾肾三脏论治本病。查阅文献发现亦有文章从肝咳或肝肺论治慢性咳嗽，但目前尚未有统一标准和认识，临床疗效各不相同[5]。肝咳起源于《内经》，《素问·咳论》：“肝咳之状，咳则两胁下痛，甚则不可以转，转则两胠下满”，此肝咳由肝受外邪、经气不利上传于肺所致，故症状属于经脉病症，未提及脏腑病症。……