第二百九十二章 立法定方(2 / 2)

中医许阳 唐甲甲 1317 字 2022-08-01

所有人都看向了许阳,虽然他们也很好奇许阳昨天到底因为什么匆忙就跑出去,连省里的会议都没时间开,但大家都默契地保持了沉默,都没有提到此事!

许阳把目光从窗外收回来,他看了看众人,道:“之前咱们已经讨论过了,今冬流感比较复杂,从运气学说的范畴上应该是属于温病,从证候来判断,这次流感为风寒外束,燥热内淫,寒气郁闭肺卫,燥热不得宣透,致卫气失和,肺失宣降。”

“所以病人如果出现发热恶寒,无汗头痛,肢体酸痛就是感受风寒之象;寒热往来,恶心呕吐是因邪在半表半里、邪正交争、胃失和降;咽痛不舒,胸闷咳嗽,痰黄、白黏或无痰,口干口渴就是肺有燥热之象。”

许阳把面前的厚厚的一叠资料拿出来,他道:“针对这次流感和病人的情况不同,昨天晚上我草拟了几个方子,大家先看看,也都讨论一下。”

坐在许阳身边的小桃,拿着这些资料发给会议室里的这些专家们。

许阳接着道:“今冬,应寒不寒,冬行春令,阳气失藏是产生疫病的因素之一。今年木气不达,金胜克木,肺金过尤不及,加上年底燥热影响,使肺津不足,正气已亏,是流感产生的第二个因素。”

“之前咱们把这次流感辨证出了寒包火的现象,往年冬季受寒感冒后部分患者也会有发热、咳嗽、痰黄等症状,也是“寒包火”现象,这种可以用麻杏石甘汤或者大青龙汤加减治疗,效果也还不错。”

“但今年就不一样了,钟主任,你前天治的那几个流感病人,用了麻杏石甘汤,效果不佳的原因就是在这里了。”

钟华顿时一怔,用询问地眼神看许阳。

许阳给他解释道:“前者的寒包火是寒邪外束肌表,肺卫失于宣肃,火热内郁。而今年的寒包火,就一定要考虑“燥”的因素,不然就不利于肺卫功能的恢复。”

许阳出言一点。

钟华便立刻露出恍然之色,在许阳出现之前,他可是全县中医水平最好的医生,但就是这个全县第一,也很容易在流感上翻车。

每一年的流感,需要考虑的因素有很多,尤其是在今年这种外邪多样复杂的情况下,一旦不能精准抓住病机,就会很容易导致疗效不佳。

所以这就是为什么在这种流感前面,一定要先对其进行研究判断。

徐原扭头问:“许老师,那这次我们该用什么方子?”

许阳微微一笑,说道:“因为目前气候偏燥,可参考朱肱《活人书》的葳蕤汤进行治疗。朱肱《类证活人书》所用葳蕤汤由玉竹、白薇、麻黄、独活、杏仁、川芎、甘草、石膏等组成,此方可养阴、润燥、清热、生津、止咳。我估计这个方子,今年应该会用的比较多。”

“另外昨天咱们也辨证流感的各个证型,总体的治疗思路还是散寒清热,兼顾化湿解表,润燥滋阴。若是出现外寒表证兼寒湿的,可以九味羌活汤治疗。”

“若是太阳和阳明同病的,可以选用九味羌活汤合白虎汤或者羌蓝石膏汤合麻杏石甘汤。兼有湿热者,可复入三仁汤,黄芩滑石汤或者薏苡竹叶散,千金苇茎汤。阴虚燥热就用葳蕤汤加减。”

“若是太阳、阳明、少阳三经同病,可以选用柴葛解肌汤。因为肺金燥热比较多,所以可以合用桑杏汤,清燥救肺汤,枇杷清肺饮,陈氏麦门冬汤治疗。”

“老年人正气虚弱,肯定会是今冬流感的一个大头,而且许多老年人都有慢性病,所以合并的基础病很多,我们在诊治的时候也需要特别注意。”

“老年人多会出现正气虚弱的表现,因此,在用药治疗之后,老年人的发热退去,一定要重视扶正,尤其要注意健运脾胃和补益气阴,我建议使用清暑益气汤。”

“若是病人发热退去之后,后半夜出现盗汗和失眠易醒的情况,可以使用黄连阿胶鸡子黄汤或者乌梅丸。”

“好了,我话说完,谁有补充!”许阳看众人。

会议室里顿时落针可闻,众人呆若木鸡。

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