论哮、喘之异

刘露 钱小军 朱俞俊

[摘要] 哮与喘，都常见于呼吸系统疾病，现代虽常合用，在医学领域既有联系，实则具有各自丰富的内涵，在临床上往往相兼并见。中医认为有声无痰谓之哮，有痰无声谓之喘。喘就气息而言，主要指呼吸气促，甚至有张口抬肩的症状;哮则是就声音而言，主要指呼吸中喉中有鸣音。哮必兼喘，而喘不一定兼哮。本研究主要研究及整理中医历代文献中关于“哮”和“喘”的记载，为临床上治疗“哮”和“喘”提供参考依据，也为中医临床诊治提供理論依据。

[关键词] 哮;喘;中医;中医概念;中医病机;中医治疗

[Abstract] Wheezing and asthma are common respiratory diseases. Although combined into one word in modern times， these two words are associated with each other with its unique connotations in the field of medicine. In clinical practice， they often occur together. According to traditional Chinese medicine， wheezing refers to sound without phlegm， phlegm without sound is called asthma. Wheezing， as far as breath is concerned， mainly refers to shortness of breath， and even has the symptoms of opening your mouth and lifting your shoulders. Wheezing， in terms of sound， mainly refers to the singing sound in the throat during breathing. Wheezing must be accompanied by asthma， while asthma may not be accompanied by wheezing. The records of "wheezing" and "asthma" in the literature of Chinese medicine in the past dynasties are mainly studied and collated in this paper， so as to provide reference basis for clinical treatment of "wheezing" and "asthma"， as well as provide theoretical basis for clinical diagnosis and treatment of traditional Chinese medicine.

[Key words] Wheezing; Asthma; Traditional Chinese medicine; Concept of TCM; Pathogenesis of TCM; Treatment of TCM

支气管哮喘是由嗜酸性粒细胞、肥大细胞、气道上皮细胞、中性粒细胞等和细胞组分参与的慢性气道炎症性疾病[1]，临床主要表现为发作性胸闷、气促、咳嗽及听诊哮鸣音等[2-3]，如不规范治疗，随病程的延长可产生重塑气道及不可逆性气道狭窄[4-6]。中医临床学将支气管哮喘归属于哮病、喘证疾病范畴。哮喘之病名，首创于丹溪[7]。在古今名医中，鉴于哮必兼喘，多以“哮喘”作为一个整体来看待;然医者理也，医之为道非精不能明其理，需贯微达幽，不失细小。明·虞抟在《医学正传》中指出：“哮以声响名，喘以气息言”。哮及喘各自具有不同的概念及辩证治疗的重点。本研究通过整理中医历代文献记载，分别做进一步归纳探讨，现报道如下。

1 探源头

《内经》查询未找到哮证病名。但在汗牛充栋的篇章中，均有描述哮病病因、病机及症状。如《素问·阴阳别论》中“阴争于内，阳扰于外，魄汗未藏四逆而起，起则熏肺，使人喘鸣”，似指哮证而言。……