以“从龙法”论治心源性胸腔积液感悟

Reflection on the Treatment of Cardiogenic Pleural Effusion with the “Conglongfa”

摘要: “从龙”源自近代名医张锡纯，用以治疗服小青龙汤药后诸变证。后世医家将治疗小青龙汤药后诸证的方法统一称为“从龙法”。本文总结张碧海教授以“从龙法”论治心源性胸腔积液的临证经验。心源性胸腔积液属中医“悬饮”范畴，其关键病机是肺脾气虚，心肾两虚，肺失宣通，饮停胸胁；乃实中夹虚证，与从龙汤证多有相似，治疗上强调扶正祛邪，以补肺气、滋肾阴、引火归元、利水消肿，在温化寒饮的同时顾护正气。

Abstract: “Conglongfa” originated from Zhang Xichun, a renowned physician in modern times, and is used to treat various complications after taking “Xiaoqinglong” Decoction. Later generations of physicians collectively referred to the method of treating these complications after “Xiaoqinglong” Decoction as the “Conglongfa”. This article summarizes Professor Zhang Bihai’s clinical experience in treating cardiogenic pleural effusion with the “Conglongfa”. Cardiogenic pleural effusion falls under the category of “suspended fluid” in traditional Chinese medicine. Its key pathogenesis is deficiency of lung and spleen qi, deficiency of both heart and kidney, lung failure in regulating, and fluid retention in the chest and hypochondrium; it is a syndrome of excess mixed with deficiency, often similar to the syndrome of “Conglong” Decoction. In treatment, emphasis is placed on strengthening the body’s resistance and eliminating pathogenic factors, with methods including nourishing lung qi, replenishing kidney yin, guiding fire back to its source, promoting diuresis to reduce swelling, and warming and transforming cold fluid while protecting vital qi.