张士卿从痰瘀辨治小儿哮喘的经验总结与临床研究
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摘要
哮喘是小儿常见的慢性呼吸道疾病。临床以反复发作性咳嗽、喘鸣和呼吸困难为主要表现,并伴有气道高反应性的可逆、梗阻性呼吸道疾病,其本质是气道的慢性变态反应性炎症。
中医对该病的防治有悠久的历史,形成了自己的特色,取得了良好的效果。张士卿教授在“小儿痰瘀相关理论”的学术思想基础上,根据小儿哮喘的发病特点,结合自己多年的临床体会,认为该病主要由痰瘀内伏,外感触发所致,提出在辨证论治的基础上兼以化痰祛瘀是治疗本病的根本方法。并创制了在哮喘缓解期采用“止哮固本汤”和“小儿咳喘贴”分别进行内服外敷法治疗,取得了较好的疗效。
本文从理论探讨和临床研究两个方面对张士卿教授从痰瘀辨治小儿哮喘进行了较为系统深入的研究。论文共分4章,第1章文献综述,第2章张士卿教授从痰瘀辨治小儿哮喘的经验,第3章缓解期“内服外敷”法防治哮喘的临床研究,第4章结语。
论文第1章,综述了从痰瘀辨治小儿哮喘临床研究进展。
论文第2章,张士卿教授从痰瘀辨治小儿哮喘的经验总结研究。首先,导言部分阐述了继承名医张士卿教授临证经验的重要意义和小儿痰瘀理论学术思想及其渊源。张士卿教授是中国中医科学院医学硕士,主任医师,教授,博士生导师。曾先后拜师于著名中医儿科专家王伯岳、全国名老中医于己百,尽得真传。他中医理论功底深厚,人文知识渊博,专业技能精湛,并具有勤奋严谨的求学、治学精神,现已成为我国知名的中医儿科学专家之一。近年来,通过临床实践,张师逐渐总结出小儿痰瘀理论思想,认为许多小儿慢性病、反复发作性疾病以及疑难杂症应从痰瘀论治,实践证明,效果显著。
其次,论文根据中医理论和临床实践详细探讨了张士卿教授从痰瘀辨治小儿哮喘的病因病机、辨证论治和处方用药的特点。
病因病机方面指出小儿哮喘内因责之于肺脾肾不足,素体虚弱,痰瘀留伏；外因为外感、饮食、情志、体虚病后等诱因诱发,以致痰随气升,壅塞气道,瘀血阻络,肺失宣降,气道狭窄而致哮喘发作,气急喘息,痰鸣如吼。强调“肺脾肾不足”和“痰瘀内伏”是哮喘的本质原因。在病机演变方面,认为发作期痰瘀互结多夹积滞,缓解期因脏腑虚生痰致瘀,痰瘀互结是病情迁延,反复发作的重要因素。
辨证论治时强调首先要遵循“三因”、“二辨”、“一对症”的辨证要领。“三因”即倡导“因人、因时、因地”辨治；“二辨”即辨分期与辨病证；“一对症”即指针对临床主要症状和其它次要症状的对症辨治。其次认为要分期辨治,发作期以邪实为主,辨治以祛外感实邪兼化痰活血,缓解期以正虚为主,辨治以补脾益气并清伏留痰瘀。第三谨守病机,化痰祛瘀贯始终。第四防重于治,穴位贴敷通经活络调气血。
处方用药的特点。处方用药是辨证论治理论实践于患者的纽带环节,用药如用兵。张士卿教授指导我们要精读《孙子兵法》,他认为用药与用兵道理相通。其在临证用药有以下几方面特点。第一,善用经方,辨“症”加减。二、药用平淡,寒温佐制。三、善用虫类,搜风通络。
论文第3章,应用“内服外敷”法对小儿哮喘缓解期进行了临床研究。
目的：观察根据补脾益气,化痰祛瘀法而研制的止哮固本汤内服和咳喘贴穴位贴敷对小儿哮喘缓解期的临床疗效及作用机理。
方法：根据研究方案,入选本研究的患者共80人,随机分为2组,治疗组40例,对照组40人,两组患者在性别、年龄、病程、病情严重程度等方面具有可比性。治疗组采用止哮固本汤内服和咳喘贴穴位贴敷综合治疗。治疗组口服“止哮固本汤”,三次／天,同一剂；治疗组同时配合给予“咳喘贴”穴位贴敷,对照组口服酮替芬,每日1.0mg,分二次口服。两组各治疗1个疗程。
观察疗效性指标,①主要症状,体征记分,以及远期随访观察发病情况,②进行肺功能测定,用药前后各1次,③血嗜酸性粒细胞计数,用药前后各一次,④血清免疫球蛋白(IgE、IgA、IgM、IgG)测量,用药前后各一次。安全性指标检测：用药前后体温、脉搏、呼吸、血压等。
结果：临床观察结果显示,支气管哮喘缓解期的患者经用“内服外敷”法治疗后能显著减轻咳嗽、咯痰、气喘、胸闷等临床症状,喉间哮鸣音等临床体征也得到不同程度的改善,近期疗效有效率为95.0%,明显高于对照组的92.5%,两者相比,有显著性差别(P<0.05)；用药以后肿功能的改善,嗜酸性粒细胞的下降,免疫球蛋白的调整等项,治疗组均优于对照组。远期疗效,治疗半年后随访,治疗组和对照组平均发病次数比较无显著性差异P>0.05,治疗1年后则平均发病次数比较差异有统计学意义(P<0.05)。说明治疗组能延长缓解期,减少发病次数。毒副作用方面,治疗组未见不良反应,各生命体征指标未见异常变化,说明本疗法安全、可靠。
结论：以痰瘀相关理论为指导,采用止哮固本汤和咳喘贴“内服外敷”法对小儿哮喘缓解期的治疗具有较好的疗效,其作用机理是通过内服外敷药物和穴位刺激治疗,调整脏腑功能,改善经络气血的运行,可以有效提高哮喘患儿的体质,降低外周血嗜酸粒细胞以减轻气道炎症和气道高反应性,调整免疫球蛋白以提高自身免疫力和抵抗力,从而改善肺功能,达到控制或减少哮喘发生的目的。本方法体现了中医药防治小儿哮喘的优势,疗效可靠,治疗方便,价格低廉,毒副作用少,值得应用推广
论文第4章,对全文进行了简要总结。
Bronchial asthma is a common chronic respiratory disease occurs in children; its essence is airways' chronic allergy inflammation. Professor Zhang Shiqing study bronchial asthma on the basis of academic thinking of phlegm and blood stasis, in accordance with the clinical characteristics and clinical experience of childhood asthma, he thinks that the disease is caused by phlegm and blood stasis retention in the body and contagious allergen. Then he propose a new method to treatment the disease, the method think the basic methods to treatment the disease is reducing phlegm and removing blood stasis on the basis of treatment according to syndrome differentiation. He makes out the prescription of "Zhi Xiao Gu Ben Tang" and "Ke Chuan Tie" and take the treatment method of taking internally and external application, and it gets satisfied results.
This paper discusses on Professor Zhang's treatment characteristic feature from etiology and pathogenesis, treatment according to syndrome differentiation and prescription.
Etiology and pathogenesis reflect that the major cause of children asthma has two aspects. In the aspect of internal causes, children asthma is caused by being deficient in spleen and kidney; in the aspect of external causes, children asthma is motivated by other disease. He emphasizes that deficient in spleen and kidney and phlegm and blood stasis retention in the body is the main reason.
Treatment according to syndrome differentiation lays emphasis on keeping "three aspects","two dialecticians" and "one symptomatic treatment"."Three aspects" preach on treating the patients different from people, time and place."Two dialecticians" are different periods and different symptoms."One symptomatic treatment" is treating accord to syndrome differentiation on the most common presenting symptom and other not important presenting symptom.
In respect of prescription, professor Zhang focuses on the following aspects:first, he is good at using Theoretic Study, an amount add or deduct on the basis of qualifying circumstances; second, he advocates using bland prescription adjust accord to cold and warming; third, he is good at using worms to resolve phlegm and remove blood stasis.
The last part of the thesis describes the study of childhood asthma using the tisane taking internally and application externally. We taken "Zhi Xiao Gu Ben Tang" internally and "Ke Chuan Tie" externally,40patients were divided into the treatment group and40patients were divided into the control group. The effects were compared between two groups. The treatment group used the tisane taking internally and application externally, the control group administered ketotifen orally, the results were evaluated after one course of treatment.
The result of clinical observation shows that the overall response rate of treatment group were95%in short-term, it is obviously higher than the control group's rate of92.5%, its effect was better than control group (P<0.05).The improving of pulmonary function, the declining of eosinophilic and the adjusting of immunoglobulins of the experimental group were greatly improved compared with that of the control group. In long-term, the incidence of childhood asthma could be significantly reduced by treatment group compared to control group (P<0.05).
Conclusion:on the basis of academic thinking of phlegm and blood stasis, taking "Zhi Xiao Gu Ben Tang" internally and "Ke Chuan Tie" externally can yield better results in childhood asthma's remission period. It can adjust the function of viscera and bowels, improve the cycling of channels and blood, lower the amount of eosinophilic, develop resistance and immunity from disease, achieve the goal of control or reduce the occurrence of asthma.
中医对该病的防治有悠久的历史,形成了自己的特色,取得了良好的效果。张士卿教授在“小儿痰瘀相关理论”的学术思想基础上,根据小儿哮喘的发病特点,结合自己多年的临床体会,认为该病主要由痰瘀内伏,外感触发所致,提出在辨证论治的基础上兼以化痰祛瘀是治疗本病的根本方法。并创制了在哮喘缓解期采用“止哮固本汤”和“小儿咳喘贴”分别进行内服外敷法治疗,取得了较好的疗效。
本文从理论探讨和临床研究两个方面对张士卿教授从痰瘀辨治小儿哮喘进行了较为系统深入的研究。论文共分4章,第1章文献综述,第2章张士卿教授从痰瘀辨治小儿哮喘的经验,第3章缓解期“内服外敷”法防治哮喘的临床研究,第4章结语。
论文第1章,综述了从痰瘀辨治小儿哮喘临床研究进展。
论文第2章,张士卿教授从痰瘀辨治小儿哮喘的经验总结研究。首先,导言部分阐述了继承名医张士卿教授临证经验的重要意义和小儿痰瘀理论学术思想及其渊源。张士卿教授是中国中医科学院医学硕士,主任医师,教授,博士生导师。曾先后拜师于著名中医儿科专家王伯岳、全国名老中医于己百,尽得真传。他中医理论功底深厚,人文知识渊博,专业技能精湛,并具有勤奋严谨的求学、治学精神,现已成为我国知名的中医儿科学专家之一。近年来,通过临床实践,张师逐渐总结出小儿痰瘀理论思想,认为许多小儿慢性病、反复发作性疾病以及疑难杂症应从痰瘀论治,实践证明,效果显著。
其次,论文根据中医理论和临床实践详细探讨了张士卿教授从痰瘀辨治小儿哮喘的病因病机、辨证论治和处方用药的特点。
病因病机方面指出小儿哮喘内因责之于肺脾肾不足,素体虚弱,痰瘀留伏；外因为外感、饮食、情志、体虚病后等诱因诱发,以致痰随气升,壅塞气道,瘀血阻络,肺失宣降,气道狭窄而致哮喘发作,气急喘息,痰鸣如吼。强调“肺脾肾不足”和“痰瘀内伏”是哮喘的本质原因。在病机演变方面,认为发作期痰瘀互结多夹积滞,缓解期因脏腑虚生痰致瘀,痰瘀互结是病情迁延,反复发作的重要因素。
辨证论治时强调首先要遵循“三因”、“二辨”、“一对症”的辨证要领。“三因”即倡导“因人、因时、因地”辨治；“二辨”即辨分期与辨病证；“一对症”即指针对临床主要症状和其它次要症状的对症辨治。其次认为要分期辨治,发作期以邪实为主,辨治以祛外感实邪兼化痰活血,缓解期以正虚为主,辨治以补脾益气并清伏留痰瘀。第三谨守病机,化痰祛瘀贯始终。第四防重于治,穴位贴敷通经活络调气血。
处方用药的特点。处方用药是辨证论治理论实践于患者的纽带环节,用药如用兵。张士卿教授指导我们要精读《孙子兵法》,他认为用药与用兵道理相通。其在临证用药有以下几方面特点。第一,善用经方,辨“症”加减。二、药用平淡,寒温佐制。三、善用虫类,搜风通络。
论文第3章,应用“内服外敷”法对小儿哮喘缓解期进行了临床研究。
目的：观察根据补脾益气,化痰祛瘀法而研制的止哮固本汤内服和咳喘贴穴位贴敷对小儿哮喘缓解期的临床疗效及作用机理。
方法：根据研究方案,入选本研究的患者共80人,随机分为2组,治疗组40例,对照组40人,两组患者在性别、年龄、病程、病情严重程度等方面具有可比性。治疗组采用止哮固本汤内服和咳喘贴穴位贴敷综合治疗。治疗组口服“止哮固本汤”,三次／天,同一剂；治疗组同时配合给予“咳喘贴”穴位贴敷,对照组口服酮替芬,每日1.0mg,分二次口服。两组各治疗1个疗程。
观察疗效性指标,①主要症状,体征记分,以及远期随访观察发病情况,②进行肺功能测定,用药前后各1次,③血嗜酸性粒细胞计数,用药前后各一次,④血清免疫球蛋白(IgE、IgA、IgM、IgG)测量,用药前后各一次。安全性指标检测：用药前后体温、脉搏、呼吸、血压等。
结果：临床观察结果显示,支气管哮喘缓解期的患者经用“内服外敷”法治疗后能显著减轻咳嗽、咯痰、气喘、胸闷等临床症状,喉间哮鸣音等临床体征也得到不同程度的改善,近期疗效有效率为95.0%,明显高于对照组的92.5%,两者相比,有显著性差别(P<0.05)；用药以后肿功能的改善,嗜酸性粒细胞的下降,免疫球蛋白的调整等项,治疗组均优于对照组。远期疗效,治疗半年后随访,治疗组和对照组平均发病次数比较无显著性差异P>0.05,治疗1年后则平均发病次数比较差异有统计学意义(P<0.05)。说明治疗组能延长缓解期,减少发病次数。毒副作用方面,治疗组未见不良反应,各生命体征指标未见异常变化,说明本疗法安全、可靠。
结论：以痰瘀相关理论为指导,采用止哮固本汤和咳喘贴“内服外敷”法对小儿哮喘缓解期的治疗具有较好的疗效,其作用机理是通过内服外敷药物和穴位刺激治疗,调整脏腑功能,改善经络气血的运行,可以有效提高哮喘患儿的体质,降低外周血嗜酸粒细胞以减轻气道炎症和气道高反应性,调整免疫球蛋白以提高自身免疫力和抵抗力,从而改善肺功能,达到控制或减少哮喘发生的目的。本方法体现了中医药防治小儿哮喘的优势,疗效可靠,治疗方便,价格低廉,毒副作用少,值得应用推广
论文第4章,对全文进行了简要总结。
Bronchial asthma is a common chronic respiratory disease occurs in children; its essence is airways' chronic allergy inflammation. Professor Zhang Shiqing study bronchial asthma on the basis of academic thinking of phlegm and blood stasis, in accordance with the clinical characteristics and clinical experience of childhood asthma, he thinks that the disease is caused by phlegm and blood stasis retention in the body and contagious allergen. Then he propose a new method to treatment the disease, the method think the basic methods to treatment the disease is reducing phlegm and removing blood stasis on the basis of treatment according to syndrome differentiation. He makes out the prescription of "Zhi Xiao Gu Ben Tang" and "Ke Chuan Tie" and take the treatment method of taking internally and external application, and it gets satisfied results.
This paper discusses on Professor Zhang's treatment characteristic feature from etiology and pathogenesis, treatment according to syndrome differentiation and prescription.
Etiology and pathogenesis reflect that the major cause of children asthma has two aspects. In the aspect of internal causes, children asthma is caused by being deficient in spleen and kidney; in the aspect of external causes, children asthma is motivated by other disease. He emphasizes that deficient in spleen and kidney and phlegm and blood stasis retention in the body is the main reason.
Treatment according to syndrome differentiation lays emphasis on keeping "three aspects","two dialecticians" and "one symptomatic treatment"."Three aspects" preach on treating the patients different from people, time and place."Two dialecticians" are different periods and different symptoms."One symptomatic treatment" is treating accord to syndrome differentiation on the most common presenting symptom and other not important presenting symptom.
In respect of prescription, professor Zhang focuses on the following aspects:first, he is good at using Theoretic Study, an amount add or deduct on the basis of qualifying circumstances; second, he advocates using bland prescription adjust accord to cold and warming; third, he is good at using worms to resolve phlegm and remove blood stasis.
The last part of the thesis describes the study of childhood asthma using the tisane taking internally and application externally. We taken "Zhi Xiao Gu Ben Tang" internally and "Ke Chuan Tie" externally,40patients were divided into the treatment group and40patients were divided into the control group. The effects were compared between two groups. The treatment group used the tisane taking internally and application externally, the control group administered ketotifen orally, the results were evaluated after one course of treatment.
The result of clinical observation shows that the overall response rate of treatment group were95%in short-term, it is obviously higher than the control group's rate of92.5%, its effect was better than control group (P<0.05).The improving of pulmonary function, the declining of eosinophilic and the adjusting of immunoglobulins of the experimental group were greatly improved compared with that of the control group. In long-term, the incidence of childhood asthma could be significantly reduced by treatment group compared to control group (P<0.05).
Conclusion:on the basis of academic thinking of phlegm and blood stasis, taking "Zhi Xiao Gu Ben Tang" internally and "Ke Chuan Tie" externally can yield better results in childhood asthma's remission period. It can adjust the function of viscera and bowels, improve the cycling of channels and blood, lower the amount of eosinophilic, develop resistance and immunity from disease, achieve the goal of control or reduce the occurrence of asthma.
引文
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