补肺健脾、清热化痰法治疗小儿哮喘缓解期肺脾气虚、痰热内阻证的临床研究
|
摘要
支气管哮喘(简称哮喘)是一种反复发作的痰鸣气喘性疾病,是儿童时期最常见的呼吸道慢性疾病之一,也是一种世界性难治性疾病。随着社会的发展,其发病率有越来越高的趋势,在新加坡,平均每5个儿童中就有一个罹患哮喘。哮喘已成为一种严重的公共卫生问题而引起世界各国的高度重视。西医学对于哮喘的防治主要是遵循《全球哮喘防治的创议》即GINA方案。
中医在防治哮喘方面具有一定的优势和特色。本研究以儿童支气管哮喘缓解期为研究对象,结合新加坡哮喘患儿的特点,因地、因质制宜,在对哮喘缓解期病因病机的传统认识基础上,提出新加坡哮喘患儿缓解期多以肺脾气虚兼痰热内蕴为病机特点,拟定补肺健脾、清热化痰为主的治法,在此基础上,筛选药物,制定补肺健脾、清热化痰方运用于临床。
观察表明:新加坡哮喘患儿的发病年龄以3～5岁和6～10岁为主,首次发病年龄以3～6岁为最多见,大多数哮喘患儿有其他过敏性疾病史,部分具有与哮喘发作相关的家族史,临床引起哮喘发作的诱因主要是呼吸道感染。
本研究对120例(试验组80例,对照组40例)临床病例进行治疗前后的临床疗效观察,试验组采用补肺健脾、清热化痰方治疗、对照组采用丙酸倍氯米松气雾剂(必可酮)雾化吸入治疗。结果:试验前两组患儿在年龄、性别、首发年龄均无显著性差异,两组具有可比性。研究结果显示:试验组经治疗后,在哮喘发作次数、哮喘发作持续时间、平均感染次数、咳嗽程度、咳嗽次数、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、出汗、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分等情况改善方面明显优于治疗前。对照组经治疗后,在哮喘发作次数、哮喘发作持续时间、平均感染次数、咳嗽程度、咳嗽次数、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、出汗、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分等情况改善方面明显优于治疗前。两组间对比,经治疗后,试验组在哮喘发作次数、哮喘发作持续时间、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分、主要结局指标、中医症候综合疗效等情况改善方面优于对照组,两组在平均感染次数、咳嗽程度、咳嗽次数、出汗情况改善方面无明显差异。两组均未见临床不良反应。
结论:新加坡哮喘患儿缓解期以肺脾气虚兼痰热内蕴证为多,治疗应当在传统扶正固本之外佐以清热化痰,补虚泻实并举。补肺健脾、清热化痰法能够有效减少哮喘发作次数和呼吸道感染次数,一定程度上缩短哮喘每次发作持续的时间,并能有效改善小儿哮喘缓解期的相关症状,疗效优于西药对照组。补肺健脾、清热化痰方是治疗新加坡哮喘缓解期患儿肺脾气虚兼见痰热内蕴证的有效方药。
Bronchial asthma (asthma) is a worldwide disease manifested by repeated onset wheeze. It is one of the most common chronic airway diseases in childhood. In Singapore, there is one child suffering from asthma in every five children. With the development of the society, asthma has become a serious public health problem with high morbidity in the world and been concerned widely and highly. For west medicine, the prevention and treatment of asthma mainly follow Global Intiative for Asthma-GINA.
Chinese medicine has certain advantages and characteristics in the prevention and treatment of asthma. In this research, main pathogenesis of Qi deficiency in lung and spleen with phlegm heat accumulation in children asthma in clinical remission stage has been brought up and the prescription of tonifying the lung and Spleen with clearing heat and resolving phlegm has been made according to characteristics of the asthmatic children in Singapore based on the traditional pathogenesis of asthma and suit treatment in terms of locality and constitution.
The observation of 120 clinical cases(80 cases in the test group and 40 cases in the control group)showed that the suffering age of children asthma in Singapore was ranged from 3 to 5 years old and from 6 to 10 years old, the first attacking age from 3 to 6 years, most children with asthma had other allergic disease history,while part of children with asthma had related family history, and respiratory infection was the main reason.
Results of clinical research showed that the difference between two groups was statistically insignificant (P<0.05) in terms of sex,age and initiating of diseases. After treatment, the analysis showed statistical significance of the difference in two groups between pre and post-treatment in aspects of the asthmatic attack times, attack duration, respiratory infection times, cough seriousness score, cough frequency score, sputum score, sputum colour score, spirit, appetite, stool, urine, sweating score,tongue and tongue fur score,fingerprint or pulse score and main, secondary and total symptom. The comparison between the two groups showed significant difference in aspects of the asthmatic attack times, attack duration, sputum score, sputum colour score, spirit, appetite, stool, urine, tongue and tongue fur score, fingerprint or pulse score and main, secondary and total symptom score, effect analysis of main end indexes and integrate effect analysis of syndrome of Chinese medicine, except respiratory infection times, cough seriousness score, cough frequency score and sweating score aspects. Both groups displayed no side effects.
In conclusion,the treatment method of Bufeijianpi and Qingrehuatan and Bufeijianpi and Qingrehuatan decoction are effective for asthmatic children in the remission stage manifested by Qi deficiency in lung and spleen with phlegm heat accumulation in Singapore.
中医在防治哮喘方面具有一定的优势和特色。本研究以儿童支气管哮喘缓解期为研究对象,结合新加坡哮喘患儿的特点,因地、因质制宜,在对哮喘缓解期病因病机的传统认识基础上,提出新加坡哮喘患儿缓解期多以肺脾气虚兼痰热内蕴为病机特点,拟定补肺健脾、清热化痰为主的治法,在此基础上,筛选药物,制定补肺健脾、清热化痰方运用于临床。
观察表明:新加坡哮喘患儿的发病年龄以3～5岁和6～10岁为主,首次发病年龄以3～6岁为最多见,大多数哮喘患儿有其他过敏性疾病史,部分具有与哮喘发作相关的家族史,临床引起哮喘发作的诱因主要是呼吸道感染。
本研究对120例(试验组80例,对照组40例)临床病例进行治疗前后的临床疗效观察,试验组采用补肺健脾、清热化痰方治疗、对照组采用丙酸倍氯米松气雾剂(必可酮)雾化吸入治疗。结果:试验前两组患儿在年龄、性别、首发年龄均无显著性差异,两组具有可比性。研究结果显示:试验组经治疗后,在哮喘发作次数、哮喘发作持续时间、平均感染次数、咳嗽程度、咳嗽次数、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、出汗、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分等情况改善方面明显优于治疗前。对照组经治疗后,在哮喘发作次数、哮喘发作持续时间、平均感染次数、咳嗽程度、咳嗽次数、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、出汗、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分等情况改善方面明显优于治疗前。两组间对比,经治疗后,试验组在哮喘发作次数、哮喘发作持续时间、咯痰、咯痰颜色、面色、精神、食欲、大便、小便、舌质、舌苔、指纹/脉象、主症积分、次症积分、总积分、主要结局指标、中医症候综合疗效等情况改善方面优于对照组,两组在平均感染次数、咳嗽程度、咳嗽次数、出汗情况改善方面无明显差异。两组均未见临床不良反应。
结论:新加坡哮喘患儿缓解期以肺脾气虚兼痰热内蕴证为多,治疗应当在传统扶正固本之外佐以清热化痰,补虚泻实并举。补肺健脾、清热化痰法能够有效减少哮喘发作次数和呼吸道感染次数,一定程度上缩短哮喘每次发作持续的时间,并能有效改善小儿哮喘缓解期的相关症状,疗效优于西药对照组。补肺健脾、清热化痰方是治疗新加坡哮喘缓解期患儿肺脾气虚兼见痰热内蕴证的有效方药。
Bronchial asthma (asthma) is a worldwide disease manifested by repeated onset wheeze. It is one of the most common chronic airway diseases in childhood. In Singapore, there is one child suffering from asthma in every five children. With the development of the society, asthma has become a serious public health problem with high morbidity in the world and been concerned widely and highly. For west medicine, the prevention and treatment of asthma mainly follow Global Intiative for Asthma-GINA.
Chinese medicine has certain advantages and characteristics in the prevention and treatment of asthma. In this research, main pathogenesis of Qi deficiency in lung and spleen with phlegm heat accumulation in children asthma in clinical remission stage has been brought up and the prescription of tonifying the lung and Spleen with clearing heat and resolving phlegm has been made according to characteristics of the asthmatic children in Singapore based on the traditional pathogenesis of asthma and suit treatment in terms of locality and constitution.
The observation of 120 clinical cases(80 cases in the test group and 40 cases in the control group)showed that the suffering age of children asthma in Singapore was ranged from 3 to 5 years old and from 6 to 10 years old, the first attacking age from 3 to 6 years, most children with asthma had other allergic disease history,while part of children with asthma had related family history, and respiratory infection was the main reason.
Results of clinical research showed that the difference between two groups was statistically insignificant (P<0.05) in terms of sex,age and initiating of diseases. After treatment, the analysis showed statistical significance of the difference in two groups between pre and post-treatment in aspects of the asthmatic attack times, attack duration, respiratory infection times, cough seriousness score, cough frequency score, sputum score, sputum colour score, spirit, appetite, stool, urine, sweating score,tongue and tongue fur score,fingerprint or pulse score and main, secondary and total symptom. The comparison between the two groups showed significant difference in aspects of the asthmatic attack times, attack duration, sputum score, sputum colour score, spirit, appetite, stool, urine, tongue and tongue fur score, fingerprint or pulse score and main, secondary and total symptom score, effect analysis of main end indexes and integrate effect analysis of syndrome of Chinese medicine, except respiratory infection times, cough seriousness score, cough frequency score and sweating score aspects. Both groups displayed no side effects.
In conclusion,the treatment method of Bufeijianpi and Qingrehuatan and Bufeijianpi and Qingrehuatan decoction are effective for asthmatic children in the remission stage manifested by Qi deficiency in lung and spleen with phlegm heat accumulation in Singapore.
引文
[1]童舜华,吴敦序,包照日格图,等.小青龙汤对大鼠哮喘模型肺组织糖皮质激素受体的影响[J].中成药,1998,20(6):32.
[2]Chay Oh Moh.Asthma in Children[J].the Singapore family physician jan-mar,2003:,29(1):16.
[3]闵亮,沈惠风.补虚三法防治哮喘[J].陕西中医,1998,19(4):191.
[4]王晓玫,李忠学.固金止喘汤治疗支气管哮喘缓解期35例的疗效分析[J].中华实用中西医杂志,2006,19(6):661.
[5]黄开珍,黄美杏,梁春才,等.补肺片防治缓解期支气管哮喘的临床研究[J].广西中医药,2001,24(6):15.
[6]龙学明,唐耀平,黄洁,等.补肺片对支气管哮喘缓解期患者CD4+、CD8+及IgE 影响的临床研究[J].新中医,2007,39(5):27.
[7]于作洋.刘弼臣教授治疗小儿哮喘的经验[J].山西中医,1998,14(2):16.
[8]刘自力,张庆荣,吴兆利.论脾虚为哮喘宿根[J].中医药学刊,2006,24(2):294.
[9]蔡润清,吴伟平.支气管哮喘缓解期从脾论治80例临床探讨[J].贵阳中医学院学报,2007,29(2):29.
[10]张庆荣,谷峰,赵世芬.脾虚对哮喘氧化抗氧化平衡改变的影响[J].辽宁中医杂志,1999,26(12):574.
[11]刘小虹,廖慧丽.补肾祛邪法治疗哮喘的临床研究[J].中医药学刊,2002,20(5):697.
[12]李容娟.固肾纳气汤治疗肾虚型哮喘缓解期42例疗效观察[J].右江民族医学院学报,1997,19(3):449.
[13]许建华,吴敦序,方肇勤,等.哮喘大鼠肺组织cAMP、cGMP的动态变化及补肾定喘汤对其的影响[J].中国中医药信息杂志,2000,7(1):26.
[14]吴彬,俞建,王营,等.补肾中药对哮喘缓解期患儿Th1/Th2平衡的影响[J].中国中西医结合杂志,2007,27(4):120.
[15]江霞,廖宝军.从痰淤论治小儿哮喘116例分析[J].陕西中医函授,2000,(5):41.
[16]刘志宏,张桂菊,王明香.益气活血汤防治儿童哮喘复发120例临床观察[J].四川中医,2004,22(6):70.
[17]董秀兰,王丽清.益气活血定喘方治疗小儿哮喘缓解期30例疗效观[J].新中医,2008,40(3):47.
[18]王志英,李向荣.中药哮宁颗粒治疗支气管哮喘缓解期的研究[J].辽宁中医杂志,2008,35(5):674.
[19]施小敏,唐运涛.儿哮散穴位敷贴治疗小儿哮喘临床研究[J].四川中医,2005,23(4)65.
[20]王奕儿,郭雄伟.敷贴疗法治疗儿童哮喘105例[J].中国乡村医药杂志,2005,12(7):50.
[21]张小平,李素莉.哮喘膏穴贴治疗小儿支气管哮喘的疗效观察[J].中国中医药信息杂志,2003,10(9):49.
[22]王伟,张燕萍,苗青,等.支气管哮喘缓解期(肺脾气虚证)中西医结合治疗研究[J].中国中医药信息杂志,2006,15(6):71.
[23]沙向红,朱慧平.健脾益肺汤防治儿童缓解期支气管哮喘临床观察[J].浙江中西医结合杂志,2006,16(8):491.
[24]梁可云.中西医结合治疗支气管哮喘缓解期37例疗效观察[J].新中医,2005,37(12):53.
[25]美国国立卫生研究院心肺血液研究所全球哮喘防治的创议[R]首都儿科研究所哮喘防治与教育中心译,2002年修订.
[26]中华儿科杂志编辑委员会.关于婴幼儿哮喘的若干问题[J].中华儿科杂志,1998,36(12):760.
[27]李明华,殷凯生,朱栓立主编.哮喘病学[M].第一版,北京:人民卫生出版社,1998:371.
[28]中华医学会儿科学分会呼吸学组,中华医学会《中华儿科杂志》编辑委员会.儿童支气管哮喘防治常规(试行)[J].中华儿科杂志,2004;42(2):100.
[29]沈华浩主编,钟南山主审.哮喘手册[M].第一版,北京:人民卫生出版社,2004:131,412.
[30]黎建安.舒利迭在儿童哮喘缓解期维持治疗的疗效观察[J].广州医药,2004;35(4):37.
[31]薛良荣,茅双根,徐国成.舒利迭治疗儿童哮喘的临床疗效观察[J].皖南医学院学报,2006:25(1):45.
[32]钟南山.我国支气管哮喘防治研究重点及努力方向[R].2006全国哮喘规范化诊治学术论坛学习通讯Ⅱ:8.
[33]杨震,孙黎.防风成分的药理活性研究概况[J].黑龙江医药,2005,18(1):36.
[34]张理平.陈皮补益效用的探讨[J].中国中西医结合杂志,2005,25(8):754.
[35]张成博.哮喘病因病机和发病机理的新构架[J].新中医,2005,37(11):3.
[36]周兆山.哮喘中医论治[M].北京:中国古籍出版社,2002:7.
[37]徐树楠,侯仙明.蝉蜕对支气管哮喘模型大鼠肺组织形态学及血清中TXB2、6-keto-PGF1α的影响[J].中国药理学通报,2008,24(10):1398.
[2]Chay Oh Moh.Asthma in Children[J].the Singapore family physician jan-mar,2003:,29(1):16.
[3]闵亮,沈惠风.补虚三法防治哮喘[J].陕西中医,1998,19(4):191.
[4]王晓玫,李忠学.固金止喘汤治疗支气管哮喘缓解期35例的疗效分析[J].中华实用中西医杂志,2006,19(6):661.
[5]黄开珍,黄美杏,梁春才,等.补肺片防治缓解期支气管哮喘的临床研究[J].广西中医药,2001,24(6):15.
[6]龙学明,唐耀平,黄洁,等.补肺片对支气管哮喘缓解期患者CD4+、CD8+及IgE 影响的临床研究[J].新中医,2007,39(5):27.
[7]于作洋.刘弼臣教授治疗小儿哮喘的经验[J].山西中医,1998,14(2):16.
[8]刘自力,张庆荣,吴兆利.论脾虚为哮喘宿根[J].中医药学刊,2006,24(2):294.
[9]蔡润清,吴伟平.支气管哮喘缓解期从脾论治80例临床探讨[J].贵阳中医学院学报,2007,29(2):29.
[10]张庆荣,谷峰,赵世芬.脾虚对哮喘氧化抗氧化平衡改变的影响[J].辽宁中医杂志,1999,26(12):574.
[11]刘小虹,廖慧丽.补肾祛邪法治疗哮喘的临床研究[J].中医药学刊,2002,20(5):697.
[12]李容娟.固肾纳气汤治疗肾虚型哮喘缓解期42例疗效观察[J].右江民族医学院学报,1997,19(3):449.
[13]许建华,吴敦序,方肇勤,等.哮喘大鼠肺组织cAMP、cGMP的动态变化及补肾定喘汤对其的影响[J].中国中医药信息杂志,2000,7(1):26.
[14]吴彬,俞建,王营,等.补肾中药对哮喘缓解期患儿Th1/Th2平衡的影响[J].中国中西医结合杂志,2007,27(4):120.
[15]江霞,廖宝军.从痰淤论治小儿哮喘116例分析[J].陕西中医函授,2000,(5):41.
[16]刘志宏,张桂菊,王明香.益气活血汤防治儿童哮喘复发120例临床观察[J].四川中医,2004,22(6):70.
[17]董秀兰,王丽清.益气活血定喘方治疗小儿哮喘缓解期30例疗效观[J].新中医,2008,40(3):47.
[18]王志英,李向荣.中药哮宁颗粒治疗支气管哮喘缓解期的研究[J].辽宁中医杂志,2008,35(5):674.
[19]施小敏,唐运涛.儿哮散穴位敷贴治疗小儿哮喘临床研究[J].四川中医,2005,23(4)65.
[20]王奕儿,郭雄伟.敷贴疗法治疗儿童哮喘105例[J].中国乡村医药杂志,2005,12(7):50.
[21]张小平,李素莉.哮喘膏穴贴治疗小儿支气管哮喘的疗效观察[J].中国中医药信息杂志,2003,10(9):49.
[22]王伟,张燕萍,苗青,等.支气管哮喘缓解期(肺脾气虚证)中西医结合治疗研究[J].中国中医药信息杂志,2006,15(6):71.
[23]沙向红,朱慧平.健脾益肺汤防治儿童缓解期支气管哮喘临床观察[J].浙江中西医结合杂志,2006,16(8):491.
[24]梁可云.中西医结合治疗支气管哮喘缓解期37例疗效观察[J].新中医,2005,37(12):53.
[25]美国国立卫生研究院心肺血液研究所全球哮喘防治的创议[R]首都儿科研究所哮喘防治与教育中心译,2002年修订.
[26]中华儿科杂志编辑委员会.关于婴幼儿哮喘的若干问题[J].中华儿科杂志,1998,36(12):760.
[27]李明华,殷凯生,朱栓立主编.哮喘病学[M].第一版,北京:人民卫生出版社,1998:371.
[28]中华医学会儿科学分会呼吸学组,中华医学会《中华儿科杂志》编辑委员会.儿童支气管哮喘防治常规(试行)[J].中华儿科杂志,2004;42(2):100.
[29]沈华浩主编,钟南山主审.哮喘手册[M].第一版,北京:人民卫生出版社,2004:131,412.
[30]黎建安.舒利迭在儿童哮喘缓解期维持治疗的疗效观察[J].广州医药,2004;35(4):37.
[31]薛良荣,茅双根,徐国成.舒利迭治疗儿童哮喘的临床疗效观察[J].皖南医学院学报,2006:25(1):45.
[32]钟南山.我国支气管哮喘防治研究重点及努力方向[R].2006全国哮喘规范化诊治学术论坛学习通讯Ⅱ:8.
[33]杨震,孙黎.防风成分的药理活性研究概况[J].黑龙江医药,2005,18(1):36.
[34]张理平.陈皮补益效用的探讨[J].中国中西医结合杂志,2005,25(8):754.
[35]张成博.哮喘病因病机和发病机理的新构架[J].新中医,2005,37(11):3.
[36]周兆山.哮喘中医论治[M].北京:中国古籍出版社,2002:7.
[37]徐树楠,侯仙明.蝉蜕对支气管哮喘模型大鼠肺组织形态学及血清中TXB2、6-keto-PGF1α的影响[J].中国药理学通报,2008,24(10):1398.