支气管哮喘慢性持续期中医分型
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摘要
中医传统上将哮喘分为发作期和缓解期,发作期以"症"分为寒哮、热哮、寒包热哮、风痰哮和虚哮,缓解期以"证"分为肺脾气虚证、肺肾两虚证两型,但这种方法过于简单、笼统,已不能很好地满足当前临床实际辨证的需要,而且与西医的哮喘三期(急性发作期、慢性持续期和临床缓解期)相矛盾。哮喘慢性持续期既有痰瘀内伏未消,又有肺脾肝肾气阴阳不足,乃虚实夹杂之证,可以分为气虚感寒证,阳虚恶寒证,阴虚夹热证,痰瘀阻滞证,其中,气虚、阳虚证可发病为寒哮;阴虚夹热证可发病为热哮;气虚、阳虚合热证可转化为寒包热哮;气虚、阳虚合痰瘀阻滞证可发病为风痰哮;气虚、阴虚、阳虚证可发病为虚哮;慢性持续期时,作为哮喘发作的过渡时期,若控制良好,患者将归于缓解期,若控制不佳,则转入急性发作期,因此慢性持续期是哮喘治疗的黄金时期,辨证准确,施治及时,可减少患者发病几率,改善患者生存质量。
According to TCM,asthma is divided into attack stage and remission stage.It is divided into cold asthma,heat asthma,asthma due to fire wrapped by cold,wind-phlegm asthma,and deficient asthma according to symptoms in the attack stage.In remission stage,it can be divided into lung-spleen qi deficiency,lung-kidney deficiency types.However,this classification method is too simple and general to satisfy the needs of clinical practice at present.It is also inconsistent with the three stages of asthma in Western Medicine(acute attack,chronic duration period and clinical remission stage).Chronic duration asthma is due to latent phlegm and blood stasis,probably also deficient qi and yin-yang of the lung,the spleen,the liver,and the kidney.In a word,it belongs to intermingled syndrome of deficiency and excess,and can be divided into qi deficiency and cold syndrome,yang deficiency and aversion to cold syndrome,yin deficiency and heat syndrome,phlegm and blood stasis syndrome.Among them,qi deficiency and yang deficiency can cause onset of cold asthma; Yin deficiency and heat syndrome can cause heat asthma; Qi deficiency,yang deficiency and heat syndrome can cause asthma due to fire wrapped by cold; Qi deficiency,yang deficiency and phlegm stagnation can develop into wind-phlegm asthma; Qi deficiency,yang deficiency and yin deficiency can lead to deficient asthma.Chronic duration as the transition period of asthma is the golden age of asthma,because if controlled well,the patient will be in remission; if not,the patient will be into acute stage.Accurate diagnosis and timely treatment can reduce the probability of attack of asthma,and improve the quality of life of patients.
According to TCM,asthma is divided into attack stage and remission stage.It is divided into cold asthma,heat asthma,asthma due to fire wrapped by cold,wind-phlegm asthma,and deficient asthma according to symptoms in the attack stage.In remission stage,it can be divided into lung-spleen qi deficiency,lung-kidney deficiency types.However,this classification method is too simple and general to satisfy the needs of clinical practice at present.It is also inconsistent with the three stages of asthma in Western Medicine(acute attack,chronic duration period and clinical remission stage).Chronic duration asthma is due to latent phlegm and blood stasis,probably also deficient qi and yin-yang of the lung,the spleen,the liver,and the kidney.In a word,it belongs to intermingled syndrome of deficiency and excess,and can be divided into qi deficiency and cold syndrome,yang deficiency and aversion to cold syndrome,yin deficiency and heat syndrome,phlegm and blood stasis syndrome.Among them,qi deficiency and yang deficiency can cause onset of cold asthma; Yin deficiency and heat syndrome can cause heat asthma; Qi deficiency,yang deficiency and heat syndrome can cause asthma due to fire wrapped by cold; Qi deficiency,yang deficiency and phlegm stagnation can develop into wind-phlegm asthma; Qi deficiency,yang deficiency and yin deficiency can lead to deficient asthma.Chronic duration as the transition period of asthma is the golden age of asthma,because if controlled well,the patient will be in remission; if not,the patient will be into acute stage.Accurate diagnosis and timely treatment can reduce the probability of attack of asthma,and improve the quality of life of patients.
引文
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[2]王力宁.中医分期序贯治疗对哮喘气道重构机制影响的研究思路[J].中华中医药杂志,2013,28(3):749-753.
[3]陈哗,蔡宛如.蔡宛如治疗咳嗽变异性哮喘经验[J].浙江中西医结合杂志,2013,23(3):161-162.
[4]王磊,唐仁康,姜德友.龙江医学流派形成与黑龙江地域气候环境相关性探析[J].辽宁中医药大学学报,2015,17(11):81-83.
[5]王雪慧,刘建秋,隋博文,等.温阳益气化痰平喘方治疗支气管哮喘慢性持续期45例临床观察[J].中医药学报,2013,41(1):102-103.
[6]李佳佳,杨玉萍,梁启军,等.补益肺肾、凉血清肝法治疗缓解期哮喘临床研究[J].中医学报,2015,30(9):1253-1255.
[7]王大伟,朱慧志.活血化瘀法治疗支气管哮喘临床研究进展[J].中医药临床杂志,2015,27(8):1178-1180.
[8]姚小芹,冯淬灵,武维屏.武维屏从病、证、症辨治间质性肺疾病经验[J].中医杂志,2016,57(2):104-107.