中医辨治久咳思路

Thinking of TCM Syndrome Differentiation and Treatment of Chronic Cough

久咳病因复杂,病机不一,切忌见咳止咳,既要注重"寒邪、风邪"在久咳中的作用,同时也要兼顾脾、肝、肾三脏的调治,祛风散寒同时还要考虑久咳入络。风邪伏肺证,治以疏风宣肺,止咳化痰,采用自拟宁肺止咳汤加减治疗。风痰恋肺证,治以疏风宣肺,利咽化痰,采用总方六味汤合苍耳子散加味。风邪袭肺证,治以疏风宣肺,化痰止咳,采用《杏林集叶》前胡止嗽汤加减。正虚邪恋证,治以和解少阳,疏风宣肺,方以小柴胡汤加减。肝郁脾虚证,治以疏肝解郁,止咳化痰,方以逍遥散加味。此外,痰的性质,咳声的深、浅、大、小、清、浊、缓、急,舌脉的异常,咳嗽发作的时间亦当审详,观其脉证,知犯何逆,随证治之。

The etiology of chronic cough is complex,and the pathogenesis is different.We should not stop cough by seeing cough.We should not only pay attention to the role of"cold pathogen and wind pathogen"in chronic cough,but also take into account the regulation and treatment of spleen,liver and kidney.Besides expelling wind and disperse cold,it is necessary to consider whether chronic cough has entered collaterals.For syndrome of wind pathogen hiding in lung,the treatment should focus on eliminating wind,dispersing lung,relieving cough and resolving phlegm.Professor Chao En-xiang′s Suhuang Cough-Stopping Decoction(苏黄止咳汤,SHCSD)or Rough and Ready Three Decoction in Formulary of the Bureau of Taiping People′s Welfare Pharmacy combined with Modified Cough-Stopping Powder in Comprehension of Medicine can be used.For syndrome of wind-phlegm stagnated in lung,the treatment should focus on eliminating wind,dispersing lung,relieving sore throat and resolving phlegm.Six-Ingredient Decoction combined with Flavored Fructus Xanthii Powder can be used.For syndrome of wind pathogen attacking lung,the treatment should focus on eliminating wind,dispersing lung,relieving cough and resolving phlegm.Modified Radix Peucedani Cough-Stopping Powder in Collection of Medical Cases can be used.For syndrome of insufficiency of healthy qi and excessive pathogenic qi,the treatment should focus on harmonizing lesser yang,eliminating wind,and dispersing lung,Modified Minor Bupleurum Decoction can be used.For syndrome of liver depression and spleen deficiency,the treatment should focus on soothing liver and relieving depression,relieving cough and resolving phlegm.Flavored Free Wanderer Powder can be used.In addition,the nature of phlegm,cough sound′s deep,shallow,large,small,clear,turbid,slow,urgent state,abnormal tongue and pulse,cough attack time should also be examined in details.It is necessary to observe the pulse syndrome,know the etiology,and adopt syndrome differentiation treatment.