张炳厚治疗慢性咳嗽用药规律探讨

Discussion on Regularity of Chinese Formulae and Herbs in Treating Chronic Cough by ZHANG Binghou

目的分析总结张炳厚教授诊治慢性咳嗽患者的临床特点、中医证型分布及用药特点,探讨张炳厚教授辨治慢性咳嗽的用药规律及临证经验。方法采用临床病例分析方法,分析99例慢性咳嗽患者的临床特点、中医证型,基于关联规则和复杂系统熵聚类算法分析张炳厚教授治疗慢性咳嗽的用药规律。结果99例慢性咳嗽患者主要临床症状包括咳嗽、咳痰、气喘、胸闷、气短、咳痰黏稠、乏力、大便稀、咽痒、口干、怕冷等;肺失宣降是慢性咳嗽的核心病机,主要证型包括痰湿蕴肺、痰热郁肺、肺燥阴伤、肺肾阴虚;炒杏仁、炙甘草、炙麻黄、枇杷叶、生石膏、桂枝、干姜、五味子、细辛、桔梗、沉香面、麦冬、桑叶、白前、款冬花、百部、蛤蚧等是治疗慢性咳嗽的基本用药;根据关联规则得出基本药对和核心药物组合,并得到5个新处方。结论张炳厚教授治疗慢性咳嗽首重对患者病因、病机的分析以及对辨证的精确把握。临床以温肺散寒、滋阴润肺、温肾纳气、健脾祛湿为主要治则。

Objective To analyze and summarize the clinical characteristics,TCM syndrome distribution and medication characteristics of Professor ZHANG Binghou′s diagnosis and treatment of chronic cough and explore the medication rules and clinical experience of Professor ZHANG Binghou in the treatment of chronic cough.Methods Using the method of clinical case analysis,the clinical characteristics and TCM syndrome types of 99 patients with chronic cough were analyzed.Based on association rules and complex system entropy clustering algorithm,the medication rules of Professor ZHANG Binghou in the treatment of chronic cough were analyzed.Results The main clinical symptoms of 99 patients with chronic cough included cough,expectoration,asthma,chest tightness,shortness of breath,sticky expectoration,fatigue,loose stool,itchy throat,dry mouth,fear of cold,etc.The core pathogenesis of chronic cough was lung failure,and the main syndrome types included phlegm-dampness accumulation in lung,phlegm-heat stagnation in lung,lung dryness and Yin injury,lung and kidney Yin deficiency.Fried Xingren(Armeniacae Semen Amarum),Zhigancao(Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle),fried Mahuang(Ephedrae Herba),Pibaye(Eriobotryae Folium),Shengshigao(Gypsum Fibrosum),Guizhi(Cinnamomi Ramulus),Ganjiang(Zingiberis Rhizoma),Xixin(Asari Radix Et Rhizoma),Jiegen(Platycodonis Radix),Chenxiang(Aquilariae Lignum Resinatum)powder,Maidong(Ophiopogonis Radix),Sangye(Mori Folium),Baiqian(Cynanchi Stauntonii Rhizoma Et Radix),Kuandonghua(Farfarae Flos),Baibu(Stemonae Radix)and Gejie(Gecko)were the main herbs.According to the association rules,the basic drug pairs and core drug combinations were obtained,and five new prescriptions were also obtained.Conclusion We focused on Professor ZHANG Binghou′s analysis of etiology,pathogenesis and accurate grasp of syndrome differentiation in the treatment of chronic cough.The main clinical treatment principles were warming lung and dispersing cold,nourishing Yin and moistening lung,warming kidney and absorbing Qi,strengthening spleen and eliminating dampness.