从“厥阴病欲解时”论治小儿咳嗽变异性哮喘

Discussion on The Syndrome-differentiation of Cough Variant Asthma in Children from Molecular Circadian Clock of Immunometabolism

部分咳嗽变异性哮喘(CVA)患儿咳嗽常在下半夜发作,符合“厥阴病欲解时”(1点至7点)。通过对厥阴病“欲解”而“不解”的机理进行探讨,提出代谢免疫因子日节律的改变,在“厥阴病欲解时”期间,血浆皮质醇浓度及促炎性细胞因子浓度升降失常或许是CVA在“欲解时”加重的潜在机理。CVA的病机特点可概括为卫虚风动,若出现寒热错杂证及咳嗽多发作或加重于下半夜时,证属厥阴咳,须寒热、气血同调,扶正、祛风并用。从“厥阴病欲解时”论治小儿CVA,即运用乌梅丸加减治疗厥阴咳,可谓圆机活法,处方切证则疗效确切。

It is necessary to study the pathogenesis and treatment of cough variant asthma(CVA)from Immunometabolism.CVA is easily relieved when cortisol is elevated and pro-inflammatory cytokines are decreased.The corresponding time period is related to Jueyin and Shaoyang disease,so CVA should be treated mainly from Jueyin and Shaoyang disease.The circadian rhythm of immune and metabolic parameters was correlated with the time for the elimination of six-meridian disease,and the mechanism of traditional Chinese medicine treatment of CVA was preliminarily discussed based on the syndrome-differentiation of the six meridians.Clinically,Wumei Pill or Xiaochaihu Decoction is the base,which has achieved satisfactory results.