从“寒留三焦”论治咳嗽变异性哮喘的思路

Thoughts on the Treatment of Cough Variant Asthma from the “Cold Retaining in Sanjiao”

提出从"寒留三焦"论治咳嗽变异性哮喘(CVA)的中医治疗思路与策略。对于以寒咳为特征的CVA患者,虽以散寒止咳为大法,但应据寒邪所在病位、脏腑及病机之不同而详加分辨:寒留上焦者,总以金沸草散、三拗汤加味为主方,若寒邪轻微者可以止嗽散化裁,寒邪重者治以麻黄汤加味,伴寒饮内伏者可以小青龙汤加减,兼水气上逆者则以苓桂剂为主方;寒留中焦者,重在脾胃,脾胃虚寒者治以理中汤加味,寒热错杂者选半夏泻心汤为主方,肝郁脾寒者则以柴胡桂枝干姜汤加味;寒留下焦者,当温补肾阳以散寒,可用二仙汤加味治疗。

This paper put forward the traditional Chinese medicine(TCM)idea and strategy of treating cough variant asthma(CVA)from"cold retaining in Sanjiao".For the CVA patients who are characterized by"cold cough",although eliminating cold to stop cough is important,we should carefully differentiate the differences of disease location,zang-fu organs and pathogenesis.For cold in the upper jiao,Jinfeicao Powder(金沸草散),modified San′ao Decoction(三拗汤)are primary prescriptions.Modified Zhisou Powder(止嗽散)is suitable for patients with ligh cold pothogen.Modified Mahuang Decoction(麻黄汤)is suitable for patients with sever cold pathogen.Patients with cold and fluid hidden interal could use modified Xiaoqinglong Decoction(小青龙汤),and series prescriptions containing Fuling(Poria)and Guizhi(Cortex Cinnamon)for combined with adverse rising of water and qi.For cold in the middle jiao,the treatment focus on the spleen and stomach.Modified Lizhong Decoction(理中汤)is suitable for patients with the deficiency-cold in the spleen and stomach.Patients with the simultaneous occurrence of cold and heat could use Banxia Xiexin Decoction(半夏泻心汤)as primary prescription.Patients with the liver depression and spleen cold could use modified Chaihu Guizhi Ganjiang Decoction(柴胡桂枝干姜汤).For cold in the lower jiao,the treatment should warm and tonify the kidney yang to disper cold,with modified Erxian Decoction(二仙汤).