养阴润燥祛风法治疗儿童上气道咳嗽综合征经验

Experience on Treating UACS in Children by Nourishing Yin,Moistening Dryness and Removing Wind

国医大师姚晶莹教授为姚氏清润流派创始人,深受朱丹溪学术思想影响,认为小儿体禀阴虚,治疗小儿诸疾皆应考虑其"阴长不足"之体质特点,阴虚则易生内热,故临诊善用养阴清热法治疗小儿阴虚内热诸症。姚老在治疗儿童上气道咳嗽综合征病症方面亦有其独到见解,系统分析该病发病机制、综合患儿病症特点,遵循小儿生理病理之要,总结出该病病机总属阴虚内热,内外风合邪。其中,阴虚内热之病因一方面由小儿本身体质所决定,另一方面则归责于久病失治误治,病邪久稽从阳化热,此二者皆可灼伤肺津,呈现一派阴虚肺热之象,故治疗时以养阴润燥为本;除阴虚内热之病因以外,姚老认为风邪亦为引起该病症不可或缺之因素,并将风邪细分为内风、外风,二者合邪致症状加重,故遣方时不可忘祛风通窍;同时指出该病病位虽以肺脏为主,但鼻喉同病,常受累心肝等脏,用药时应顾护多脏。在明确病因病机的基础上,姚晶莹教授总结各派医家用药规律,博采众长,突破创新,自拟"治鼻一号"方,切中病机,用药灵活,验之临床,疗效显著。龙旭浩教授自1988年起跟随姚老学习及临诊,为姚氏清润流派第三代传承人,传承导师特色诊疗方法,对姚老的养阴清热疗法进行深入研究和发扬推广,参悟精研,灵活运用。笔者跟随导师临诊抄方,对姚老治疗小儿上气道咳嗽综合征之理念颇有感悟,现将该病病机、治则阐述如下,并附验方一例,以资验证。

Professor YAO Jingying,the founder of YAO’s Qingrun School,was deeply influenced by ZHU Danxi’s academic thought.He believed that the physical characteristics of Yin deficiency should be taken into account in the treatment of children’s diseases.Yin deficiency is prone to internal fever.Therefore,the method of nourishing Yin and clearing heat should be used to treat children’s internal fever due to Yin deficiency.YAO Lao also has his own unique views on the treatment of children’s upper airway cough syndrome.Through the systematic analysis of the pathogenesis of the disease,the characteristics of children’s symptoms and following the essentials of children’s physiology and pathology,it is concluded that the pathogenesis of the disease is always Yin deficiency and internal heat,internal and external wind.Among them,the etiology of Yin deficiency and internal heat is determined by children’s constitution on the one hand,and on the other hand,it is attributed to long-term illness and mistreatment.The pathogenic factors are Yin deficiency and internal heat.Both of them can damage lung and body,presenting an image of Yin deficiency and lung heat,and so nourishing Yin and moistening dryness is the basis of treatment.Besides the etiology of Yin deficiency and internal heat,YAO believes that wind evil also exists.In order to cause the disease indispensable factors,the wind evil could be divided into internal wind and external wind,and the symptoms are aggravated due to the combination of the two pathogens.And so we should not forget to expel wind and dredge orifices when dispatching prescriptions.At the same time,it is pointed out that although the disease is mainly located in the lung,the nose and throat are also abnormal,often involving heart,liver and other Zang-fu organs.Therefore,we should take care of multiple organs when using drugs.On the basis of defining the etiology and pathogenesis,Professor YAO Jingying summarized the medication rules of various medical schools,learned from the advantages of all,made breakthroughs and innovations,and formulated the"No.1 Nose Treatment"prescription by himself,which can treat the key pathogenesis.The drugs selection was flexible and the clinical effect was remarkable.Since 1988,Professor LONG Xuhao has been learning from YAO Lao.He is the third generation successor of YAO’s Qingrun School,inheriting the characteristic diagnostic and therapeutic methods of his tutor.He has carried out in-depth research and promotion of YAO Lao’s Yin-nourishing and heat-clearing therapies,participating in intensive research and flexible application.Following the tutor’s clinical prescriptions,the author has some insights into YAO Lao’s idea of treating children’s upper airway cough syndrome.Now,the pathogenesis and treatment principles are elaborated as follows,and an empirical prescription is attached for verification.