程燕教授辨证论治百日咳综合征经验

CHENG Yan’s experience in treatment based on syndrome differentiation for whooping cough syndrome

程燕教授认为百日咳综合征为感染疫疠时邪所致。病机主要是小儿肺脾气虚,卫外不固,时邪犯肺,郁而化热,炼津为痰,痰热交阻,肺失宣肃,气逆上冲所致。病位初咳期在肺,痉咳期在肺、脾、肝,恢复期在肺、脾,可累及大肠、膀胱、心。该病初咳期多为风热犯肺证,治疗以疏风散热、清宣止咳为法,选用风热咳方加减,多用桑叶、淡豆豉等轻宣之品,使邪从汗而解。不可骤用寒凉收敛药,以免损伤肺胃阳气,引邪入里。痉咳期分为痰热郁肺证和燥热袭肺证,其中痰热郁肺证在开肺化痰、止咳平喘治疗的基础上,还需重视平肝解痉止咳,选用痰热咳方加减,多用僵蚕、地龙以搜风通络化痰,白茅根以清热凉血、通利二便;燥热袭肺证治疗以清热润肺、降逆止咳为法,选用燥热咳方加减,多用竹茹、枇杷叶、瓜蒌子等以清热生津、降气止咳止呕。但应注意滋阴药味的选用,以免闭门留寇,致病情迁延。后期多属气阴不足证,治疗以滋阴润肺、益气健脾为法,选用金土汤加减,因患儿常余热未清,临证注意不可单纯补气养阴。附典型案例1则,以资说明。

Professor CHENG Yan holds that whooping cough syndrome resulted from contracting pestilence and seasonal pathogen.The pathogenesis is mainly caused by asthenia of pulmonosplenic qi in children,weakness of exterior aspect,seasonal pathogen attacking the lung,transformation of depression into heat,condensing fluid into phlegm,phlegm-heat interwined accumulation,failure of lung to disperse and depurate and upward attack of adverse flow of qi.As for the location of disease,the early cough period is in the lung,the spasmodic cough period is in the lung,spleen and liver,the convalescent period is in the lung and spleen involving the large intestine,bladder and heart.The disease in the early cough period is mainly wind-heat invading lung syndrome,the therapeutic method is dispelling wind and eliminating heat as well as stopping cough with light medicines.Selecting modified Fengreke Fang(风热咳方)and mostly using the light medicines,namely Morus alba L.and Glycine max(L.)Merr.etc.,expel pathogenic factors from the sweat.It is not allowed to suddenly use cold,cool and astringent medicines in case they impair yangqi in lung and stomach and conduce pathogenic factors to the interior.In the spasmodic cough period,it is classified as stagnation of phlegm-heat in lung syndrome and dryness-heat invading lung syndrome.Among them,based on the treatment of relieving lung to resolve phlegm as well as relieving cough and stopping asthma,the former should focus on soothing liver,relieving spasm and stopping cough,select modified Fengreke Fang and mostly use Bombyx Batryticatus and Pheretima to expel wind,dredge collaterals and resolve phlegm,using Imperatae Rhizoma to clear away heat and cool blood as well as promoting urination and defecation;the latter takes clearing away heat to moisten lung and descending adverse flow of qi to stop cough as the therapeutic method,selects modified Zaoreke Fang(燥热咳方),mostly uses Bambusae Caulis In Taenias,Eriobotryae Folium and Trichosanthis Semen etc.to clear away heat and promote production of body fluid as well as descending qi to stop cough and vomiting.However,attention should be paid to the selection of nourishing yin medicines in case the pathogenic factors linger inside,giving rise to pathological conditions persist.In the late period,it mostly belongs to insufficiency of qi and yin syndrome,the treatment takes nourishing yin to moisten lung and replenishing qi to invigorate spleen as the method,and selects modified Jintu Tang(金土汤).Due to the residual heat in children patients,in clinic practice attention should be paid not to invigorate qi to nourish yin alone.One typical case is attached for illustration.