分期论治小儿化脓性扁桃体炎

Syndrome differentiation treatment of children with suppurative tonsillitis by stages

依据中医六经辨证法探讨了小儿化脓性扁桃体炎的发病特点和基本病机,并提出了分期论治的解决方案。脓未成期,病机特点为邪伏少阳(膜原),少阳阳明合病,积热内生,治以透达少阳、清宣退热,方用柴胡达原饮加减,治疗要点在于用药要早,剂量要足,力求将病情控制在此阶段;脓已成期,病机特点为三阳合病、热壅化毒或少阴阳明合病、阳虚毒结,治以解表清里、通腑泄热,方用防风通圣散或麻黄附子细辛汤合薏苡附子败酱散化裁,治疗要点需在发热前频服,剂量要足,得汗减量,中病即止;脓消退期,病机特点为太阴阳明合病、正虚邪恋、湿热蕴结或脾虚伏热、气阴亏虚,治以清热化湿、解毒利咽,方用甘露消毒丹或竹叶石膏汤加减治疗,治疗要点是常规剂量,苔化转方,调理巩固。

According to syndrome differentiation of six meridians method of traditional Chinese medicine,this paper discusses the attack characteristics and basic pathogenesis of suppurative tonsillitis in children,and puts forward the solution of syndrome differentiation treatment by stages.In pre-suppurative stage,its pathogenic characteristics are pathogen hidden in shaoyang meridian(the pleurodiaphragmatic interspace)and combined disease involving both shaoyang and yangming meridians,causing interior produce of accumulated heat.The treatment is expelling pathogenic factors from shaoyang meridian and clearing,dispersing and abating heat,selecting prescription modified Chaihu Dayuan Yin(柴胡达原饮),the key point of treatment lies in the early medication and sufficient dosage,and strives to control the disease in this stage.In stage of suppuration,its pathogenic characteristics are combined disease of three yang meridians,congested heat transforming into toxin or combined disease involving both shaoyin and yangming meridians,and yang-deficiency and toxin accumulation.The treatment is relieving superficial pathogenic factors and clearing the interior as well as dredging intestines to dispel heat,selecting modified prescription Fangfeng Tongsheng San(防风通圣散)or Mahuang Fuzi Xixin Tang(麻黄附子细辛汤)combined Yiyi Fuzi Baijiang San(薏苡附子败酱散)along with symptoms,the key point of treatment lies in that it should be taken at short intervals before fever,with sufficient dosage,reducing the dose after sweating and withdrawal treatment as soon as the signs are eliminated.In resolution stage of suppuration,its pathogenic characteristics are combined disease involving both taiyin and yangming meridians and lingering of pathogenic factors due to asthenia of healthy qi,accumulation of damp-heat or latent heat due to spleen-asthenia,and consumption of qi and yin.The treatment is clearing away heat to eliminate dampness as well as removing toxic materials and soothing throat,selecting modified Ganlu Xiaodu Dan(甘露消毒丹)or Zhuye Shigao Tang(竹叶石膏汤),the key point of treatment lies in routine dose,change medication and prescription in accordance with the variation of the syndrome types,regulating and consolidating.