邱晓堂教授治疗顽固性咳嗽经验

Experience of Professor Qiu Xiaotang in treating intractable cough

邱晓堂教授将发作时间超过8周的慢性咳嗽者统称为“顽固性咳嗽”,其特点如下:以干咳为主,咳甚后可见少量白痰,咽干咽痒,在闻及刺激性气味或言谈较多时加重。然该类患者临床并未见咳嗽咯痰,而常以干咳为主,同时亦无风寒袭表的卫分症状,由于患者出现咽干、咽痒,而常被误诊为燥邪犯肺。根据燥为“次寒”的理论,同时结合多年的临床治疗经验,邱教授认为顽固性咳嗽以外感风寒引起者居多,乃由风寒袭肺,肺失宣降,气机上逆而作咳,咳嗽迁延日久或失治误治导致脏腑功能失调则为顽固性咳嗽。该类患者,早期因诊断为“感冒”或“支气管炎”,而被运用寒凉药物或滥用抗生素来治疗,此均为失治、误治,造成风寒未能完全发散,余邪留恋,内伏于肺,壅阻肺气。因肺主气司呼吸,以宣发肃降为要,为清虚娇嫩之脏,易受邪侵,受邪则宣发肃降失职而咳嗽不已。肺气宣发与肃降协调有序,有宣有降,清气吸入,浊气呼出,才能保证人体正常的气体交换。据此,邱教授提出顽固性咳嗽的核心病机为“风寒袭肺,肺失宣发,肺气上逆”。治疗以轻清宣肺为理念,制定“疏散风寒,宣肺止咳”的治则,以杏苏散加减组方,疗效显著,值得借鉴。

Professor Qiu Xiaotang refers to chronic cough with an onset duration of more than 8 weeks as"intractable cough".Its characteristics are as follows:dry cough is the main symptom,with a small amount of white sputum visible after coughing,and dry and itchy pharynx,aggravated by smelling and pungency or talking more.However,this type of patients does not clinically show symptoms of cough or sputum,but usually dry cough,and no symptoms of cold,therefore,the patients with dry throat and throat itching are often misdiagnosed as dryness of the lung.According to the dryness as"sub cold"theory,and combined with years of clinical experience,Professor Qiu believes that the most common cause of intractable cough is exogenous cold,which is a result from wind-cold attacking lung,failure of lung Qi in dispersing and reversed flow of Qi.Intractable cough is caused by dysfunction of organs due to prolonged treatment or mistreatment.Such patients are diagnosed as"cold"or"bronchitis"in the early stage,and are given cold drugs,or abuse of antibiotics,which causes missed treatment or mistreatment,resulting in the wind and cold’s completely diverging,residual evil nostalgia,which is embedded in the lung and obstructs lung Qi.Because the lung is responsible for breathing,it is necessary for it to ascend or descend.The lung is a delicate organ and is vulnerable to evil,which makes it fail the duty of ascending or descending,and leads to cough unceasingly.In order to ensure the normal gas exchange of the human body,the lung gas ascending and descending are coordinated orderly.The clear air is inhaled and the turbid air is exhaled.Accordingly,Professor Qiu proposes that the core pathogenesis of intractable cough is"wind-cold attacking lung,lung Qi fails to disperse and lung Qi moves upward reversal."The treatment is based on the concept of opening the inhibited lung Qi with drugs of mild action,and formulating the treatment of"dispelling wind,and dispersing lung qi for arresting cough".Qiu dialectically applies modified Xingsu powder(杏苏散加减),which has a significant effect.It is worth reference.