基于脾胃学说分期论治小儿咳嗽变异性哮喘

Treatment of Children's Cough Variant Asthma by Stages Based on Spleen-stomach Theory

咳嗽变异性哮喘是儿科常见疾病,是儿童慢性咳嗽的首位原因,发病率日益增加。小儿脾常不足,基于李东垣之脾胃学说“内伤脾胃,百病由生”理论,本病病位在肺,病机为正气亏虚,痰瘀伏肺,风邪引触,将其分为急性发作期和平稳恢复期,急性发作期风邪侵袭,肺失宣肃,治则祛风解表,宣肺止咳,方选桑菊饮化裁,平稳恢复期肺脾气虚,痰瘀阻肺,治则健脾补肺,化痰散瘀,方选加味六安煎化裁。健运脾胃与化痰散瘀之法贯穿始末。因时制宜,同病异治,以期为本病的治疗提供新的思路。

Cough variant asthma is a common pediatric disease and the primary cause of chronic cough in children,with an increasing incidence.Children are characterized by insufficient spleen qi,and based on the spleen-stomach theory of Li Dongyuan that“internal injuries of spleen and stomach result in various diseases”,the location of this disease is in lungs,and the pathogenesis is deficiency of healthy qi,phlegm-stasis obstructing lungs,and wind evil invasion.Cough variant asthma can be divided into acute stage and convalescent stage.In acute stage,the pathogenesis is wind evil invasion and lungs'failure to govern ascent and purification,and the therapeutic methods are dispelling wind to release exterior and lung qi failing in ascent and purification,with modified Sangju Decoction as the main formula.In convalescent stage,the pathogenesis is lung-spleen qi deficiency and phlegm-stasis obstructing lungs,and the therapeutic methods are invigorating spleen,tonifying lungs,resolving phlegm and dissipating stasis,with modified Jiawei Liu'an Decoction as the main formula.The methods of tonifying spleen and stomach in transportation,resolving phlegm and dissipating stasis were used throughout the whole treatment process.Measures are adjusted according to different disease stages and same disease is treated with different therapies,so as to provide new ideas for the treatment of cough variant asthma.