从“玄府失司”探析儿童慢性咳嗽临证法要

Analysis of the treatment method of chronic cough in children from the perspective of“xuanfu loss of function”

慢性咳嗽是儿科常见疾病之一,其发生、发展、转归与玄府理论密切相关。本病的核心病机为正气不足,玄府失司。其中,脏腑娇嫩、玄府失养为发病的基础;痰阻食积、玄府郁滞为致病的因素;风邪触发、玄府失司为发病的诱因。儿童肺、脾、肾不足,易致玄府失养,进而影响玄府输布津液之功,玄府因虚而滞,则邪气有可乘之机;加之后天脾胃失养,运化失常,易聚湿生痰,或食滞中焦而阻滞玄府通道,影响气机畅通,为发病埋下隐患;若遇风邪触发,内外邪气相互交感,玄府功能失司,导致肺失宣肃而诱发咳嗽,且病情缠绵。治疗上,本文强调因势利导、通玄达郁的原则,分别予祛风散邪、化痰除积、扶正补虚以开玄,同时,注重特色开玄药物的应用,尤其理气开玄药、搜剔开玄药和活血开玄药,以恢复肺玄府失司之职,则疾病自愈。

Chronic cough is one of the common diseases in pediatrics,and its occurrence,development and regression are closely related to the theory of xuanfu.Our team believes that the core pathogenesis of this disease is the deficiency of vital qi and the invasion of evil qi,resulting in a loss of control of the xuanfu.Among them,the deficiency of zang-fu organs and the loss of nourishment of the xuanfu are the basis of the disease;the accumulation of phlegm and food and the stagnation of the xuanfu are the root cause of the disease;the wind evil triggers the xuanfu to be the cause of the disease.In children,the lung,spleen and kidney are often deficient,making it easy for the xuanfu to lose its nourishment,which in turn affects the function of the xuanfu in transporting fluids,and when the xuanfu is stagnant due to deficiency,evil qi has an opportunity to take advantage of it;In addition,if the spleen and stomach are not nourished,and the transportation and transformation are not normal,it is easy to accumulate dampness and produce phlegm,or if food stagnates in the middle jiao and stagnates in the xuanfu channel,it will affect the smooth flow of qi and lay the hidden danger for the development of disease;If the cough is triggered by wind pathogen,the internal and external evil qi will interact with each other and the xuanfu will malfunction,resulting in the failure of lung qi to diffuse and purify and coughing,and the condition will linger.In treatment,our team adopted the principle of promoting the situation and removing the stagnation in the xuanfu by dispelling wind evil,resolving phlegm and removing stagnation,and reinforcing vital qi and supplementing deficiency to open up the xuanfu.At the same time,we pay attention to the application of the characteristic medicine to unblock the xuanfu,especially the medicine to regulate qi to unblock the xuanfu,the medicine to dredge the meridians to unblock the xuanfu and the medicine to invigorate the blood to unblock the xuanfu,so as to restore the function of the xuanfu of the lung,then the disease can be cured.