中医药治疗小儿上气道咳嗽综合征临床研究进展

Overview of clinical research progress of TCM in children with upper airway cough syndrome

上气道咳嗽综合征(UACS)是小儿慢性咳嗽的主要病因之一,现代医家辨治本病或从邪立论,突出风、湿、热、痰、瘀在本病发生发展过程中的重要作用;或重视脏窍、脏腑之间的相互关系,认为病位虽主要在肺,但又不局限于肺;或主张将辨病与辨证相结合,根据其原发病分为鼻源性和咽源性2大类。治疗从祛邪、扶正入手,祛风、化痰、活血各有侧重,宣肺、运脾、调肝见解相异;临证时多鼻咽分治,巧妙运用以苍耳子散、六味汤、小青龙汤、止嗽散等为代表的古方、验方,加减化裁。该病目前可参考的文献多以经验总结为主,临床研究仍缺乏公认的证型标准、诊疗规范,咳嗽主观评估测量标准、疗效判定指标具体执行情况不明朗、欠规范,整体研究观察周期也较短。完善和丰富儿童UACS中医诊疗规范,开发和验证中文版咳嗽主观评估问卷,确定相应的临床研究标准迫在眉睫。

Upper airway cough syndrome is one of the main causes of children’s chronic cough in China.Mod-ern physicians analyse and recognize this disease follow the theory of pathogen,emphasize the important role of wind,dampness,heat,phlegm and blood stasis in the incidence and development of this disease;or attach impor-tance to the interrelationships with zang-fu organs and orifices,and think that although the main location is in heart,it is not limited to the lung;or advocate the combination of disease differentiation and syndrome differentia-tion,and divide it into nasal and pharyngeal origin according to its primary disease.The treatment starts from dispel-ling the evil and supporting the positive.Doctors who focus on dispelling wind,resolving phlegm and activating blood circulation have different opinions on promoting lung,transporting the spleen and regulating the liver.The treatment is divided into nasopharyngeal and pharyngeal parts,and ancient and tested prescriptions such as Cangerzi San(苍耳子散),Liuwei Tang(六味汤),Xiaoqinglong Tang(小青龙汤),and Zhisou San(止嗽散)are skillfully used to modified in order to customize the treatment.The current literature available for this disease is mostly empiri-cal,and clinical research still lacks recognized standards of evidence,diagnosis and treatment.The specific imple-mentation of subjective assessment and measurement standards for cough and indicators for determining the efficacy of treatment is unclear and nonstandard.The overall research observation period of the study is also short.It is urgent to improve and enrich the Chinese medicine diagnosis and treatment standard of children’s upper airway cough syn-drome,develop and validate the Chinese version of cough subjective assessment questionnaire,and determine the corresponding clinical research standard.