基于《证治汇补·哮病》探析儿童哮喘防治思路

Prevention and Treatment of Childhood Asthma Based on Zheng Zhi Hui Bu:Asthma

儿童哮喘是儿科常见疾病之一,明末清初医家李用粹所著《证治汇补·哮病》总结前人医家的观点,指出“非时之感”为本病的外在诱因,“胶固之痰”为内在根本,“壅塞之气”则是病机所在。儿童哮喘急性发作期以肺气壅塞为主,治疗应当以宣肺理气为主,兼顾疏风散邪和化痰祛饮;缓解期的治疗则当以祛除“伏痰”为主要目标,化痰祛饮和补虚扶正双管齐下,其中补虚尤当注重补脾胃,且补脾胃当重健运而非进补之法;而对“非时之感”的防范和治疗则应当贯彻疾病的全过程,尤其在缓解期和迁延期,需意识到其仍有未尽之风痰,邪不去则正难复,此外也要将患儿精神心理因素纳入防治的范畴;愈后当防复发,日常饮食生活调摄当尤为重视,家长应积极引导患儿养成健康的生活习惯。

Childhood asthma is one of the common diseases in pediatrics.In the late Ming and early Qing dynasties,physician Li Yongcui summarized the views of earlier doctors in his book Zheng Zhi Hui Bu:Asthma,and pointed out that “untimely external factors” are the external triggers of this disease,“stubborn phlegm” is the internal root cause,and “obstructed qi” is the pathological mechanism.The acute phase of childhood asthma is characterized by lung qi obstruction,and treatment should focus on ventilating lung and regulating qi,while also dispelling wind,removing pathogens,and resolving phlegm.The remission phase should focus on eliminating “hidden phlegm” in combination with resolving phlegm,removing retained fluids,tonifying deficiency,and reinforcing healthy qi.In particular,tonifying deficiency should focus on the spleen and stomach,which emphasizes promoting their function rather than simply nourishing.Prevention and treatment of “untimely external factors” should be implemented throughout the entire course of the disease.During the remission and protracted phases,it is important to recognize that there may still be residual wind-phlegm,which can hinder recovery if not fully addressed.Additionally,the psychological factors of the child should be included in the prevention and treatment strategy.To prevent recurrence,special attention should be paid to daily diet and lifestyle adjustments.Parents should actively guide their children to develop healthy living habits.