李岚教授治疗小儿肺炎支原体肺炎经验

The Clinical Experience of Professor LI Lan in Treating Pediatric Mycoplasma Pneumoniae Pneumonia

[目的]总结李岚教授辨证论治小儿肺炎支原体肺炎的临证经验。[方法]通过搜集整理住院病历、跟师侍诊病案,查阅相关古籍及文献资料,阐述李师对该病病因病机的认识,分析其诊疗思路,并附验案二则以资验证。[结果]李师认为,小儿肺炎支原体肺炎病因多责之于外感之风邪及小儿肺脾本虚,临床分期可分为初期、极期、恢复期三期。在治疗中,总体以宣肺开闭为基本治则,同时采用清热涤痰、活血化瘀、回阳救逆、扶正祛邪等治法,临床辨证施治,屡获佳效。验案一辨证为极期(心阳虚衰证),治法为回阳救逆,以参附龙牡救逆汤为主方,同时选用黄芪、茯苓补气健脾、扶正祛邪。验案二辨证为极期(痰热闭肺证),治法为清热涤痰、宣肺开闭,以麻杏石甘汤合千金苇茎汤为主方,考虑兼有瘀血阻滞,选用桃仁、丹参活血化瘀;在恢复期时,选用白术、太子参培土生金、健脾益气。[结论]李师辨证论治小儿肺炎支原体肺炎,灵活运用中医药治疗,解决小儿肺炎支原体肺炎极期高热难退、恢复期咳嗽咳痰迁延不愈等问题,疗效显著,其经验值得临床学习及推广。

[Objective]To summarize the clinical experience of Professor LI Lan in treating pediatric Mycoplasma pneumoniae pneumonia(MPP).[Methods]By following Professor LI's hospitalized medical records from outpatient department,collecting,sorting out and analyzing medical cases,accessing to relevant antiquities and literature,this article describes Professor LI's understanding of the etiology and pathogenesis of the disease,and analyzed and summarized her academic mentality and clinical experience,and two typical cases were attached as proof.[Results]Professor LI figures that the pathogenic wind evil and the deficiency of the lung and spleen are the courses of pediatric MPP.Clinical staging can be divided into three phases:initial,extreme and recovery phases.In the treatment,the basic rule is to diffuse and open the lung,and at the same time,clear heat and dissolve phlegm,invigorate blood circulation and dissolve blood stasis,restore Yang to rescue from counter-flow,reinforce healthy Qi and dispel pathogen,etc.Professor LI gives the treatments according to pattern differentiation,and has obtained excellent therapeutic results.The syndrome differentiation of the first case was extreme phase(heart Yang deficiency).The treatment was restoring Yang to rescue from counter-flow,and Shenfu Longmu Jiuni Decoction was used,and also chose Astragalus membranaceus-Poria cocos to supplement Qi and fortify the spleen,reinforce healthy Qi and dispel pathogen.The syndrome differentiation of the second case was extreme phase(phlegm-heat blocking the lung).The treatment was clearing heat and dissolving phlegm,diffusing and opening the lung,and Maxing Shigan Decoction and Qianjin Weijing Decoction were used,considering static blood obstructing,Semen persicae-Salvia miltiorrhiza was selected;during the recovery phase,Atractylodes macrocephala Koidz.-Pseudostellaria heterophylla were used to bank up earth to generate metal and fortify the spleen and supplement Qi.[Conclusion]Professor LI's diagnosis and treatment of pediatric MPP,flexible use of traditional Chinese medicine solve the dilemma of pediatric MPP in the extreme phase of high fever being difficult to subside,cough and phlegm being prolonged and difficult to heal in the recovery phase,etc.,the efficacy of the treatment is remarkable,and the experience is worthy of clinical study and popularization.