从痰、瘀、闭、虚分期辨治儿童闭塞性细支气管炎

Syndrome Differentiation and Treatment of Children Bronchiolitis Obliterans by Stages from the Perspective of Phlegm,Stasis,Block and Deficiency

认为儿童闭塞性细支气管炎病位在肺,与脾肾密切相关,主要病机可概括为痰、瘀、闭、虚。临证主张根据临床表现和病机特点进行分期辨证论治,发作期病机为痰瘀闭肺,治以化痰祛瘀、止咳平喘,其中寒痰闭肺证予小青龙汤合三子养亲汤加减,痰热闭肺证予自拟五虎汤加味;持续期病机为上实下虚兼痰瘀闭证,治以化痰祛瘀、开闭补虚,予小青龙汤合都气丸加减;恢复期病机为肺脾肾亏虚兼有余邪,治以补虚固本、兼清余邪,予宝根1号方加减。

It is believed that children bronchiolitis obliterans(BO)is located at the lung and closely related to the spleen and kidney.Phlegm,stasis,block and deficiency are the main pathogenesis.This article promotes staged differentiation and treatment of BO considering the clinical manifestations and pathogenesis characteristics.The attack stage is dominated by phlegm and stasis blocking the lung,for which the method of dissolving phlegm and dispelling stasis,relieving cough and calming panting should be used;Xiaoqinglong Decoction(小青龙汤)and Sanzi Yangqin Decoction(三子养亲汤)with modifications and selfmade Modified Wuhu Decoction(五虎汤加味)are recommended for cold-phlegm blocking the lung syndrome and phlegm heat blocking the lung syndrome,respectively.In sustained stage,the upper excess and lower deficiency together with phlegm-stasis blocking the lung are the pathogenesis,for which the method of dissolving phlegm and dispelling stasis,reopening the block and supplementing deficiency is suggested,and Xiaoqinglong Decotion(小青龙汤)and Duqi pills(都气丸)with modifications can be used.In convalescent stage,the pathogenesis is lung-spleen-kidney depletion with residual pathogen.It suggested to supplement the deficiency and consolidate the root,as well as clear the residual pathogen,for which Baogen NO.1 Decoction(宝根1号方)with modifications can be used.