吴深涛教授从火湿分治论治原发性头汗症经验总结

吴深涛教授认为原发性头汗症的病机关键在于火邪因湿所困,蓄于阳明、少阳两经之中,郁而不发则上蒸于头,故汗出于头颈。故在治疗时应把握阳明经从燥化、少阳经从火化的特点,注重火与湿邪之间的矛盾关系,强调火、湿分治之法,并注重斡旋气机以恢复患者阴阳平衡。火重于湿则采用泻肝汤、小柴胡汤、蒿芩清胆汤,自拟白虎止汗散等方剂,湿重于火则采用柴胡桂枝干姜汤、清燥汤。

原发性头汗症的外科手术治疗

目的：比较胸腔镜下第二肋骨表面交感神经链（ R2）切断术及第三肋骨表面交感神经链（R3）切断术治疗原发性头汗症效果。方法65例原发性头汗症患者，实施R2节段手术23例（ A组），R3节段42例（ B组），通过随访术后头面部出汗程度，代偿性多汗，患者满意程度等评估两种术式优缺点。结果随访61例患者，A组19例患者头面部多汗缓解，2例单侧缓解。B组35例缓解，2例单侧缓解，3例复发，两组之间头面部多汗缓解率差异无统计学意义。A组（95.2%）代偿性多汗发生率与B组（95%）相似，两组之间差异无统计学意义，但重度代偿性多汗A组明显高于B组（p〈0.05）。两组术后患者满意度A组为90.4%，B组为87.5%，两组之间差异无统计学意义。结论 R3交感神经切断术治疗原发性头汗症安全、有效，并可减少重度代偿性多汗的发生。

胸腔镜下T_2交感神经夹闭治疗头汗症初探

[目的]:探讨电视胸腔镜下行T2交感神经夹闭治疗头汗症的有效性和安全性。[方法]:从2005年起,我们在胸腔镜下应用10 mm钛夹,胸膜腔内不切开纵隔胸膜,不游离交感神经链,直接于星状神经节下缘夹闭第2胸交感神经(T2)治疗12例头汗症,对合并有手汗症者同时夹闭T3。[结果]:本组12例患者效果均满意。无术中併发症,无较严重的术后併发症。随访3～15个月(平均9个月),无一例复发,无一例出现明显的代偿性多汗。[结论]:经胸腔镜直接夹闭T2交感神经是一种治疗头汗症安全、有效、微创的方法。

胸腔镜T_2交感神经干阻断术治疗头面部多汗症随访与疗效评估

目的：评价电视胸腔镜行双侧胸交感神经链T2节段阻断术治疗头面部多汗的远期疗效及术后生活质量。方法2002-01至2007-12，通过阻断T2交感神经干的手术方式治疗头面部多汗症20例，每年进行定期电话随访，最近一次随访时间为2014-06，术后最短随访时间均超过5年。结果20例头面部多汗患者，手术持续时间30～45 min，平均（37．5±7） min。术后头汗消失率为100％，代偿性出汗总发生率为100％。代偿性出汗主要集中在后背和前胸，分别为96．7％，100％。其他部位如腹部、大腿也存在不同程度的代偿性出汗。随访结果对于手术效果“满意”10人（50％），“一般”7人（35％），“不满意”3人（15％）。术后生活质量明显改善9人（45％），改善8人（40％），无改善3人（15％）。结论胸腔镜下阻断T2交感神经干治疗头汗症效果确实，但术后出现代偿性多汗不可避免，对术后生活质量和心理影响较大，应谨慎实施这类手术。

Prescriptions from Traditional Chinese Medicine compared with salbutamol and montelukast for the treatment of pediatric asthma： a randomized controlled trial

OBJECTIVE: To compare the effects of a series of Traditional Chinese Medicine(TCM) empirical prescriptions with salbutamol and montelukast(SM) in children with asthma.METHODS: A total of 182 children with asthma were randomized into the TCM group(n = 97) or SM group(n = 85). Patients in the TCM group were treated with a series of TCM prescriptions, whereas those in the SM group received salbutamol and montelukast; both groups received their respective treatment for 12 weeks. Asthma control, changes in scores of TCM symptom patterns, and asthma symptom control(SC) scores after treatment were compared between the two groups.RESULTS: A higher percentage of patients in the TCM group had asthma control compared withthose in the SM group(91.67% and 76.83%, respectively, P = 0.006). Scores for abnormal feces(P <0.001), hyperhidrosis(P < 0.001), and tongue appearance(P = 0.001) in the TCM group were significantly better than those in the SM group. However,the total scores of TCM symptom patterns and SC scores did not differ significantly between the two groups(P > 0.05).CONCLUSION: Compared with salbutamol and montelukast, the TCM prescriptions tested were better for symptom control in children with asthma.