基于“伏痰-血瘀”理论分期辨治小儿哮喘

Stage-based syndrome-differentiated treatment for pediatric asthma based on the theory of "latent phlegm-blood stasis"

摘要

总结丁利忠教授从“伏痰-血瘀”论治小儿哮喘的学术经验。小儿哮喘以“伏痰”为核心病机, 其生成责之于肺、脾、肾三脏功能失调, 津液代谢失常, 伏痰藏于肺窍, 遇外邪引动则发为喘鸣。病久痰气交阻, 肺失宣降, 不能助心行血, 血行迟滞而成血瘀；瘀血既成, 又阻滞气机、妨碍津布, 痰浊愈聚, 终成“痰瘀互结”之病理格局。丁利忠教授临证主张分期论治：发作期以邪实为主, 治以止哮平喘、活血通络, 予龙蝎除哮汤；迁延期正虚邪恋, 痰瘀未尽, 肺脾气伤, 治以平哮化痰、养血活血, 予平哮化痰汤；缓解期邪去正虚, 伏痰潜藏、余瘀待清, 治以固本防哮、培元化瘀, 予固本防哮汤。丁利忠教授“伏痰-血瘀, 分期论治”辨治体系, 理法方药环环相扣, 对小儿哮喘的规范化诊疗具有重要指导意义。

Abstract

The paper summarizes Professor Ding Lizhong's academic experience in treating pediatric asthma based on the theory of "latent phlegm-blood stasis". The core pathogenesis of pediatric asthma is "latent phlegm" which arises from dysfunction of the lung, spleen, and kidney viscera, leading to disordered fluid metabolism; the latent phlegm is retained in the lung orifices and manifests as wheezing when triggered by exogenous pathogenic factors. As the disease progresses, phlegm and Qi become intermingled, and the lung fails to disperse and descend and is unable to assist blood circulation, resulting in sluggish blood circulation and leading to blood stasis; the blood stasis obstructs the movement of Qi and impedes the distribution of body fluids, so the phlegm-turbidity accumulates progressively, resulting in a pathological pattern of intertwined phlegm and stasis. In clinical practice, Professor Ding Lizhong advocates stage-based treatment: during the attack phase, pathogenic excess factors predominate, and the treatment is to arrest asthma, relieve panting, activate blood circulation and dredge collaterals, so Longxie Chuxiao decoction is given; during the protracted phase, the deficient healthy-Qi with lingering pathogenic factors and unresolved phlegm-stasis lead to impaired lung-spleen Qi, and the management approach is to calm asthma, resolve phlegm, nourish blood, and activate blood circulation, so Pingxiao Huatan decoction is used;during the remission phase, pathogenic factors are eliminated yet healthy-Qi is deficient, latent phlegm remains inside and residual blood-stasis awaits clearance, and the treatment is to consolidate the root to prevent asthma recurrence and reinforce primordial Qi to resolve blood stasis, so Guben Fangxiao decoction is administered. Professor Ding Lizhong's syndrome-differentiated treatment system of "latent phlegm-blood stasis and stage-based treatment" is characterized by close interlinkage of principles, therapeutic methods, formulas and medicines, which has great significance in guiding standardized diagnosis and treatment of asthma in children.

关键词

哮喘 / 伏痰-血瘀 / 分期辨治 / 儿童

Key words

Asthma / Latent phlegm-blood stasis / Stage-based treatment / Child

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基金资助

吉林省科技发展计划项目(YDZJ202401141ZYTS)

吉林省教育厅“十三五”科学技术项目(JJKH20200889KJ)