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    小兒咳嗽中醫治療體會
    關鍵字:體會,治療,中醫,GH,IJ,EF,CD,yz,AB,KL, 發布時間:2011-08-21

    李小燕 736200甘肅敦煌市中醫院 關鍵詞咳嗽中醫治療 doi:10.3969/j.issn.1007—614x.2010. 26.00l 資料與方法 一般資料:d,JL咳嗽300例,男女比 例無明顯差異,年齡0.5—14歲,病程1 天~3個月。 治療方法:以八綱辨證為主,輔參咳 嗽的聲音、痰量及顏色分為風寒、風熱、陰 虛、氣虛4型。①風寒咳嗽:凡起病急,受 涼后咳聲頻作,咳聲螢濁,無痰或痰少色 白清稀,微汗,不發熱,食減,二便調,舌苔 薄白,脈浮緊者為風寒型。方用桑荊湯: 桑葉lOg,荊芥69,前胡lOg,桔梗lOg,杏 仁69,蟬蛻69,魚腥草lOg,牛子69,甘草 69。取2劑,涼水浸泡30分鐘,文火煎煮 20分鐘,過濾清出湯液,繼續涼水煎煮, 兩次共約400ml,分3次服完,幼兒可少 量多次頻服。本方具有疏風解表、宣肺止 咳之功效,對外感初起的咳嗽、無痰或痰 少具有良效。寒邪較蓖加炙麻黃、細辛, 辛溫宣肺;鼻寒不通,涕多清稀加辛夷、木 通、蒼耳子散寒通竅;頭身疼痛加羌活、藁 本、川芎祛風止痛。②風熱咳嗽:凡起病 較急,身熱,呼吸粗,咳痰不利,痰黃黏稠, 咽喉腫痛,小便色黃,大便干,舌苔黃,脈 浮滑數為風熱型。方用清肺飲:荊芥 dxJL咳嗽中醫治療體會 lOg,前胡69,黃芩lOg,百部lOg,板藍根 99,連翹lOg,桑自皮lOg,貝母lOg,陳皮 69,半夏69,知母99,生大黃39,甘草69。 煎服同前,1劑后去板藍根、生大黃,加生 姜39再服2劑。本方具有疏風解熱、宣 肺止咳之功效,對于風熱咳嗽患兒有較好 療效。肺熱重加金銀花、梔子清宣肺熱; 咽喉腫痛加牛子、玄參利咽消腫;痰多黃 稠加瓜蔞仁、薏苡仁止咳化痰。③陰虛肺 咳:凡病程長,咳嗽月余,陣發咳嗽,連聲 不斷,干咳無痰或痰少而黏,咳時面赤握 拳,舌伸向外,喉癢聲嘶,日咳數十次,夜 間更甚,口舌干燥,舌紅少苔,脈細數為陰 虛型。方用二冬湯:天冬129,麥冬129, 桑白皮lOg,黃芩lOg,白頭翁lOg,浙貝 lOg,杏仁lOg,半夏69,桔紅69,炙百部 99,瓜蔞仁99,生大黃39。煎服同前,分 多次服。本方具有清肺止咳、化痰養陰之 功效,對咳聲不斷、干咳無痰的陰虛肺咳 有較好療效。咳嗽蓖加炙紫苑、炙枇杷葉 潤肺止咳;陰虛重加地骨皮、石斛養陰清 熱;口干舌燥加花粉、玄參潤肺生津。④ 肺脾氣虛:凡病程長,咳嗽反復不已,咳而 無力,痰白清稀,面色蒼白,氣短懶言,食 少納呆,自汗畏寒,舌淡嫩有齒痕,脈細無 力為肺脾氣虛型。方用人參麥冬五味子 湯:人參129,麥冬lOg,五味子lOg,白術 lOg,茯苓99,炙甘草69,生姜39,大棗3 枚。煎服同前,本方具有補肺健脾、益氣 化痰之功效。適用于咳嗽反復不已、咳而 無力、氣短懶言的患兒。氣虛重加黃蓖、 黃精益氣補虛;咳重加杏仁、貝母、枇杷葉 化痰止咳;痰多加陳皮半夏理氣化痰;食 少納呆加焦三仙和胃消食。 結果 300例中,屬風寒型120例,風熱型 80例,氣虛型38例,陰虛型62例,以3天 為1個療程。180例服藥1個療程后咳 嗽停止,諸癥好轉,為治愈;96例因年齡偏 小、喂藥閑難,服藥2個療程后咳嗽明顯減 輕或緩解,為有效;另外24例服藥2個療程 后咳嗽無明顯好轉,為無效,其巾8例經胸 片診斷為肺門淋巴結核,6例經肺功能檢查 診斷為咳嗽變異性哮喘,10例為依從性差 者,綜合判定治療總有效率92%。 討論 dxJL咳嗽發生的原因主要為感受外 邪,其中又以感受風邪為主,d,JL臟腑嬌 嫩,形體未充,易感外邪,而肺脾虛弱又是 本病的主要內因。咳嗽的病變部位在肺, 常涉及脾。正如《幼幼集成?咳嗽證治》 中說:“凡有聲無痰謂之咳,肺氣傷也;有 痰無聲謂之嗽,脾濕動也;有聲有痰謂之 咳嗽,初傷于肺,繼動脾濕也。”然咳嗽日 久不愈,耗傷正氣,可轉為內傷咳嗽。小 兒咳嗽的主要病理機制為肺臟受累,宣肅 失司。外感咳嗽病起于肺,內傷咳嗽可有 肺病及他臟。在治療方面,外感咳嗽以疏 散外邪,宣通肺氣為基本法則,不宜過早 使用滋膩、收澀、鎮咳之藥,以免留邪。內 傷咳嗽應辨別癇位、病性、氣傷、陰傷等, 隨證施治,無論外感內傷只要合理用藥, 就能效如桴鼓。 云南白藥等局部外敷輔助治療新生兒硬腫癥的體會 牛莉蘋楊新芳 471000河南洛陽市中心醫院兒科 摘要探討新生幾硬腫癥的病因、臨床 表現、發病機制及護理,探討用自制的云 南白藥等藥物外敷輔助治療新生兒硬腫 癥的方法、效果及作用原理和體會。 關鍵詞新生兒硬腫癥云南白藥 輔 助 治療 doi:10.3969/j.issn.1007—614x.2010. 26.00l 藥物配制 取云南白藥粉劑49加654—2針劑 lOmg放入清潔容器內,倒入75%酒精 10IIll,調成糊狀即可。 用法:每日早晨沐浴后將配制好的藥 糊用干凈棉箍均勻外敷于新生兒硬腫癥 患處,外敷范圍超出患部1—2cm,外蓋保 鮮膜2小時,每日3次,最好每8小時敷1 次。治療方法上將患兒置入新生兒暖箱 內保暖行預防感染、預防肺出血、提供足 夠的熱卡、預防并發癥等治療,一般3—4 天硬腫即可消失。 討論 本病的常見病因:①新生兒體溫調節 功能低下,體表面積出生后早期主要以棕 色脂肪化學產熱為主,缺乏寒戰的物理產 熱,故散熱大于產熱,這種情況在早產、低 體重、小于胎齡兒更為明昆;飽和脂肪酸 含量高,當體溫降低時皮脂易發q三凝固變 性而形成皮下硬腫;②新生兒紅細胞相對 較多,血液黏滯易引起微循環障礙;③寒 冷環境,出生體重越低、胎齡越小,要求環 境溫度越高;④攝人不足,特別是低體重 兒先大儲備不足,若不及時補充則引起能 源耗竭;⑤感染因素,新生兒期的各種疾 病如肺炎、敗血癥、新,毛兒膿皰瘡、新生兒 臍炎、腹瀉等均叮加重或導致上述病理過 程的發生。 本病以皮膚低溫和皮膚硬腫為特征, 常見誘因為寒冷、缺氧、感染。寒冷造成 血管收縮、皮下脂肪凝固,紅細胞表面電 中國社區醫師-醫學專業1010年第26期(第12卷總第251期)129 萬方數據 換頁

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