仲景祛痰法治疗上气道咳嗽综合征理论与临床研究

发布时间：2018-01-01 00:10

本文关键词：仲景祛痰法治疗上气道咳嗽综合征理论与临床研究　出处：《南京中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：背景:上气道咳嗽综合征(upper airway cough syndrome,UACS)是临床上慢性咳嗽的常见原因之一。患者多见咳嗽、鼻塞、咽痒、鼻后滴流感等症状。但长期、频繁、剧烈的咳嗽将影响患者的工作和生活。本课题是对仲景祛痰法治疗上气道咳嗽综合征应用的研究,以希望对这类人群的治疗和保健作出贡献。目的:导师经过长期治疗上气道咳嗽综合征后,发现无论是在治法或用方方面都符合《伤寒杂病论》。在此,通过对上气道咳嗽综合征的诊治进行中医辨治分析、研究、归纳,从而找出上气道咳嗽综合征的病因病机、证型规律及上气道咳嗽综合征复方的遣方用药的特色,以期更好地指导临床诊断及治疗。除此之外,也将南京的上气道咳嗽综合征患者与新加坡的患者作比较,以便找出他们之间的证治的异同。方法:是通过临床研究调查统计120例,从2015年3月至2016月6月来南京明基医院求诊的患者。分析临床资料,并从中医的辨证基础上,对临床运用加以剖析;对上气道咳嗽综合征复方中常用中药的临床应用和药理,加以分析整理,以期在临床的治疗时提供更加全面的理论依据。结果:分析上气道咳嗽综合征患者的相关特征,发现其成因、辨证论治及治法等方面与张仲景《伤寒杂病论》的祛痰法较为切合,可以巩固患者的疗效、改善症状,降低发病和复发率。结论:患者在久咳中累及脾、肝、肾等各脏腑,治疗过程中需考虑到肺与其他脏腑之间的关系,加以治疗。此外导师也十分重视辨证,由于上气道咳嗽综合征的主要病理因素是痰,因此在复方中使化痰止咳平喘药最多占86%,常用的化痰药有浙贝母、桔梗、陈皮、半夏和枳壳等化痰止咳药物。除此之外,上气道咳嗽综合征还涉及鼻和咽喉等多种疾病,临床特点以咳嗽、咯痰、鼻后滴流感为主,还伴有咽痒和咽喉黏液附着感。因此在解表药中,有一部分是针对鼻渊和喉痹等疾病,如白芷常于辛夷配对,用于解表散寒之外,也有通鼻窍的作用。还有解表兼治喉痹、喉痒等症状的药物,如牛蒡子、桔梗、薄荷等。上气道咳嗽综合征复方能改善上气道咳嗽综合征的临床症状,在临床上能广泛的应用,有较强的可行性。希望本论文从从病因病机、辨证论治、遣方用药等角度探讨的上气道咳嗽综合征的辨治规律,复方方剂的组方配伍规律能为上气道咳嗽综合征的辨治提供新的思路与方法。除此之外,将南京的上气道咳嗽综合征患者与新加坡的患者作比较之后,发现无论是在地域、气候、环境、饮食或生活习惯都会直接影响上气道咳嗽综合征的证型分布,比如新加坡以痰湿蕴肺为多,占41.3%,南京的痰湿蕴肺,则占2.5%。这主要是新加坡为一个处在四面围海,湿气很重的热带国家,居民长期在空调的地方作息。在饮食方面,居民多爱喝冷饮,又嗜食油炸及辛辣的食品。由于很多患者素体脾虚,加之饮食不当,助湿生痰,以致痰湿蕴肺。当天气温度稍有变化,而自身的免疫力下降时,特别容易感受寒邪、湿邪,引起上气道咳嗽综合征。
[Abstract]:Background: upper airway cough syndrome (upper airway cough syndrome, UACS) is one of the common causes of chronic cough in clinic. Patients with more common cough, stuffy nose, throat itching, nasal drops after flu symptoms. But in the long term, frequent cough will affect the patient's life and work. This topic is the study of syndrome the application of cough and phlegm Zhongjing treatment of upper airway, in the hope of treatment and care for this population. Objective: to contribute to the teacher after long-term treatment of upper airway cough syndrome, found both in the treatment or are consistent with this theory. "Typhoid miscellaneous diseases with the party, the upper airway cough syndrome the diagnosis and treatment of traditional Chinese medicine research, analysis, induction, so as to identify the etiology and pathogenesis of upper airway cough syndrome, syndrome type of prescription and upper airway cough syndrome of characteristics, in order to guide the clinical diagnosis and treatment in addition. In addition, Nanjing will also be the patients with upper airway cough syndrome patients compared with Singapore, in order to find out the similarities and differences between them and treatment. Methods: through clinical investigation of 120 cases of statistics, from March 2015 to June to 2016 month from Nanjing BenQ hospital. Clinical data analysis, and from the basis of TCM syndrome differentiation on the clinical application analysis of upper airway cough; clinical application and pharmacological syndrome commonly used in compound prescription of traditional Chinese medicine, will be analyzed, in order to provide theoretical basis in a more comprehensive clinical treatment. Results: the analysis of upper airway cough syndrome related characteristics, find the causes, treatment based on syndrome differentiation and treatment and phlegm and the Zhang Zhongjing "Shanghanzabinglun" more realistic, can consolidate the therapeutic effect, improve symptoms, reduce the incidence and recurrence rate. Conclusion: patients involved in chronic cough in the spleen, liver, kidney and other viscera Fu, need to consider the relationship between lung and other organs in the treatment process to treatment. In addition to instructors also attaches great importance to differentiation, because the main pathological factors of upper airway cough syndrome is phlegm, so in the compound Huatanzhike asthma drugs accounted for 86%, apophlegmatisant are commonly used in Fritillaria thunbergii, Platycodon grandiflorum, tangerine peel. Pinellia and Fructus aurantii etc. Huatanzhike drug. In addition, upper airway cough syndrome also relates to the nose and throat and other diseases, the clinical characteristics of cough, expectoration, nasal drops after the flu, accompanied by itching throat and throat mucus. Therefore in diaphoretic, one part is for nasosinusitis and pharyngitis other diseases, such as Angelica in Xinyi often paired for the table of cold dispelling, also have a nose. There are jiebiao symptoms due to drugs, symptoms such as itching of the throat, burdock, Platycodon grandiflorum, mint. Upper airway cough syndrome compound can improve the upper airway cough The clinical symptoms of cough syndrome, can be widely used in clinic, there is a strong possibility. I hope this paper from the etiology and pathogenesis, syndrome differentiation, treatment of upper airway cough syndrome of prescription compatibility law angle, compound prescription for gas channel cough syndrome and provide new ideas and methods. In addition, the Nanjing patients with upper airway cough syndrome patients compared with Singapore, found both in geography, climate, environment, diet or lifestyle will directly affect the upper airway cough syndrome distribution comprehensive syndromes, such as Singapore with phlegm dampness the lung is more, accounted for 41.3% of Nanjing's phlegm retention in the lung, which is mainly accounted for 2.5%. of Singapore in an enclosed sea, humid tropical countries, long-term residents in the air conditioning place to rest. In the diet, many residents love cold drink and eat Fried and spicy food. Because many patients with deficiency of spleen, inappropriate diet, so as to help wet phlegm, phlegm retention in the lung. When the weather temperature change slightly, but their immunity drops, especially easy to feel cold evil, dampness, causing upper airway cough syndrome.

【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R256.11

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