儿童腺样体肥大辨证论治研究

发布时间：2018-05-12 07:11

本文选题：儿童腺样体肥大 + 辨证论治　；参考：《云南中医学院》2014年硕士论文

【摘要】：儿童腺样体肥大（PAH）是耳鼻喉科、儿科的常见多发病。目前，西医主要以手术切除治疗本病。腺样体在儿童时期具有免疫防御作用，手术切除免疫防御功能受损，容易导致上呼吸道反复感染[1]，手术麻醉也会给患儿带来一定的风险。相比之下，，中医药毒副作用小、治疗效果较好。对PAH中医证治规律进行系统研究具有重要意义。研究目的：系统研究PAH文献资料及辨证论治规律，为防治PAH提供借鉴。研究方法：收集相关文献和著作资料；整理、归纳、分析；总结PAH辨证论治和用药规律。在导师指导下，研究PAH发病因素、病因病机，提出临床辨证论治思路，通过病例回顾性分析，介绍导师治疗PAH临床常见证型的临床经验。结果：古代医籍中没有对儿童腺样体肥大的专门论述，类似症状散见于“鼾眠”“窠囊”“痰核”“颃颡”“鼻窒”“乳蛾”等疾病中。现代的中医耳鼻咽喉科专著中，借用西医病名“腺样体肥大”、“增殖体肥大”。历代医家认为儿童腺样体肥大的病因病理主要表现为：肺卫不固，易感外邪；肺经湿热；肺热炽盛，脾失健运；气滞血瘀，痰湿结聚。本病与肺、脾、肝等脏腑关系密切。历代医家常用养阴润肺，补肾填精；补益肺脾，化痰散结；行气活血，软坚散结；疏散风热，化痰散结；宣肺通窍，清热利咽等法治疗。浙贝母、茯苓、桔梗、当归、玄参、柴胡、生地黄、赤芍、川芎、陈皮、甘草、夏枯草等药使用频率最高。熟地黄、百合、麦冬、山萸肉、党参、升麻、人参、桃仁、红花、枳壳、海蛤壳、海浮石、瓦楞子、瓜蒌仁、三棱、莪术、苍耳子、白芷、金银花、薄荷、黄芩、辛夷花、皂角刺等药物相对较高。本研究认为：儿童时期，“稚阳未充，稚阴未长”，“五脏六腑，成而未全，全而未壮”，肺常不足、脾常不足、肾常虚是本病的发病基础。感受外邪，致痰、虚、瘀内生。病邪久留，虚其虚，实其实，互为因果，交相燔灼故致本病迁延反复。本研究对临床最常见的肺经蕴热、肺脾气虚、气血瘀阻、肺肾阴虚四个证型进行了辨证论治设计。回顾总结55例临床病例，PAH各型所占比例依次为：肺脾气虚型13例,占总比例的23.64%；肺经蕴热型12例，占总比例的21.82%；气血瘀阻型20例，发病率最高占总发病率的36.36%；肺肾阴虚型10例，发病率最低占总发病率的18.18%。郭兆刚教授辨证论治PAH患儿55例，治疗总有效率81.8%，肺经蕴热型总有效率83.3%，肺脾气虚型总有效率84.6%，肺肾阴虚型与气血瘀阻型总有效率80%，经χ2检验结果显示P值为0.985（P＞0.05），无统计学意义。结论：儿童腺样体肥大的中医辨证分型应分为4型,分别为肺脾气虚、肺经蕴热、气血瘀阻、肺肾阴虚。郭兆刚教授以补益肺脾、扶正益气、活血通窍为主要思路治疗本病，临床疗效显著，改善患儿的生活质量。
[Abstract]:Adenoid hypertrophy (PAH) is a common disease in pediatrics and otolaryngology. At present, Western medicine is mainly surgical excision treatment of this disease. Adenoid has the function of immune defense in childhood, the immune defense function of surgical excision is damaged, it is easy to lead to repeated infection of upper respiratory tract [1], and surgical anesthesia will also bring certain risks to the children. In contrast, traditional Chinese medicine has little side effect and good therapeutic effect. It is of great significance to systematically study the law of TCM syndrome and treatment in PAH. Objective: to systematically study the literature and treatment of PAH and provide reference for the prevention and treatment of PAH. Methods: collecting relevant literature and literature, arranging, summarizing, analyzing, summarizing the law of PAH syndrome differentiation and drug use. Under the guidance of the tutor, this paper studies the pathogenesis, etiology and pathogenesis of PAH, puts forward the idea of clinical syndrome differentiation and treatment, and introduces the clinical experience of tutor in the treatment of common clinical syndromes of PAH by retrospective analysis of cases. Results: there was no special discussion on children's adenoid hypertrophy in ancient medical books. Similar symptoms were found in diseases such as "snoring sleep", "nest sac", "phlegm nucleus", "antagonism", "obteobagrus," nasal smothering "," mammoid moth "and so on. Modern Chinese medicine otorhinolaryngology monographs, borrow Western medicine disease name "adenoid hypertrophy", "Adenoid hypertrophy". The etiology and pathology of adenoid hypertrophy in children were considered by doctors in the past dynasties as follows: the lung was not strong and susceptible to exogenous pathogens; the lung meridian was dampness and heat; the lung heat was abundant and the spleen was not healthy; the qi stagnation and blood stasis; phlegm and dampness knot accumulation. This disease and lung, spleen, liver and other viscera close relationship. Doctors used to nourish yin and nourish the lung, tonify the kidney and fill the essence; tonify the lung and spleen, dissipate phlegm and dissipate the knot; carry out qi and blood circulation, soft firm and scattered knot; disperse wind and heat, dissipate phlegm and disperse knot; and purge the lung and clear the orifices, clearing away heat and promoting pharynx and so on. Fritillaria thunbergii, Poria cocos, Platycodon grandiflorum, Angelica sinensis, Radix Xuanshen, Bupleurum chinensis, Rehmannia Rehmanniae, Radix Paeoniae rubra, Ligusticum chuanxiong, Radix Glycyrrhizae Radix Rehmanniae, Lilium, Ophiopogon, Cornel, Codonopsis, Codonopsis, Panax ginseng, peach kernel, safflower, Fructus aurantii, sea clam shell, sea pumice, corrugated seed, Trichosanthes seed, Sanleng, Curcuma, Fructus Xanthium, Radix angelicae dahurica, honeysuckle, mint, Scutellaria baicalensis, Flos Magnoliae, The drugs such as prickles were relatively high. This study holds that in childhood, "childish yang is not sufficient, childish yin is not long", "five viscera and six Fu organs are not complete, complete and not strong", lung is often insufficient, spleen is often insufficient, and kidney deficiency is the basis of this disease. Feel external evil, causing phlegm, deficiency, blood stasis endogenetic. The disease remains long-term, vacuity, in fact, cause and effect each other, the intersection of burnt-burning causes the disease to delay repeatedly. The most common syndrome types of lung meridian, lung and spleen qi deficiency, qi and blood stasis, lung and kidney yin deficiency were designed. The proportions of PAH in 55 clinical cases were summarized retrospectively: 13 cases of lung and spleen qi deficiency type (23.64% of the total), 12 cases of lung meridian heat accumulation type (21.82%), 20 cases of Qi and blood stasis type (20 cases) with the highest incidence rate of 36.3636%, 10 cases of lung and kidney yin deficiency type, The lowest incidence was 18.18% of the total incidence. Professor Guo Zhaogang treated 55 children with PAH according to syndrome differentiation. The total effective rate was 81.8%, the total effective rate was 83.3% in lung meridian and heat accumulation type, 84.6% in lung and spleen Qi deficiency type, 80% in lung kidney yin deficiency type and Qi and blood stasis type. The result of 蠂 2 test showed that P value was 0.985P > 0.05, with no statistical significance. Conclusion: the syndrome differentiation of adenoid hypertrophy in children should be divided into 4 types: deficiency of lung and spleen qi, heat accumulation of lung meridian, stagnation of qi and blood, deficiency of lung and kidney yin. Professor Guo Zhaogang treated this disease with the main idea of tonifying the lung and spleen, nourishing the qi and activating blood circulation, thus improving the quality of life of the children.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R276.1

【参考文献】