CN108653552B - 一种清肺止咳中药 - Google Patents
一种清肺止咳中药 Download PDFInfo
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- CN108653552B CN108653552B CN201810955592.0A CN201810955592A CN108653552B CN 108653552 B CN108653552 B CN 108653552B CN 201810955592 A CN201810955592 A CN 201810955592A CN 108653552 B CN108653552 B CN 108653552B
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Abstract
本发明提供一种清肺止咳中药,包含桑白皮5‑10g;苦杏仁3‑10;紫苏子5‑15g;及川贝1‑3g、蝉蜕2‑10g、木蝴蝶2‑6g中的至少两种。该中药组合物用于儿童慢性咳嗽的治疗,对风邪伏肺证感染后咳嗽尤为有效。
Description
技术领域
本发明涉及中医药领域,具体涉及感染后咳嗽的中医药治疗,尤其涉及风邪伏肺证感染后咳嗽的中医药治疗。
背景技术
咳嗽是儿童呼吸***疾病最常见的症状之一。根据病程的长短,儿童咳嗽分为急性咳嗽(病程在2周以内)、迁延性咳嗽(病程在2-4周)和慢性咳嗽(病程超过4周)。慢性咳嗽可以分为特异性咳嗽和非特异性咳嗽,前者指咳嗽伴有能够提示特异性病因的其他症状或体征,即咳嗽是这些诊断明确的疾病症状之一;后者则指咳嗽为主要或惟一表现,胸部X线片未见明显异常的慢性咳嗽。中国儿童慢性咳嗽诊断与治疗指南(2013年修订,中华儿科杂志,2014,52(3):184-188.)指出引起中国儿童慢性咳嗽的前3位病因是咳嗽变异性哮喘(cough variant asthma,CVA)、上气道咳嗽综合征(upper airway cough syndrome,UACS)和呼吸道感染后咳嗽(post-infection cough,PIC)。因儿童感染后咳嗽患病率高、病程长,成为困扰患儿家属和医生的一大难题。在目前临床中,很多患儿长期被误诊为“慢性支气管炎”或“支气管炎”,大量使用抗菌药物治疗无效,或者因诊断不明而反复进行各种检查,不仅增加了患儿痛苦,也加重了经济负担。随着该病逐渐被大家认识与关注,寻求对感染后咳嗽快速有效的治疗显得尤为迫切。近年来对感染后咳嗽的研究颇多,但其确切发病机制仍不明了,致使西医对本病的治疗尚缺乏公认的有效药物,而中医独特的辨证论治体系在治疗儿童感染后咳嗽方面具有显著优势,且近年来中医药治疗儿童感染后咳嗽的研究愈渐增多(郭琳.止咳平喘配方颗粒联合敷胸散治疗儿童感染后咳嗽痰湿蕴肺型疗效观察[D].湖北:湖北中医药大学,2015年;刘燕梅.中医药治疗感染后咳嗽的Meta分析及王玉光教授治疗经验总结[D].北京:北京中医药大学,2016年)。
前述“中国儿童慢性咳嗽诊断与治疗指南”是中华医学会儿科学分会呼吸学组慢性咳嗽协作组于2013年对2008年的中国“儿童慢性咳嗽诊断与治疗指南(试行)”(中华儿科杂志,2008,46(2):104-107)的修订版。两部指南中均未提及儿童慢性咳嗽的中医中药治疗,直到2015年“咳嗽的诊断与治疗指南(2015)”(中华结核和呼吸杂志,2016,39(5):323-354)中才增加了咳嗽的中医中药治疗,明确提出了咳嗽证型、治法及方药,其中包含肺阴亏虚证、肺肾阳虚证、胃气上逆证、肝火犯肺证、风邪伏肺证、风寒袭肺证、风热犯肺证7个证型。中国《咳嗽的诊断与治疗指南(2015)》“中医部分”解读(张纾难,刘剑.环球中医药,2016,9(6):699-701)指出,在中国西医的疾病《指南》中加入篇幅达1400余字的中医药相关内容尚属首次。这体现了中国西医同行的学术包容性和实事求是的学术作风,也在一定程度上反映出中、西医两种医学体系并存的现状以及中医药在这个领域具有独到疗效这一事实。指南所介绍的七个临床常见证型是《指南》中医内容的核心,既有中医界公认的传统教科书所列的六个常见类型(肺阴亏虚证、肺肾阳虚证、胃气上逆证、肝火犯肺证、风寒袭肺证、风热犯肺证),又有近年逐渐被学界认识且接纳的“风邪伏肺”(或曰“风盛挛急”)证,力图体现中医界传承与创新并重的重要共识与发展理念。
现代医家多把感染后咳嗽归属于中医“咳嗽”、“久咳”、“干咳”、“风咳”、“顽咳”范畴。查阅古代文献,并无感染后咳嗽一词,但其中不乏与感染后咳嗽症状、发展相一致的描述。《素问·风论》所述:“肺风之状,多汗恶风……时咳短气,昼日则瘥,暮则甚”,指出了类似的发病特点。《内经》中指出“风盛则痒”,“无风不作痒”,“风邪之为病,善行而数变,风盛则挛急”,则认识到了以痒为特征的疾病的病因病机和风邪有关。隋代巢元方《诸病源候论》记载:“风咳,欲语因咳,言不得竟是也”,此与感染后咳嗽之表现相近。清代冯兆张的《冯氏锦囊秘录》认为:“此等咳嗽,既不同于风热犯肺证,又与燥咳有着根本区别;病位既涉咽喉、肺器,又及肝扰心;病变特点,既有肺气上逆的一般表现,更具风动、过敏、气道挛急、喉痒逆呛作咳的自身特征;病机关键在于虚实夹杂,表里同病,累及数脏,既有阴血亏虚,又蕴风动气逆邪结”。清代高世试谓:“若喉痒而咳是火热之气上冲也,火越发而烟先起,烟气冲喉,故痒而咳”,与临床所见感染后咳嗽之特征亦不谋而合。
在临床诊治中不可避免地会接诊到大量运用了抗生素控制感染后,仍然存留咳嗽未愈的患儿。据研究调查(湖北中医杂志,2016,38(11):34-35),在具有上呼吸道感染病史的患者,大约11%-25%会发生感染后咳嗽,而在流行季节,发生率更会高达25%-50%。本发明人在临证时发现相当一部分患儿的感染后咳嗽症状独特且相似,主要表现为阵发性干咳或仅有少量白粘痰,咳嗽较剧烈,甚至呈痉挛性咳嗽,咳嗽无规律,常因咽痒而咳且难以控制,遇冷热空气、刺激性气味或因说话、情绪激动等诱发或加重咳嗽,症状与风邪致病特点如“风性善行数变”、“风盛则痒”、“风盛则挛急”等特点高度契合。经过辨证此类咳嗽多属于风邪伏肺证,此类咳嗽病机关键为病初为风邪外袭肺,气机失调,后表证已除,仅风邪久伏于肺,肺失宣降,气机不利,肺气上逆而作咳。临床表现寒热之象不突出,但有突发突止、阵发咳嗽、咽痒等主要表现。
这部分患儿及家属有着很大的就诊意愿,在临床中这部分患儿需要给予足够重视,寻求一种简便、廉价、适合大众的诊疗方案有着十分重大的意义。本发明人借鉴中医学相关理论,通过大量辩证施治临床实践,完成了本发明。
本发明的目的是提供一种清肺止咳中药组合物,该中药组合物针对儿童慢性咳嗽,尤其是风邪伏肺证感染后咳嗽。
发明内容
本发明提供一种清肺止咳中药组合物,包含如下中药:
桑白皮5-10g;苦杏仁3-10g;紫苏子5-15g;及
川贝1-3g、蝉蜕2-10g、木蝴蝶2-6g中的至少两种。
本发明的一个优选实施方案中,各味中药的用量分别为:桑白皮5-8g、苦杏仁3-8g、紫苏子5-10g、川贝1-2g、蝉蜕2-4g、木蝴蝶2-4g。
本发明的更优选实施方案中,各味中药的用量分别为:桑白皮5-6g、苦杏仁3-6g、紫苏子6-10g、川贝1g、蝉蜕3g、木蝴蝶3g。
本发明的更优选实施方案中,还包含一种或一种以上如下中药:黄芩2-6g、桔梗2-6g、辛夷2-10g、生甘草2-6g。
该实施方案中,各中药的用量可为黄芩2-6g、桔梗2-3g、辛夷5-6g、生甘草2-4g。
本发明的另外一些实施方案中,还可包含一种或一种以上如下中药:金荞麦6-15g、玄参6-15g、大青叶6-15g、胖大海6-10g、鱼腥草6-15g、款冬花6-10g。
本发明人根据风邪伏肺证感染后咳嗽的病因病机特点,提出清肺止咳、疏风利咽的治疗方案,并提供一种清肺止咳中药。
本发明的清肺止咳中药中以桑白皮为君,苦杏仁、紫苏子为臣,川贝母、蝉蜕为佐,木蝴蝶为使。
君药桑白皮甘寒,主入肺经,此药不燥不刚,虽泻肺热而无伤于娇脏,清肺止咳不伤正气;
苏子味辛性温,归肺、脾经,下气平喘,润肺止咳。杏仁味苦微温,归肺、大肠经,擅长宣通肺气,具宣肺止咳平喘之功,与桑白皮、苏子等降气药物合用一升一降,共奏调节肺金宣肃功能。《本草便读》言苦杏仁“功专降气,气降则痰消嗽止”,《药品化义》谓:“苏子主降,味辛……下定气喘”。二者则均能降气化痰止咳,且性偏温,与君药寒性药物相配,可防寒性太过,以免损伤脾胃,同为臣药。
川贝母、蝉蜕为佐药。贝母:性寒,归肺、心经,具有清热化痰、开郁散结的功用,与桑白皮合用共奏清肺止咳之效。蝉蜕:味甘,性寒,归肺、肝经,质轻味薄,善开宣肺气,疏一切风邪,具有散风除热,祛风止痉,既可疏散在表久恋之风邪,又可利咽止痒,《药性论》曰“兼能止咳”,是治疗刺激性干咳、痉咳之要药,蝉蜕功能疏风以祛邪,宣肺而利气滞,与紫苏子同用可疏散风邪,又可开宣肺气。
使药木蝴蝶归肺、肝、胃经,功效清肺利咽、疏肝和胃,《中药大辞典》记载其“清肺热,利咽喉,治急慢性支气管炎、咽喉肿痛、扁桃体炎”,《现代实用中药》记载其为"镇咳药,治百日咳及干性支气管炎”。
针对咽部不适、鼻塞流涕等兼证,黄芩善清上焦火,尤善清肺,且“引药入肺经”;桔梗善开提肺气,为肺经之专药;辛夷功效发散风寒、通鼻窍;生甘草清咽泻火,《本草撮要》记载其“得桔梗清咽喉……生用泻火”。因而,本发明的清肺止咳中药组合物中还可包含黄芩、桔梗、辛夷、生甘草中的一种或一种以上。
针对咳嗽有痰,咽喉肿痛等兼证,金荞麦功效清热解毒,消痈利咽,《本草纲目拾遗》谓其“治喉痹,喉风喉毒”;玄参清功效热凉血解毒,《本草品汇精要》载其“消咽喉之肿,泻无根或之火”;大青叶功效清热解毒利咽,善治热毒、咽喉肿痛;胖大海功效清热利咽,润肺开音,《本草正义》曰:“善于开提肺气,并能通泄皮毛”;鱼腥草功效清热解毒,善清泻肺热;款冬花功效润肺下气、止咳化痰,《神农本草经》言其“治咳逆上气,善喘,喉痹”。因而,本发明的清肺止咳中药组合物中还可包含金荞麦、玄参、大青叶、胖大海、鱼腥草、款冬花中的一种或一种以上。
本发明的清肺止咳中药方中诸药合用,寒温并用,宣降同施,相辅相成,共奏清热止咳、疏风利咽之功,使肺金得清,肺气得肃,风祛热清,气顺痒止而咳嗽自愈。
服用方法:可将本发明中药组合物的一日量水煎两次、去渣后服用;也可将数日量一起水煎后分装成袋,每次温服一包;也可将常用方制成浸膏或进一步制成颗粒,温水冲服。
具体实施方式
下面结合典型病例更具体地说明本发明的内容,并对本发明作进一步阐述,但这些典型病例绝非对本发明有任何限制。
病例1
陆某某,男,6岁,上海市嘉定区中医医院门诊号:34934480
因“咳嗽5周”就诊,曾外院多次就诊未愈。来诊时咳嗽阵作,痰少不易咳出,咽痒,鼻流浊涕,无气喘,胃纳不振,大便偏干。摄胸片提示支气管炎,血常规检验正常范围,西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减7天后,咳嗽咽痒即止,无流涕,胃纳好转,大便正常。
本病例方药成分(单位:克):
桑白皮6、苦杏仁6、紫苏子10、川贝母2、蝉蜕5、木蝴蝶3、黄芩6、金荞麦10、玄参10、大青叶10、生甘草3、辛夷6、六神曲10、胖大海6、桔梗3。
病例2
王某某,女,4岁,上海市嘉定区中医医院门诊号:34666973
因“咳嗽4周”就诊,来诊时呈刺激性干咳,无痰,常因冷空气诱发,咽痒少涕,无气喘,胃纳不振,二便尚调。西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减(方一)7天,咳嗽大减,无明显咽痒流涕,胃纳好转。继予方二巩固调理7天而愈。
本病例方药成分(单位:克):
方一:
桑白皮6、苦杏仁5、紫苏子10、川贝母1、蝉蜕5、木蝴蝶3、黄芩2、生甘草3、辛夷6、鱼腥草15、葶苈子6、款冬花6、蒲公英10、六神曲10。
方二:
桑白皮6、紫苏子10、川贝母1、蝉蜕3、木蝴蝶3、生甘草3、辛夷6、蒲公英10、六神曲10、金荞麦10、射干3、佛手5、防风3。
病例3
叶某某,女,9岁,上海市嘉定区中医医院门诊号:34956172
因“咳嗽4周余”就诊,曾外院多次就诊未愈。来诊时咳嗽咽痒,痰少不易咳出,流涕,无气喘,胃纳可,二便调。摄胸片提示支气管炎,血常规检验正常范围,西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减(方一)7天,咳嗽咽痒明显好转,少涕。继予方二巩固调理7天而愈。
本病例方药成分(单位:克):
方一:
桑白皮10、苦杏仁10、紫苏子15、川贝母3、蝉蜕10、木蝴蝶6、黄芩3、生甘草6、鱼腥草15、葶苈子10、大青叶15、款冬花10、辛夷10、玄参10。
方二:
桑白皮6、紫苏子15、川贝母2、蝉蜕6、木蝴蝶3、生甘草6、鱼腥草15、款冬花10、辛夷6、玄参10、蒲公英10、胖大海10、桔梗6。
病例4
严某某,女,7岁,上海市嘉定区中医医院门诊号:34560596
因“咳嗽6周”就诊,曾外院多次就诊未愈。来诊时咳嗽频作,咳痰不易,咽痒,无流涕气喘,胃纳不振,二便正常。西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减7天后,咳嗽咽痒即止,胃纳好转。
本病例方药成分(单位:克):
桑白皮6、苦杏仁10、紫苏子10、川贝母3、蝉蜕6、木蝴蝶6、黄芩3、生甘草6、鱼腥草10、蒲公英10、六神曲10。
病例5
朱某某,女,6岁,上海市嘉定区中医医院门诊号:34727747
因“咳嗽5周”就诊,曾外院多次就诊,咳嗽症状反复不愈。近日来因复感而咳嗽加重,来诊时咳嗽阵作,咳白色粘痰,咽痒,无流涕气喘,胃纳一般,二便调。西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减7天后,咳嗽咽痒即止,无痰,胃纳好转。
本病例方药成分(单位:克):
桑白皮6、苦杏仁6、紫苏子10、川贝母2、蝉蜕5、木蝴蝶3、黄芩2、生甘草3、鱼腥草10、葶苈子6、款冬花6、蒲公英10、六神曲10。
病例6
龚某某,女,4岁,上海市嘉定区中医医院门诊号:35085515
因“咳嗽5周”就诊,曾外院多次就诊未愈。来诊时咳嗽呈刺激性干咳,咯痰不畅,咽痒,无流涕气喘,胃纳可,二便正常。西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减(方一)7天,咽痒即止,偶有咳嗽。继予方二巩固调理7天而愈。
本病例方药成分(单位:克):
方一:
桑白皮6、苦杏仁6、紫苏子6、川贝母1、蝉蜕3、木蝴蝶3、生甘草3、蒲公英10、鱼腥草6、射干6、金荞麦15、桔梗2、款冬花10。
方二:
桑白皮6、川贝母1、蝉蜕3、木蝴蝶3、生甘草3、蒲公英5、金荞麦10、白术6、白茯苓10、六神曲10、佛手6。
病例7
陈某某,女,5岁,上海市嘉定区中医医院门诊号:34449617
因“咳嗽5周”就诊,曾外院多次就诊未愈。来诊时咳嗽阵作,痰少不易咳出,咽痒,无流涕气喘。摄胸片提示两肺纹理增粗,血常规检验正常范围,西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减7天后,咳嗽咽痒即止。
本病例方药成分(单位:克):
桑白皮5、苦杏仁6、紫苏子6、川贝母2、蝉蜕5、木蝴蝶3、生甘草3、蜜紫菀10、鱼腥草10、葶苈子6、金荞麦10、款冬花6、蒲公英10。
病例8
黄某某,男,3岁,上海市嘉定区中医医院门诊号:35109349
因“咳嗽7周”就诊,曾中西医外院多次就诊未愈。来诊时咳嗽阵作,咳伴咽痒,咳少许白色粘痰,夜寐汗多伴磨牙,无发热流涕气喘,胃纳一般,二便正常。摄胸片提示支气管炎,血常规检验正常范围,西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减7天,咳嗽咽痒即止,胃纳好转。
本病例方药成分(单位:克):
桑白皮5、苦杏仁5、紫苏子5、川贝母1、蝉蜕3、木蝴蝶3、生甘草2、金荞麦6、蒲公英6、六神曲10、桔梗2、佛手6、郁李仁10、浮小麦15。
病例9
严某某,男,4岁,上海市嘉定区中医医院门诊号:35045956
因“咳嗽5周余”就诊,来诊时咳嗽阵作,痰少不易咳出,咽痒,无发热流涕,无气喘,胃纳不振,二便正常。西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减(方一)7天,咳嗽咽痒大减,咽痒即止,无流涕,胃纳好转,大便正常。继予方二巩固调理7天而愈。
本病例方药成分(单位:克):
方一:
桑白皮6、苦杏仁6、紫苏子6、川贝母1、蝉蜕3、木蝴蝶3、生甘草3、蒲公英10、鱼腥草10、桔梗3、六神曲10、板蓝根10。
方二:
桑白皮6、蝉蜕3、木蝴蝶3、生甘草3、金荞麦10、桔梗3、六神曲10、板蓝根6、佛手6、南沙参10。
病例10
张某某,女,6岁,上海市嘉定区中医医院门诊号:34513071
因“咳嗽5周”就诊,曾外院多次就诊未愈。来诊时咳嗽呈刺激性,咽痒而咳,遇冷空气加重,痰少不易咳出,时有鼻衄,无发热流涕气喘,胃纳一般,二便正常。摄胸片提示支气管炎,血常规检验正常范围,西医诊断为感染后咳嗽,中医诊断为小儿咳嗽病,辨证分型为风邪伏肺证,治以清肺止咳、疏风利咽,予口服本发明药物加减(方一)7天,鼻衄即止,咳嗽咽痒大减,胃纳好转。继予方二巩固调理7天而愈。
本病例方药成分(单位:克):
方一:
桑白皮6、苦杏仁6、紫苏子10、川贝母2、蝉蜕5、木蝴蝶3、生甘草3、蒲公英6、金荞麦10、白茅根10、六神曲10、佛手6。
方二:
桑白皮6、紫苏子10、川贝母2、蝉蜕3、木蝴蝶3、生甘草3、蒲公英6、瓜蒌仁10、六神曲10、厚朴6、辛夷3、浮小麦15。
Claims (6)
1.一种清肺止咳中药组合物,由桑白皮5-10g、苦杏仁3-10g、紫苏子5-15g和川贝1-3g、蝉蜕2-10g、木蝴蝶2-6g中的至少两种组成。
2.如权利要求1所述的中药组合物,其中所述各药的用量为:桑白皮5-8g、苦杏仁3-8g、紫苏子5-10g、川贝1-2g、蝉蜕2-4g、木蝴蝶2-4g。
3.如权利要求1所述的中药组合物,其中所述各药的用量为:桑白皮5-6g、苦杏仁3-6g、紫苏子6-10g、川贝1g、蝉蜕3g、木蝴蝶3g。
4.一种清肺止咳中药组合物,由权利要求1所述中药组合物加黄芩2-6g、桔梗2-6g、辛夷2-10g和生甘草2-6g中的一种或一种以上组成。
5.如权利要求4所述的中药组合物,其中所述黄芩、桔梗、辛夷和生甘草的用量为:黄芩2-6g、桔梗2-3g、辛夷5-6g、生甘草2-4g。
6.一种清肺止咳中药组合物,由权利要求1或4所述的中药组合物加金荞麦6-15g、玄参6-15g、大青叶6-15g、胖大海6-10g、鱼腥草6-15g和款冬花6-10g中的一种或一种以上组成。
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