石亚杰运用葛根汤加减治疗上气道咳嗽综合征经验  

SHI Yajie’s experience in treating upper airway cough syndrome with the Gegen decoction

作　　者：金菁 石亚杰[1] 徐春秀 梁快 王世强[1] JIN Jing

机构地区：[1]浙江中医药大学附属杭州市中医院,浙江杭州310007

出　　处：《中医临床研究》2024年第34期94-98,共5页Clinical Journal Of Chinese Medicine

基　　金：全国名老中医药专家传承工作室建设项目:张志娣全国名老中医药专家传承工作室(国中医药人教函[2022]75号)。

摘　　要：上气道咳嗽综合征是指由于鼻炎、鼻窦炎等鼻部疾病引起分泌物倒流至鼻后和咽喉部,或咽喉部慢性炎症导致的以咳嗽为主要表现的综合征,临床以咳嗽、鼻后滴漏感、咽部不适为主要症状,属于中医“咳嗽”“鼻鼽”“喉痹”等疾病范畴。石亚杰主任中医师总结多年临证经验,发现多数患者素体阳明伏热,加之外邪侵袭,内外相因,发为此病,认为其病因病机为太阳外感六淫之邪,邪气未散,日久入阳明化热,太阳与阳明合病,关键在于风寒之邪侵袭太阳,间接影响阳明,病位偏重于太阳,主张治疗该病要以祛除太阳之外邪为先,表邪得解,阳明之伏热方有出路,最后外邪散而内邪清,病得愈。石亚杰主任中医师根据本病“风寒外束、内热郁闭”的病机特点,遵循“表里同治”之治法,重用解表散寒之药,加少量清泻内热之药,从而达到“表邪散,里热清”之功效,临证以葛根汤为主方,随症加减治疗。方中以葛根为君药,有解肌退热之功,桂枝、麻黄一则调和营卫,以利太阳经气运行,一则发汗解表,以治恶风无汗之表实,从而达到表里双解、寒热并治之效。本研究总结石亚杰主任中医师运用葛根汤加减治疗上气道咳嗽综合征的临床经验,并附验案1则。Upper airway cough syndrome is a clinical syndrome caused by nasal diseases such as rhinitis and sinusitis,which leading to the backflow of secretions into the throat.The main symptoms of this disease include coughing,postnasal drip,and pharyngeal discomfort.In traditional Chinese medicine,it falls under categories such as cough,Biqiu(鼻鼽)and Houbi(喉痹).SHI Yajie,a chief TCM physician with extensive clinical experience,has observed that most patients has heat in the Yangming(阳明)meridian and combined with external pathogenic factors causing this condition.SHI Yajie believes that the pathogenesis of upper airway cough syndrome is mainly the presence of wind and cold in the Taiyang(太阳)and Yangming meridians,as well as stagnant heat in the Yangming meridian.SHI Yajie recommends treating the condition by first dispelling external pathogens from the Taiyang meridian to allow for resolution of heat in the Yangming meridian before ultimately dispersing internal pathogens for complete healing.Following a treatment approach based on the disease’s pathogenesis of external cold entrapment and internal heat closure,SHI Yajie utilizes an external-internal treatment method involving dispelling surface cold while adding a small amount of purging internal heat medicion to achieve both external dispersion and internal clearance effects.The Gegen decoction(葛根汤)is the main prescription.Gegen(Radix Puerariae Lobatae)is the main medicine in the prescription,which has the function of relieving muscle and reducing fever.Guizhi(Cinnamomi Ramulus)and Mahuang(Ephedrae Herba)can regulate Ying(营)and Wei(卫),promote the circulation of Qi(气),and relieve exterior syndrome by diaphoresis to treat the evil in the surface.This article summarizes the clinical expertise of Chief TCM physician SHI Yajie in managing upper airway cough syndrome through the application of the Gegen decoction,and one typical case is attached.

关 键 词：上气道咳嗽综合征 咳嗽 葛根汤 太阳阳明合病 

分 类 号：R256.11[医药卫生—中医内科学]