桑皮止咳方治疗小儿肺郁热型慢性咳嗽的理论探讨

王敏　白晓红

摘要：小兒慢性咳嗽是儿童呼吸系统常见病症，主要以慢性咳嗽、咳痰以及鼻塞为主要临床表现。辽宁中医药大学附属医院儿科专家对治疗慢性咳嗽有着独到的见解，他们认为慢性咳嗽的原因为邪热内伏于肺，阻滞气机，使肺失宣肃，而出现咳嗽气喘。桑皮止咳方就是针对这一病机，结合临床治疗小儿慢性咳嗽的经验，辨证论治据症加减研制而成。该方中重用桑白皮为君药以清泻肺中所余伏火;地骨皮、杏仁为臣药，地骨皮可助君药清肺降火，苦杏仁可降气止咳平喘;桔梗可引药上行，与杏仁一升一降，调节肺的宣发肃降，前胡可降气化痰，散风清热，牛蒡子可疏散风热，三药共同协作，同为佐药。甘草可止咳、祛痰，培土生金，调和诸药，为使药。并举典型临床病案一例，佐以治疗方法、诊疗思路。

关键词：肺郁热型;肺伏火;慢性咳嗽;桑皮止咳方

中图分类号：R256.11文献标志码：A文章编号：1007-2349（2020）04-0024-04

Theoretical Discussion on Mulberry Bark Cough-relieving Prescription in TreatingChronic Cough in Children with Pulmonary Heat and Suffocating Syndrome

WANG Min2，BAI Xiao-hong1

（1. The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine，Shenyang 110032，China;2. Liaoning University of Traditional Chinese Medicine，Shenyang 110032，China）

【Abstract】Chronic cough in children is a common disease of childrens respiratory system，with chronic cough，sputum and nasal congestion as the main clinical manifestations. Pediatric experts from The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine have unique insights into the treatment of chronic cough. They believe that the causes of chronic cough are due to invading of evil heat into lungs and air-resistance and lungs-ventilating loss to cause cough and wheeze. Mulberry Bark Cough-relieving Prescription is developed on the base of this pathogenesis，combined with the clinical experience of treating children with chronic cough and the treatment based on syndrome differentiation. The prescription stresses that the mulberry bark is used as a monarch medicine to clear the remaining fire in the lungs and cortex lycii radicis and almonds used as ministerial medicines in which the cortex lycii radicis can help the monarch medicine to clear the lungs and reduce the fire and the bitter almonds can lower qi to relieve cough and asthma. Platycodon Grandiflorum can be used for ascending medicine，rising and falling with almonds，regulating the lungs dispersion and purification. Peucedanum praeruptorum can depress qi to reduce phlegm，disperse wind and clear heat. Arctium lappa can evacuate wind and heat. The three drugs work together as adjuvant. Licorice can relieve cough and eliminate phlegm，cultivating soil to produce gold to reconcile various medicines，as conductant drug. A typical clinical case is supplemented with treatment methods and diagnosis and treatment ideas.

【Key words】pulmonary heat and suffocating syndrome，lung fire，chronic cough，Mulberry Bark Cough-relieving Prescription

小儿慢性咳嗽是指以咳嗽为主要或唯一的临床表现，病程大于4 周，胸部X 线片没有明显异常的疾病[1]。现代医学常予镇咳、祛痰、消炎、抗过敏等治疗此类疾病，效果不理想，而中医医家依据中医辨证论治的方法，治疗小儿慢性咳嗽，效果显著[2-4]。桑皮止咳方即根据辽宁中医药大学附属医院儿科多位专家临床治疗小儿慢性咳嗽的经验，辨证论治据症加减研制而成，追其溯源为钱乙《小儿药证直诀》的泻白散与《医学心悟》的止嗽散合裁而来。经过中医临床研究[5]，证实，该方对治疗各类持续、慢性咳嗽，清肺中郁热伏火有独到作用[6]。……