柴胡桂枝湯合參蘇飲治療慢性咳嗽病例報告

The Treatment of Chronic Cough with ChaiHuGuiZhiTang and ShenSuYin-A Case Report

楊登凱(Deng-Kai Yang) ； 張晉賢(Chin-Hsien Chang)

《北台灣中醫醫學雜誌》 4卷2期 (2012/12) Pp. 35-46

https://doi.org/10.30127/BTWZYYXZZ.201212.0004

摘要

咳嗽是臨床上相當常見的主訴症狀，也是身體的防禦機制，卻會影響生活作息、工作及社交表現，帶給患者許多困擾。咳嗽持續超過八週以上，則定義為慢性咳嗽。成人的慢性咳嗽最常見的原因有以下四種：上呼吸道咳嗽症候群（舊稱鼻涕倒流症候群）、咳嗽變異型氣喘、胃食道逆流疾病、嗜酸粒細胞性支氣管炎，上述病因約佔慢性咳嗽患者的70%以上。中醫治療慢性咳嗽有其優勢，對於不明原因或久治不癒的慢性咳嗽，中醫治療比單獨使用西醫治療具有較佳的療效。本案是一位苦於慢性咳嗽的55歲女性，三個月來幾經中西醫治療，仍久咳不癒，經辨證診斷為外感風寒，正虛邪戀，氣血兩虛，予以柴胡桂枝湯合參蘇飲等扶正解表之劑治療，病患之咳嗽在兩星期內得以顯著改善。雖然痰熱壅肺、肝火犯肺、痰濕蘊肺、肺陰虧虛、肺氣虧虛為慢性咳嗽的主要證型，但祛除外邪的診治思路仍不應被忽略。尤其是對於上呼吸道咳嗽症候群及咳嗽變異型氣喘，風寒戀肺以及外感風邪、伏肺致病等病機仍被不少學者所強調。最後，我們還對小柴胡湯的使用時機和少陰咽痛的治療原則做了一些討論。

關鍵字

慢性咳嗽 ； 柴胡桂枝湯 ； 參蘇飲 ； 中醫 ； 小柴胡湯 ； 少陰咽痛

並列摘要

Cough is a very common symptom in clinical practice. Although it is a defense mechanism of human body, it also disturbs our daily life and work. Chronic cough is defined as persistent cough for more than 8 weeks. The most common causes of chronic cough in adults include upper airway cough syndrome (also called postnasal-drip syndrome), cough variant asthma, gastroesophageal reflux disease, and eosinophilic bronchitis, which take more than 70% of patients. For cause unknown or persistent chronic cough, treating with traditional Chinese medicine has better outcome compared with western medicine alone. A 55-year-old female patient suffered from persistent cough for more than 3 months, even with treatment of both traditional Chinese and western medicine. The diagnosis after pattern identification were externally contracted wind-cold, right vacuity and abiding evil, and qi-blood vacuity. After treatment with ChaiHuGuiZhiTang and ShenSuYin for the purpose of support right and resolve the exterior, the patient's cough relieved in two weeks. Even if phlegm-heat congesting the lung, liver fire invading the lung, phlegm-damp obstruction the lung, lung yin vacuity, lung qi vacuity are the main patterns of Chinese medical diagnosis for chronic cough, the thinking process of treatment with dispel evil should not be ignored. Especially for upper airway cough syndrome and cough variant asthma, pathomechanism of external contraction is still emphasized. In the end, we also discussed the timing for using XiaoChaiHuTang and the therapeutic principle for ShaoYin odynophagia.

並列關鍵字

Chronic Cough ； ChaiHuGuiZhiTang ； ShenSuYin ； Traditional Chinese Medicine ； XiaoChaiHuTang ； ShaoYin Odynophagia