本文選題：兒童腺樣體肥大 + 辨證論治��； 參考：《云南中醫(yī)學(xué)院》2014年碩士論文

【摘要】：兒童腺樣體肥大（PAH）是耳鼻喉科、兒科的常見多發(fā)病。目前，西醫(yī)主要以手術(shù)切除治療本病。腺樣體在兒童時期具有免疫防御作用，手術(shù)切除免疫防御功能受損，容易導(dǎo)致上呼吸道反復(fù)感染[1]，手術(shù)麻醉也會給患兒帶來一定的風(fēng)險。相比之下，，中醫(yī)藥毒副作用小、治療效果較好。對PAH中醫(yī)證治規(guī)律進行系統(tǒng)研究具有重要意義。 研究目的：系統(tǒng)研究PAH文獻資料及辨證論治規(guī)律，為防治PAH提供借鑒。 研究方法：收集相關(guān)文獻和著作資料；整理、歸納、分析；總結(jié)PAH辨證論治和用藥規(guī)律。在導(dǎo)師指導(dǎo)下，研究PAH發(fā)病因素、病因病機，提出臨床辨證論治思路，通過病例回顧性分析，介紹導(dǎo)師治療PAH臨床常見證型的臨床經(jīng)驗。 結(jié)果：古代醫(yī)籍中沒有對兒童腺樣體肥大的專門論述，類似癥狀散見于“鼾眠”“窠囊”“痰核”“頏顙”“鼻窒”“乳蛾”等疾病中。現(xiàn)代的中醫(yī)耳鼻咽喉科專著中，借用西醫(yī)病名“腺樣體肥大”、“增殖體肥大”。歷代醫(yī)家認為兒童腺樣體肥大的病因病理主要表現(xiàn)為：肺衛(wèi)不固，易感外邪；肺經(jīng)濕熱；肺熱熾盛，脾失健運；氣滯血瘀，痰濕結(jié)聚。本病與肺、脾、肝等臟腑關(guān)系密切。 歷代醫(yī)家常用養(yǎng)陰潤肺，補腎填精；補益肺脾，化痰散結(jié)；行氣活血，軟堅散結(jié)；疏散風(fēng)熱，化痰散結(jié)；宣肺通竅，清熱利咽等法治療。浙貝母、茯苓、桔梗、當(dāng)歸、玄參、柴胡、生地黃、赤芍、川芎、陳皮、甘草、夏枯草等藥使用頻率最高。熟地黃、百合、麥冬、山萸肉、黨參、升麻、人參、桃仁、紅花、枳殼、海蛤殼、海浮石、瓦楞子、瓜蔞仁、三棱、莪術(shù)、蒼耳子、白芷、金銀花、薄荷、黃芩、辛夷花、皂角刺等藥物相對較高。 本研究認為：兒童時期，“稚陽未充，稚陰未長”，“五臟六腑，成而未全，全而未壯”，肺常不足、脾常不足、腎常虛是本病的發(fā)病基礎(chǔ)。感受外邪，致痰、虛、瘀內(nèi)生。病邪久留，虛其虛，實其實，互為因果，交相燔灼故致本病遷延反復(fù)。 本研究對臨床最常見的肺經(jīng)蘊熱、肺脾氣虛、氣血瘀阻、肺腎陰虛四個證型進行了辨證論治設(shè)計。 回顧總結(jié)55例臨床病例，PAH各型所占比例依次為：肺脾氣虛型13例,占總比例的23.64%；肺經(jīng)蘊熱型12例，占總比例的21.82%；氣血瘀阻型20例，發(fā)病率最高占總發(fā)病率的36.36%；肺腎陰虛型10例，發(fā)病率最低占總發(fā)病率的18.18%。郭兆剛教授辨證論治PAH患兒55例，治療總有效率81.8%，肺經(jīng)蘊熱型總有效率83.3%，肺脾氣虛型總有效率84.6%，肺腎陰虛型與氣血瘀阻型總有效率80%，經(jīng)χ2檢驗結(jié)果顯示P值為0.985（P＞0.05），無統(tǒng)計學(xué)意義。 結(jié)論：兒童腺樣體肥大的中醫(yī)辨證分型應(yīng)分為4型,分別為肺脾氣虛、肺經(jīng)蘊熱、氣血瘀阻、肺腎陰虛。郭兆剛教授以補益肺脾、扶正益氣、活血通竅為主要思路治療本病，臨床療效顯著，改善患兒的生活質(zhì)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.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R276.1

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