激素依赖型哮喘撤减激素过程中的证候学变化及其治疗特点

探讨激素依赖型哮喘(SDA)撤减激素过程中的证候学变化及其治疗特点,认为在撤减激素的过程中,SDA患者存在着由阴虚火旺(撤前)→阴阳两虚(撤中)→肾阳亏虚(撤后)的病机演变规律,而痰瘀内阻则贯穿于整个激素撤减过程中.根据其证候学变化建立了中药三步序贯撤减激素的新方案,即撤前滋阴血,清虚热,化痰瘀;撤中滋阴养血熄风,益气温阳活血,化痰降逆平喘;撤后温肾阳,和气血,畅气机.由于三步序贯法根据SDA撤减激素过程中的动态变化规律而设计,因而较既往任何一种单一治法更能符合SDA临床发生、发展、变化的全过程,反映了其病机演变的实质特征.

Changes of Syndromes and Therapeutic Characteristics in the Patient of Steroid-dependent Asthma during Steroid Withdrawal

Changes of syndromes and therapeutic feature of the patients with steroid-dependent asthma(SDA)during steroid withdrawal were investigated.It was held that the patient presented pathological changes from deficiency of Yin and hyperactivity of evil fire before steroid withdrawal to deficiency of Yin and Yang during steroid withdrawal to deficiency of kidney-Yang after steroid withdrawal,with the syndrome of stasis of phlegm and blood throughout the whole process.Therefore,a new scheme for weaning the steroid with the TCM three-step sequential therapy was established according to the changes of syndromes,i,e., nourishing Yin and blood,clearing away excessive heat and eliminating stasis of phlegm and blood before steroid withdrawal; nourishing Yin and blood,inhibiting pathogenic wind,replenishing Qi and Yang,activating blood circulation,resolving phlegm and lowering the adverse rise of Qi to relieve asthma during steroid withdrawal;warming kidney-Yang and adjusting Qi and blood,and regulating functional activity of Qi after steroid withdrawal.Because the three-steep sequential therapy was designed based on the dynamic change of SDA during steroid withdrawal,it conformed with the whole clinical process of the occurrence,development and changes of SDA than any other single way,and reflected the essential characteristics of the pathological changes.