【作者】 张桂菊；

【导师】 欧阳兵；

【作者基本信息】 山东中医药大学 ， 中医医史文献， 2007， 博士

【摘要】 肺为“华盖”,为脏腑之外卫;肺为娇脏,为清虚之体,与天气直接相通,故六淫等外邪侵入,最易犯肺。肺难调而易伤,小儿之肺尤易受伤。外感、内伤诸多因素,均可伤及小儿肺脏,表现为感冒、咳嗽、肺炎喘嗽、哮喘等,而致肺虚证候。肺虚常表现为肺气不足、肺阴亏损或肺阳不足。补肺法是针对肺虚证候而设的儿科常用治法,历代多有论述。现代中医儿科临床对补肺法的应用和研究相对较少,尤其缺少基于古代文献的系统研究。现代诸多儿科常见疾病均可以补肺法取效。因此,本课题运用文献研究的基本方法,对古代、现代补肺法儿科文献进行系统研究,“辨章学术,考镜源流”,分析其异同,推寻其规律,探求补肺法对现代儿科临床的指导和启示。以古代、现代文献为研究对象,运用整理、归纳、分析等方法,对补肺法进行系统研究。通过对《黄帝内经》、《伤寒杂病论》、《诸病源候论》、《小儿药证直诀》、《保婴撮要》、《本草纲目》等古代文献进行系统整理和研究,发现肺气(阴)虚证为历代儿科常见证候,古代儿科广泛应用补肺法,儿科医家普遍重视补益肺气(阴);补肺法常和补脾、益肾、解表等法相互为用;灵活运用补肺法等扶正方法,辅以祛邪等法,对防治小儿疾病具有重要作用。分析古代医家运用补肺方药的规律性,得出结论:补肺方剂中首重补气,常与收涩、化痰、补脾、益肾、解表、清热等药物配伍。对古代文献记述的药食两用之品在补肺法中的作用进行分析研究,以期拓展现代中医儿科治疗思路。对十年来现代中医儿科文献进行分析总结,从实验研究和临床报道两方面分析肺气虚证和补肺法的研究结果。对古代和现代儿科文献进行对比研究,发现古今对小儿肺气(阴)虚证认识不同。在治疗上都重视肺脾同补、肺肾同补,不同之处是古人重温补,常配合化痰和收涩法;今人少用温补,重视配合活血法和消导法。更多还原

【Abstract】 In the theory of TCM, the lung-zang is a guard to the Zangfu-organ, which act as an umbrella covering all the other zang and fu organ; and the lung-zang is a delicate viscus, the body of which is pure and empty that connect with the external atmosphere, so the pathgenic factor always invade the lung-zang easily. Among all the Zangfu-organs, the lung-zang is more vulnerable to be injuried and the diseseas of the lung-zang are more difficult to be cured, especially the lung-zang and diseseas of the children’s. There are factors of both the exopathy and internal impairment to induce the pediatric respiratory disease, usually display as influenza, cough, pneumonia, asthma, etc. The TCM disease pattern of these are always deficiency syndromes of the lung-zang, often the deficiency of the vital-qi and the lung-yin.The therapy of tonifying the lung-zang of paediatric diseases is a treatment for the common children’s diseases, which was recorded in many ancient medical books and is still effective in modern medical practice, but nowadays this therapy is neglectd by the pediatrician of TCM. And the study of this therapy is so scarce, especially lack of the literatural study. So this thesis is dedicated to the study of the therapy of tonifying the lung-zang of paediatric diseases. The method used in this study is the Chinese literatural approaches, the aim is to identify the chapters and the academic value and to do profound examination on the literatural sources, to analyze the differences between all the documents, and to explore the rules in these materials, which can give clinical guidance and inspiration for the modern pediatric practice.This study is based on both the ancient and modern documents, using the methods of collating, summarizing, analyzing to do systemic research of the therapy of tonifying the lung of paediatric diseases. This thesis have done extensive researches to the TCM classic books, such as The Yellow Emperor’s Canon of Internal Medicine,Treatise on Cold-induced Febride Diseases and Medical Treasures of the Golden Chamber, General Treatise on Causes and Symptoms of Diseases, Key to Therapeutics of Children’s Diseases, Protect Infants Summary and Compendium of Materia Medica,etc.The discovery is that the therapy of tonifying the lung-zang of paediatric disease was been used all the ancient time, the doctors and experts put emphasis on the vital-qi of the lung and the lung-yin. They used to connect with the methods of tonifying the spleen and kidney treatment, expelling wind and promoting blood circulation by removing blood stasis together to strength the curative effect which shows the importance of the combination of these therapy. By using all the methods above, which are supporting vital-qi therapy, in the meantime, they supplemented with treatments of eliminating pathogenic factors, and now using these method flexibly is still a vital factor to prevent the ill invasion in paediatrics. Analyzing the rule of ancient Chinese doctors using the herbs and TCM formulas to tonify the lung-zang of paediatric diseases, we come to conclusion that the first important type of herb is of tonifying the vital-qi, then matching with the other types such as arrresting discharge, resolving phlegm, tonifying the spleen-zang, reinforcing the kidney-zang, expelling exterior pathogenic factors, clearing away heat, etc. In order to expand the thinking of modern TCM treatment of pediatric diseases, the study do analysis to ancient prescriptions of dietotherapy on the food and herb of tonifying the lung-zang.From both aspect of experimental and clinical research reports of the tonifying the lung-zang traetment, the last part of this thesis analyze the latest ten years modern paediatric literature. And with the comparison of ancient and modern literature,this study shows the differnce as follow: the understanding of the deficiency of the lung-qi and lung-yin is partly different. They both think highly of tonifying the lung-zang rherapy with the spleen-zang and the kidney-zang, the diffrence is that the anciants regarded the warming tonifying method as important, and matching with treatment of resolving phlegm and arrresting discharge, but this therapy is used rarely in mowdays, and now the doctors prefer putting emphasis on combining with method of promoting blood flow and digestant.更多还原