蒋健教授诊治“喉咳”的临床经验(1)
摘要“喉咳”为国医大师干祖望所提出的一种新的病证，以咽痒即咳、不痒不咳、痒止咳亦止为其临床特征。蒋健教授对此补充了以下主要学术见解：“喉咳”的外感病因为“6+1”，即除了传统风寒暑湿燥火六淫外，更多由空气污染之“雾霾”所导致；诊断时勿忘询问患者是否伴有咽痒而咳的特点；提出治疗“喉咳”以抗过敏、养阴利咽、清热解毒及宣肺止咳为主，4种治疗原则可灵活组合。这些学术见解进一步丰富了“喉咳”的病脉症治。
关键词喉源性咳嗽；经验；学术见解； @ 蒋健
Analysis on Professor Jiang Jian′s Clinical Experience of Diagnosing and Treating “Laryngeal Cough”
Geng Qi1，Cui Chen1，Li Jingwei1，Li Xin2，Li Wei3，Yang Xiaofan1，Zhou Dan1，Jiang Jian1
(1 Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China； 2 Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 200437，China； 3 Shanghai Huangpu District Central Hospital，Shanghai 200002，China)
Abstract“Laryngeal cough” is a new syndrome proposed by National TCM Master，Gan Zuwang.It has a clinical feature，that is，the patient′s cough is caused by throat itching，and when throat itching stops，cough also stops.Professor Jiang Jian added the following major academic insights to this：The pathogenic factors of “laryngeal cough” is “6+1”，which is caused by the “haze” of air pollution in addition to the traditional six evilswind，cold，heat，dampness，dryness and fire.When we try to diagnose “laryngeal cough”，do not forget to ask our patients whether his cough is caused by throat itching or not.In the treatment of “laryngeal cough”，Professor Jiang Jian pointed out four main therapeutic principles，which are based on antiallergy，replenishing yin to ease the throat，clearing heat and toxic materials，ventilating the lung to suppress cough.These four principles can be flexibly combined.All of the above academic insights have enriched the therapy of “laryngeal cough” further.
Key WordsLaryngeal cough； Experience； Academic insights； @ Jiang Jian
中图分类号：R2492/7文献标识码：Bdoi：10.3969/j.issn.1673-7202.2018.10.044
蔣健教授在临床上发现，有一种咳嗽以咽痒致咳为特点，表现为咽痒则咳，咽不痒则不咳，咽痒止则咳嗽亦随之而止，干咳居多，缺乏全身症状，对此仅用宣肺止咳药治疗难以取效。通过查阅文献得知这种咽痒致咳的疾病，原来同国医大师干祖望先生曾经于1995年报道的“喉源性咳嗽(简称‘喉咳’)”[1]十分相似，或基本上所指是同一疾病。由于当今空气污染日益严重，导致“喉咳”患者日益增多，而蒋健教授对此病诊疗有一些独到的见解，进一步丰富了国医大师干祖望先生“喉咳”的学术思想，结合其案例诊疗经过介绍如下，以期对“喉咳”的病脉症治广而知之。
1验案
验案1：某，女，48岁，2013年5月21日就诊。主诉：咽痒咳嗽2个月余。自今年3月8日感冒发热以来一直咳嗽至今，伴咽痒，白昼尚可，夜间尤甚，痰少。曾自行服用过各类止咳药，均告罔效。舌淡红，苔薄，脉细弦。证属喉咳，治以抗敏利咽，清热养阴；处方：柴胡15 g、防风12 g、蝉蜕10 g、土茯苓30 g、白鲜皮12 g、生甘草12 g、白僵蚕12 g、桔梗12 g、胖大海3 g、金银花15 g、玄参12 g、麦冬12 g、生地黄15 g，7剂。
二诊(5月28日)：服上药后咽痒止，咳嗽几止，唯偶有泛酸，舌脉同上。原方加煅瓦楞40 g，7剂，以资巩固。
按：本案除咽痒咳嗽外，别无他苦。蒋健教授认为咽痒咳嗽多与过敏有关[2]，故方投过敏煎，患者咳嗽已有2个月余，恐余毒未清，肺阴耗损，故酌加金银花、胖大海清热解毒，生地黄、麦冬、玄参养阴利咽。, 百拇医药(耿琦 崔晨 李敬伟)
关键词喉源性咳嗽；经验；学术见解； @ 蒋健
Analysis on Professor Jiang Jian′s Clinical Experience of Diagnosing and Treating “Laryngeal Cough”
Geng Qi1，Cui Chen1，Li Jingwei1，Li Xin2，Li Wei3，Yang Xiaofan1，Zhou Dan1，Jiang Jian1
(1 Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China； 2 Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 200437，China； 3 Shanghai Huangpu District Central Hospital，Shanghai 200002，China)
Abstract“Laryngeal cough” is a new syndrome proposed by National TCM Master，Gan Zuwang.It has a clinical feature，that is，the patient′s cough is caused by throat itching，and when throat itching stops，cough also stops.Professor Jiang Jian added the following major academic insights to this：The pathogenic factors of “laryngeal cough” is “6+1”，which is caused by the “haze” of air pollution in addition to the traditional six evilswind，cold，heat，dampness，dryness and fire.When we try to diagnose “laryngeal cough”，do not forget to ask our patients whether his cough is caused by throat itching or not.In the treatment of “laryngeal cough”，Professor Jiang Jian pointed out four main therapeutic principles，which are based on antiallergy，replenishing yin to ease the throat，clearing heat and toxic materials，ventilating the lung to suppress cough.These four principles can be flexibly combined.All of the above academic insights have enriched the therapy of “laryngeal cough” further.
Key WordsLaryngeal cough； Experience； Academic insights； @ Jiang Jian
中图分类号：R2492/7文献标识码：Bdoi：10.3969/j.issn.1673-7202.2018.10.044
蔣健教授在临床上发现，有一种咳嗽以咽痒致咳为特点，表现为咽痒则咳，咽不痒则不咳，咽痒止则咳嗽亦随之而止，干咳居多，缺乏全身症状，对此仅用宣肺止咳药治疗难以取效。通过查阅文献得知这种咽痒致咳的疾病，原来同国医大师干祖望先生曾经于1995年报道的“喉源性咳嗽(简称‘喉咳’)”[1]十分相似，或基本上所指是同一疾病。由于当今空气污染日益严重，导致“喉咳”患者日益增多，而蒋健教授对此病诊疗有一些独到的见解，进一步丰富了国医大师干祖望先生“喉咳”的学术思想，结合其案例诊疗经过介绍如下，以期对“喉咳”的病脉症治广而知之。
1验案
验案1：某，女，48岁，2013年5月21日就诊。主诉：咽痒咳嗽2个月余。自今年3月8日感冒发热以来一直咳嗽至今，伴咽痒，白昼尚可，夜间尤甚，痰少。曾自行服用过各类止咳药，均告罔效。舌淡红，苔薄，脉细弦。证属喉咳，治以抗敏利咽，清热养阴；处方：柴胡15 g、防风12 g、蝉蜕10 g、土茯苓30 g、白鲜皮12 g、生甘草12 g、白僵蚕12 g、桔梗12 g、胖大海3 g、金银花15 g、玄参12 g、麦冬12 g、生地黄15 g，7剂。
二诊(5月28日)：服上药后咽痒止，咳嗽几止，唯偶有泛酸，舌脉同上。原方加煅瓦楞40 g，7剂，以资巩固。
按：本案除咽痒咳嗽外，别无他苦。蒋健教授认为咽痒咳嗽多与过敏有关[2]，故方投过敏煎，患者咳嗽已有2个月余，恐余毒未清，肺阴耗损，故酌加金银花、胖大海清热解毒，生地黄、麦冬、玄参养阴利咽。, 百拇医药(耿琦 崔晨 李敬伟)