WEBVTT00:00:01.560 --> 00:00:03.240今天来讲一下00:00:03.240 --> 00:00:06.080哮喘的中医辨证和分型00:00:06.080 --> 00:00:09.740科普从以下几个方面来讲00:00:10.800 --> 00:00:12.940从哮喘的中医基础00:00:13.840 --> 00:00:15.780哮喘的辨证分型00:00:16.600 --> 00:00:18.540哮喘的常见证型00:00:19.200 --> 00:00:22.300以及哮喘的治疗方法00:00:23.320 --> 00:00:26.660还有就是预防与调护00:00:27.960 --> 00:00:31.020另外就是现代的研究与案例分析00:00:33.320 --> 00:00:35.220哮喘的中医基础呢00:00:35.240 --> 00:00:37.460也在中医对哮喘的认识00:00:39.120 --> 00:00:40.880哮喘的病因病机是00:00:40.880 --> 00:00:44.460中医认为哮喘是由外邪侵袭00:00:44.760 --> 00:00:45.940饮食不当00:00:46.120 --> 00:00:48.620情志失调等因素引起00:00:49.040 --> 00:00:50.700导致肺气不宣00:00:50.800 --> 00:00:52.100反应内生00:00:52.880 --> 00:00:57.000哮喘与脏腑的关系哮喘呢00:00:57.000 --> 00:01:00.700与肺脾肾三脏关系密切00:01:01.120 --> 00:01:02.380肺失宣降00:01:02.440 --> 00:01:03.680脾失健运00:01:03.680 --> 00:01:04.940肾不纳气00:01:05.160 --> 00:01:07.780均可等导致哮喘的发作00:01:09.400 --> 00:01:11.180哮喘的辨证分型00:01:11.880 --> 00:01:15.620中医将哮喘分为寒喘热喘00:01:15.720 --> 00:01:17.180肢喘等类型00:01:17.440 --> 00:01:20.080根据患者的体质和症状00:01:20.080 --> 00:01:21.820进行个体化的治疗00:01:23.680 --> 00:01:28.180哮喘的病因病机外邪侵袭00:01:28.280 --> 00:01:31.140饮食不当情志失调00:01:31.200 --> 00:01:34.100劳逸失度均可引起哮喘00:01:35.120 --> 00:01:38.340风寒或风热外邪侵袭肺脏00:01:38.560 --> 00:01:40.500导致肺气失宣00:01:40.560 --> 00:01:43.140是哮喘发作的常见外因00:01:44.120 --> 00:01:49.500过食生冷油腻或辛辣食物损伤脾胃00:01:49.720 --> 00:01:51.820导致痰湿内湿00:01:51.840 --> 00:01:53.100诱发哮喘00:01:54.160 --> 00:01:56.140长期情绪波动00:01:56.240 --> 00:01:58.500如忧思愤怒等00:01:58.600 --> 00:02:00.620可导致肝气郁结00:02:00.800 --> 00:02:02.700进而影响肺气00:02:02.880 --> 00:02:04.100诱发哮喘00:02:05.160 --> 00:02:09.700过度劳累或缺乏运动均可损伤正气00:02:10.080 --> 00:02:11.700使肺位不固00:02:11.880 --> 00:02:13.740易受外邪侵袭00:02:13.880 --> 00:02:15.100引发哮喘00:02:17.440 --> 00:02:19.460中医的治疗原则呢00:02:19.520 --> 00:02:24.380是辨证失治整体观念以及调和阴阳00:02:25.240 --> 00:02:26.120分别来说00:02:26.120 --> 00:02:30.140就是根据患者体质和病情变化00:02:30.360 --> 00:02:33.300中医采用辨证施治原则00:02:33.440 --> 00:02:35.060为哮喘患者00:02:35.200 --> 00:02:37.660制定一个个性化的治疗方案00:02:39.040 --> 00:02:42.260中医强调人体是一个整体00:02:42.560 --> 00:02:43.920治疗哮喘时00:02:43.920 --> 00:02:44.760会考虑00:02:44.760 --> 00:02:48.380身体各系统间的相互影响和联系00:02:49.760 --> 00:02:53.660中医认为哮喘与阴阳失衡有关00:02:53.880 --> 00:02:58.100治疗时会通过药物和疗法调整阴阳00:02:58.240 --> 00:02:59.980以达到身体平衡00:03:02.680 --> 00:03:04.540哮喘的辩证分型00:03:05.560 --> 00:03:09.740实证哮喘分为风寒束肺型00:03:10.040 --> 00:03:13.540寒热雍肺型和肺气郁闭型00:03:14.400 --> 00:03:19.380宫寒疏肺型表现为咳嗽痰白而稀00:03:19.520 --> 00:03:21.180伴有雾寒发热00:03:21.200 --> 00:03:23.460舌苔舌苔淡白00:03:23.600 --> 00:03:26.900脉浮景常见于哮喘的初期00:03:28.080 --> 00:03:31.660寒热拥肺型表现为咳嗽气喘00:03:32.000 --> 00:03:33.900痰黄稠难咳00:03:34.080 --> 00:03:35.460口干口苦00:03:35.640 --> 00:03:37.420舌红苔黄腻00:03:37.720 --> 00:03:41.780脉滑数多见于哮喘急性发作期00:03:42.840 --> 00:03:47.580肺气郁闭型表现为胸闷气短00:03:47.760 --> 00:03:49.100呼吸困难00:03:49.280 --> 00:03:51.660情绪紧张时症状加重00:03:51.840 --> 00:03:53.940舌质暗红外旋00:03:54.080 --> 00:03:56.860常见于哮喘持续状态00:03:59.200 --> 00:04:00.460虚症哮喘00:04:01.680 --> 00:04:05.940有以下几种肺气虚型哮喘00:04:06.760 --> 00:04:11.020脾气虚型哮喘和肾气虚型哮喘00:04:11.880 --> 00:04:15.500肺气虚型哮喘的表现为呼吸短促00:04:15.760 --> 00:04:17.220动则喘肾00:04:17.760 --> 00:04:19.060声音低弱00:04:19.240 --> 00:04:20.100自汗00:04:21.240 --> 00:04:23.880易感冒舌淡苔白00:04:23.880 --> 00:04:24.940脉喜弱00:04:25.680 --> 00:04:29.980脾气虚行哮喘常见症状为气短懒言00:04:30.120 --> 00:04:31.420食欲不振00:04:31.600 --> 00:04:33.080大便溏薄00:04:33.080 --> 00:04:34.500四肢乏力00:04:34.960 --> 00:04:37.660舌淡胖脉缓弱00:04:39.160 --> 00:04:43.620肾气虚行是要喘表现为喘息日久00:04:43.880 --> 00:04:45.420忽多稀少00:04:46.720 --> 00:04:48.140动则柔顺00:04:48.160 --> 00:04:49.580腰膝酸软00:04:49.880 --> 00:04:51.300夜尿频多00:04:51.560 --> 00:04:54.380舌淡苔白脉喘细00:04:55.680 --> 00:04:58.940还有一部分是混合型哮喘00:04:59.600 --> 00:05:04.680有肺脾气虚型寒热雍肺型00:05:04.680 --> 00:05:06.500以及肾不纳气型00:05:07.480 --> 00:05:10.340肺脾气虚型表现为咳嗽气短00:05:10.400 --> 00:05:11.700动则喘慎00:05:11.720 --> 00:05:12.920神疲乏力00:05:12.920 --> 00:05:14.100面色苍白00:05:14.320 --> 00:05:16.380舌淡苔白脉细弱00:05:17.880 --> 00:05:20.600痰热雍醉型可表现为咳嗽00:05:20.600 --> 00:05:22.420痰多色黄00:05:22.640 --> 00:05:23.860胸闷气促00:05:24.080 --> 00:05:25.380口干口苦00:05:25.800 --> 00:05:28.820舌红苔黄腻脉滑数00:05:30.040 --> 00:05:33.620肾不纳气型表现为喘息日久00:05:33.640 --> 00:05:35.020动则加剧00:05:35.120 --> 00:05:36.420呼多稀少00:05:36.760 --> 00:05:38.860腰酸腰膝酸软00:05:38.960 --> 00:05:40.780夜频夜尿频多00:05:40.880 --> 00:05:43.620舌淡苔白脉沉细00:05:46.240 --> 00:05:49.260哮喘的常见阵型00:05:51.200 --> 00:05:54.260第一个就是含痰阻肺型00:05:54.400 --> 00:05:56.980它主要表现为就像刚刚提过的00:05:57.280 --> 00:05:59.980咳嗽痰多色白00:06:00.200 --> 00:06:02.060胸闷气短00:06:02.240 --> 00:06:04.340遇寒则症状加重00:06:04.800 --> 00:06:06.000他的治疗方法呢00:06:06.000 --> 00:06:09.560主要是用常用温00:06:09.560 --> 00:06:13.340肺化痰散寒止咳的中药方剂00:06:14.320 --> 00:06:16.420在生活起居方面00:06:16.440 --> 00:06:19.020建议患者注意保暖00:06:19.160 --> 00:06:21.020避免接触冷空气00:06:21.200 --> 00:06:22.840饮食衣物温热00:06:22.840 --> 00:06:24.620避免生冷的食物00:06:26.160 --> 00:06:31.640肺热瘀盛型临床表现为咳嗽痰黄稠00:06:31.640 --> 00:06:32.820呼吸急促00:06:33.120 --> 00:06:36.340甚至会出现胸闷发热等症状00:06:37.040 --> 00:06:40.540治疗的方法是通常采用清热宣肺00:06:40.600 --> 00:06:42.420化痰止咳的中药00:06:43.400 --> 00:06:44.480在生活方面00:06:44.480 --> 00:06:47.560建议患者避免辛辣油腻的食物00:06:47.560 --> 00:06:49.700保持室内空气流通00:06:49.800 --> 00:06:52.540适当的进行呼吸功能的锻炼00:06:54.480 --> 00:06:58.920肺脾气虚型常表现为气短乏力00:06:58.920 --> 00:07:00.460咳嗽无力00:07:00.520 --> 00:07:01.960痰白而稀00:07:01.960 --> 00:07:04.020易感冒面色苍白00:07:04.360 --> 00:07:05.560治疗的方法呢00:07:05.560 --> 00:07:10.160是通常采用补补肺00:07:10.160 --> 00:07:13.620健脾益气固表的中药方剂00:07:13.960 --> 00:07:14.880在生活方面00:07:14.880 --> 00:07:17.180建议患者保持情绪稳定00:07:17.200 --> 00:07:18.880避免过度劳累00:07:18.880 --> 00:07:21.040适当进行体育锻炼00:07:21.040 --> 00:07:22.220增强体质00:07:25.120 --> 00:07:29.460中医治疗哮喘的方法有中药内治法00:07:29.600 --> 00:07:32.420针灸疗法以及饮食调00:07:33.160 --> 00:07:36.200分别来讲就是中药内治法00:07:36.200 --> 00:07:38.620遵循辨证失治的原则00:07:38.640 --> 00:07:42.460根据哮喘患者的具体体质和病情00:07:42.520 --> 00:07:44.860来选用不同的中药配方00:07:45.400 --> 00:07:49.140比如寒喘用温肺散寒的药00:07:50.080 --> 00:07:51.200经典的方剂呢00:07:51.200 --> 00:07:54.780比如说小青龙汤定喘汤等00:07:55.040 --> 00:07:57.820都可以针对不同的哮喘进行治疗00:07:59.280 --> 00:08:02.040还可以结合患者的个人特点00:08:02.040 --> 00:08:04.940制定个性化的一个中药治疗方案00:08:05.280 --> 00:08:07.060以提高治疗的效果00:08:08.720 --> 00:08:10.180针灸疗法呢00:08:10.680 --> 00:08:13.860主要是背经穴位的刺激00:08:14.040 --> 00:08:15.480背部穴位的治疗00:08:15.480 --> 00:08:17.700以及足三里穴的应用00:08:19.200 --> 00:08:21.520通过针刺肺经上的穴位00:08:21.520 --> 00:08:24.020比如尺泽太渊00:08:24.120 --> 00:08:25.940可以调节肺气00:08:26.120 --> 00:08:28.140舒缓哮喘症状00:08:29.040 --> 00:08:31.300在背部的肺枢00:08:33.720 --> 00:08:35.840睾盲等穴位进行针灸00:08:35.840 --> 00:08:37.960有助于改善呼吸功能00:08:37.960 --> 00:08:39.780减轻哮喘的发作00:08:41.239 --> 00:08:44.440针灸足三里穴能够增强体质00:08:44.440 --> 00:08:45.780提升免疫力00:08:45.840 --> 00:08:48.780对哮喘患者有辅助治疗的作用00:08:51.160 --> 00:08:53.180在生活饮食方面呢00:08:53.400 --> 00:08:56.320哮喘患者应避免食用00:08:56.320 --> 00:08:58.960可能导致过敏反应的食物00:08:58.960 --> 00:09:01.220比如海鲜牛奶等00:09:01.320 --> 00:09:03.300以减少哮喘的发作00:09:04.080 --> 00:09:04.960中医建议00:09:04.960 --> 00:09:09.500哮喘患者可以多吃润肺止咳的食物00:09:09.720 --> 00:09:11.980比如梨蜂蜜等00:09:12.000 --> 00:09:14.820有助于缓解呼吸系统症状00:09:16.560 --> 00:09:18.800适量的摄入温性食物00:09:18.800 --> 00:09:21.300如葱姜等00:09:21.520 --> 00:09:23.060可以帮助驱寒00:09:23.160 --> 00:09:25.260对于寒性哮喘的患者00:09:25.320 --> 00:09:26.980有一定的缓解作用00:09:29.360 --> 00:09:32.900关于哮喘患者的一个预防与调护00:09:33.360 --> 00:09:36.580首先就体现在一个生活习惯的调整00:09:37.480 --> 00:09:38.560哮喘患者00:09:38.560 --> 00:09:42.180应避免食用易引发过敏的食物00:09:42.880 --> 00:09:46.960应选用清淡易消化的食物00:09:46.960 --> 00:09:49.020来进行一个合理的饮食00:09:50.040 --> 00:09:53.380适当的体育锻炼也有助于增强体质00:09:53.640 --> 00:09:55.700但应避免剧烈运动00:09:55.880 --> 00:09:57.900选择像太极拳00:09:57.920 --> 00:10:02.220散步等低强度的运动来增强体质00:10:03.720 --> 00:10:08.220哮喘患者应尽量减少接触花粉尘螨00:10:08.360 --> 00:10:11.100宠物皮屑等已知的过敏源00:10:11.320 --> 00:10:13.420保持室内空气的流通00:10:14.600 --> 00:10:17.300另外可以保持乐观情绪00:10:17.320 --> 00:10:19.220避免过度紧张00:10:19.480 --> 00:10:23.960可通过冥想瑜伽等方式缓解压力00:10:23.960 --> 00:10:25.660减少哮喘发作00:10:28.800 --> 00:10:30.280就像刚刚提过的00:10:30.280 --> 00:10:31.620在饮食方面00:10:32.520 --> 00:10:35.360患者应避免食用00:10:35.360 --> 00:10:37.480可能导致过敏的一些食物00:10:37.480 --> 00:10:39.960比如海鲜牛奶鸡蛋等00:10:39.960 --> 00:10:41.860这个也是因人而异的00:10:42.280 --> 00:10:44.440另外需要注意的就是00:10:44.440 --> 00:10:46.860减少辛辣刺激性的食物00:10:46.920 --> 00:10:50.380比如辣椒胡椒等可能刺激呼吸道00:10:51.400 --> 00:10:54.740因哮喘患者应减少摄入这类食物00:10:55.280 --> 00:10:57.440可以适当地食用如梨00:10:57.440 --> 00:10:59.940蜂蜜等润肺止咳的食物00:11:00.040 --> 00:11:03.180有助缓解哮喘患者的呼吸不适00:11:04.960 --> 00:11:06.440在情志方面00:11:06.440 --> 00:11:09.980我们也建议患者保持情绪的稳定00:11:10.840 --> 00:11:13.740因为情绪的波动可能诱发哮喘00:11:15.560 --> 00:11:18.440中医建议能够通过冥想瑜伽等方式00:11:18.440 --> 00:11:19.840保持心态平和00:11:19.840 --> 00:11:20.980减少发作00:11:22.320 --> 00:11:23.160过度的劳累00:11:23.160 --> 00:11:23.520呢会00:11:23.520 --> 00:11:24.820耗伤正气00:11:25.360 --> 00:11:26.840因此我们也建议患者00:11:26.840 --> 00:11:29.260能够合理安排工作与休息00:11:29.280 --> 00:11:30.920保证充足的睡眠00:11:30.920 --> 00:11:32.020预防哮喘00:11:33.120 --> 00:11:36.960在培养乐观和的心态00:11:36.960 --> 00:11:40.580都有助于增强患者的机体抵抗力00:11:40.800 --> 00:11:42.160提倡通过读书00:11:42.160 --> 00:11:46.620听音乐等方式培养乐观的一个情绪00:11:49.200 --> 00:11:52.320有几个现代研究与案例分析00:11:52.320 --> 00:11:53.420大家分享00:11:54.480 --> 00:11:56.940中医治疗哮喘的现代研究00:11:57.520 --> 00:11:58.840有临床的试验00:11:58.840 --> 00:12:01.640研究机制的探讨研究00:12:01.640 --> 00:12:03.780以及病例的分析研究00:12:06.400 --> 00:12:08.220典型的病例分析00:12:08.760 --> 00:12:10.220也印证了00:12:10.320 --> 00:12:14.860中医将哮喘分为了寒痰阻肺型哮喘00:12:15.400 --> 00:12:17.040肺脾气虚型哮喘00:12:17.040 --> 00:12:19.560和热邪雍肾雍肺型哮喘00:12:19.560 --> 00:12:21.460的一些临床表现00:12:21.640 --> 00:12:22.940与之相对应00:12:25.400 --> 00:12:29.000中医中西医治疗结合00:12:29.000 --> 00:12:32.980能够治疗哮喘有一定的长处00:12:33.240 --> 00:12:34.040比如00:12:34.080 --> 00:12:37.220哮喘急性发作期的中西医协同治疗00:12:37.560 --> 00:12:39.520通过案例分析展示00:12:39.520 --> 00:12:42.740中西结合在哮喘急性发作时00:12:43.120 --> 00:12:45.060能够快速缓解症状00:12:45.200 --> 00:12:47.220提高治疗的一个效率00:12:48.240 --> 00:12:51.700长期管理中的中西医互补策略00:12:52.520 --> 00:12:55.680中西结合在哮喘的长期管理中00:12:55.680 --> 00:12:57.140是有一定优势的00:12:57.280 --> 00:13:00.860比如中药调理与西药控制相结合00:13:01.240 --> 00:13:02.900能够减少复发00:13:03.080 --> 00:13:04.300稳定病情00:13:05.680 --> 00:13:08.460改善患者生活质量的综合方案00:13:09.080 --> 00:13:11.520是可以通过改善肺功能00:13:11.520 --> 00:13:13.700和减少药物的副作用00:13:13.840 --> 00:13:16.540提升哮喘患者的一个生活质量00:13:19.560 --> 00:13:23.460那么讲到这里再强调一下00:13:24.760 --> 00:13:28.140对于长期这些慢性的哮喘患者00:13:28.320 --> 00:13:30.700他有一些注意事项00:13:30.800 --> 00:13:34.700比如说什么时候复诊00:13:35.440 --> 00:13:36.280复诊的话00:13:36.280 --> 00:13:39.980一般呢是在药物治疗的一到两周后00:13:41.240 --> 00:13:42.940症状如果没有改善00:13:42.960 --> 00:13:45.100那么需要再去医院就诊00:13:45.520 --> 00:13:48.340或者出现了一些新的症状00:13:48.480 --> 00:13:53.700比如说胸闷气促和痰颜色的变化00:13:54.160 --> 00:13:55.560与之前的一些症状00:13:55.560 --> 00:13:57.400出现了明显的变化00:13:57.400 --> 00:13:59.080那么也是需要及时00:13:59.080 --> 00:14:03.120去医院就诊来看一下病情变化的话00:14:03.120 --> 00:14:05.940用药方面是不是需要调整00:14:07.560 --> 00:14:08.320注意事项00:14:08.320 --> 00:14:09.140就是00:14:09.800 --> 00:14:11.380因为哮喘患者00:14:11.880 --> 00:14:16.060大多是需要通过长期的00:14:16.440 --> 00:14:18.400低剂量服用一些激素药物00:14:18.400 --> 00:14:19.860来控制病情的00:14:20.120 --> 00:14:24.080那么就需要患者有一些是小患者00:14:24.080 --> 00:14:25.720有一些可能是大患者00:14:25.720 --> 00:14:28.260都需要严格遵医嘱用药00:14:28.720 --> 00:14:29.120呃00:14:29.120 --> 00:14:32.620建议做到不自行增减药量或停药00:14:34.120 --> 00:14:36.040如果是一些小患者的话00:14:36.040 --> 00:14:38.740就需要一些家长进行一个配合00:14:40.880 --> 00:14:43.620另外就是避免滥用抗生素00:14:44.000 --> 00:14:46.840除非呢是有临床依据00:14:46.840 --> 00:14:48.700有合并的细菌感染00:14:48.840 --> 00:14:51.660那么在医生的医嘱情况下00:14:52.120 --> 00:14:55.240配合一个抗生素的疗程00:14:55.240 --> 00:14:57.220和规范使用药00:14:57.280 --> 00:14:58.340使用抗生素