谢文 黄青松

摘要：黄青松教授认为正气虚损为成人难治性哮喘发病的基础，病位主要责于脾、肺、肾三脏。难治性哮喘患者素体本虚、药物耗损、或反复发作，缠绵难愈，耗伤正气，外邪易侵，诱因易动，引触伏痰，痰气相搏，哮喘反复发作。临床上采用分期辨证的方法，序贯治疗，发作期以宣肺化痰为主，攻补兼施，缓解期以健脾补肾益气为基础辨证施治，并结合难治性哮喘患者的症状特点进行个体化治疗，强调补虚贯穿于疾病治疗的始终。

关键词：难治性哮喘;名医经验;虚证

中图分类号：R256.12 文献标志码：A 文章编号：1007-2349（2021）05-0001-05

【Abstract】Professor Huang Qingsong believes that the deficiency of vital qi is the basis for the onset of refractory asthma in adults and the disease location is mainly responsible for spleen， lung and kidney. The patients with refractory asthma are weak in their body， drug depletion or recurrent attacks， lingering and difficult to heal， loss of vital qi， easy invasion of external pathogens， movability of inducement， leading long-standing phlegm， sputum mutual pulsation and recurrent asthma attacks. Clinically， the stage differentiation method and sequential treatment are adopted. During the attack period， the patients are mainly treated through ventilating the lung to resolve phlegm， combination of expelling evil and tonifying qi and in the remission period， the treatment is based on the syndrome differentiation to strengthen the spleen and tonify the kidney and qi. By integrating the characteristics of the symptoms of the patients with refractory asthma， the individualized treatment has been conducted， emphasizing to tonify deficiency throughout the treatment of the disease.

【Key words】Refractory Asthma; Experience of Famous Doctors; Deficiency Syndrome

黄青松教授是全国国务院特殊津贴补助专家，四川省名医，从事中医临床、教学和科研30余年，黄师勤求古训，学思相济，强调病证结合，重视辨证论治，调度灵活，务实重效，在肺病的诊治中颇有见解，临床疗效显著，尤其擅长咳、喘、哮的诊治。笔者有幸侍诊，现对黄青松教授诊治难治性哮喘经验进行总结提炼，以供同行参考。

1 难治性哮喘的治疗现状

难治性哮喘在支气管哮喘中的发病率为5%～10%，就诊率、住院率、死亡率和经济负担远高于其他类型哮喘[1-2]，《全球哮喘防治创议》以激素治疗反应作为定义难治性哮喘主要准则，认为难治性哮喘是尽管进行了GINA步骤4或5治疗（例如，中度或高剂量吸入性糖皮质激素（ICS）与辅助治疗者联用;维持OCS）仍无法良好控制的哮喘[3]。其发病机制主要与气道重塑严重、气道炎症持续存在及异质性明显、糖皮质激素敏感性减低、遗传因素等有关[4]。……