小儿频繁清嗓子西医多诊断为咽喉炎，或者一种抽动症的表现，非常容易反复，且治疗效果差。由于它体现在小朋友身上往往就是单一症状，而单一症状往往很难准确建立中医的证型模型，故而看似简单却不易治疗。<\/p>\n
患儿，女，5岁，有一段时间嗓子里老是发出吭吭吭清嗓子的声音，受凉时会有所加重，她似乎觉得嗓子里有痰，但从未清出过痰，余无其他不适。根据以往一位师兄介绍的经验，用了桂枝汤加味。据他的使用经验效果非常好，但是，我给患者用了2天效果不好。于是在原方基础上加味，合上半夏厚朴汤的方义，但是没有加一味紫苏。患者用后明显见效，清嗓子的频率减少了70%，但是没有达到我期待的更好的效果，且有所反复。<\/p>\n
近日，因天气降温，患者感受风寒。两日内其病脉非常清晰地经历了太阳和少阳两个阶段，分别对症用药后感冒迅速好了，但是又开始吭吭吭清嗓子。此时再摸其脉象，符合半夏厚朴汤的特征。之前的治疗效果满意，但没有达到最佳效果，想到可能的因素之一是之前虽然合用了半夏厚朴汤但是没有放紫苏。于是在原来没吃完的药粉当中加入了紫苏。这次效果就非常明显了，服用完之后显著改善，很少再听到吭嗓子声了。<\/p>\n
这次治疗给我的经验就是，经方是有非常完整的结构的，无论是单用还是合方，都不该轻易变动经方的结构，故而针对经方的加减要非常谨慎，尽量少改动。<\/p>\n
另一个经验就是，他人的经验固然可以参考，但不该变成思维定式而造成对自己诊断的干扰，用患者当下的脉象进行判断才是最精准的。<\/p>\n
回到小儿的此类问题，在临床中根除不易，却非常容易出现反复。一方面，体内的无形之痰本身是不容易从身上去掉的，小儿又很难坚持服药，且只要饮食不节就容易生痰；第二方面，小儿的此类问题同家长对孩子过于严格有关。所以，除了儿童需要注意饮食和各方面的养护，成人也需要反思并调整跟儿童的相处方式，降低给孩子的压力。<\/p>\n
<\/p>\n
注意：中医根据个体差异所采取的治疗手段和治疗效果亦有差异，医案分享不构成治疗建议。<\/p>\n
NO.052<\/p>\n","protected":false},"excerpt":{"rendered":"
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