新西兰最近大面积爆发流感，尤其是很多儿童中招，主要症状包括咳嗽，发烧，流涕，咽痛等。由于目前COVID-19的影响，出现咳嗽症状，一般的家医都是无法直接接诊的，作为中医诊所我们也无法接诊此类患者。但这个案例是我女儿，故而有一个详细完整的中医治疗过程。<\/p>\n
患者，女，6岁，前日参加学校跑步比赛，第二日出现轻微咳嗽症状，脉浮紧，舌淡白辩为伤寒咳嗽，晚间予以风寒咳嗽方一剂。不料晚间被子滑落，一晚上没有盖被子，第二天开始喷嚏不断，且咳嗽加重。无汗，清涕，舌淡白，脉浮紧略数，按伤寒太阳阳明合病予伤寒感冒方一剂，汗出后，打喷嚏和流清涕消失。患者脉象变弦，精神变差，食欲下降，舌边红苔白厚，此为病传少阳，投少阳方以使病转出少阳，患者精神好转。在第三天，患者开始发热明显，脉数，舌尖红，咳嗽伴有黄痰，咳时咽痛。同时，出现下腹痛。此时，患者的症状可以转用温病的思路进行进一步治疗，服用清解郁热方剂，同时配合局部针灸拔罐（曲池，大椎，肺俞），病情显著缓解。隔日除了偶尔咳嗽一声，已无其他症状。但是，从舌脉来看，仍有余邪，以针灸法善后。<\/p>\n
分析：<\/p>\n
一、患者前期有典型的伤寒及六经传变特征，而后期转为典型的温病特征，应该是身体从皮肤先受了风寒，同时也从口鼻被感染了流感。这种情况下，不应该被病名所束缚，而是根据其病脉特征各用其法，随证治之；<\/p>\n
二、温病为由口鼻而入，属于病毒感染，向内传变非常快，首先犯肺，逆传心包，同时肺与大肠相表里，也会出现消化系统相关的症状。相对于风寒，病毒入体的祛除难度更大一些，而且病势去了之后，往往留邪，还需要持续善后；<\/p>\n
三、针药并用是很好的治疗方法。虽然单用任一种方法都可以去病，但是针药并用一方面有辅助增强的作用，另一方面，对于儿童而言，即可以降低用针灸的恐惧感，也可以减少吃药的量；<\/p>\n
四、在这个案例中，只有极早期的时候也许可以用发汗法，所以西医的Panadol或者中医的发汗剂可以用，但是，转到温病阶段，再用就会恶化病情。同时在整个治疗过程中没有发展到纯气分病，所以不能用清下法，包括西医的抗生素或者中医的白虎汤都不能用，如果用了就算抑制了症状，也一定会出其他问题。中医对内科疾病比任何医学都看得清楚，所以，中医不仅可以指导中药在不同阶段的使用，也可以同理指导其他医学的用药。<\/p>\n
<\/p>\n
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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.053<\/p>\n","protected":false},"excerpt":{"rendered":"
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