過敏性鼻炎與支氣管哮喘的中醫辨證與治療

TCM Syndrome Differentiation and Treatment on Allergic Rhinitis and Bronchial Asthma

近些年來在台灣氣喘、鼻過敏、異位性皮膚炎、結膜過敏這一類的過敏性疾病，因為國人的飲食習慣及社會形態的改變，發病率有越來越高的趨勢。過敏性鼻炎屬於中醫「鼻鼽」範疇，又稱鼽嚏、鼽鼻、鼻流清涕等，以突然和反復發作鼻塞、鼻癢、噴嚏、鼻流清涕為特徵。過去一直認為過敏性鼻炎是上呼吸道疾病，哮喘是下呼吸道疾病，二者是相對獨立的疾病，但越來越多的研究發現二者在流行病學、病因學和組織病理學甚至是治療方面存在著許多共同的特徵。鼻鼽主要是由於肺氣不足，衛外不固，風邪乘襲，犯及鼻竅，邪正相搏，肺氣不得通調所致。至於哮喘，以痰為主《丹溪心法》提出「專主於痰」，認為痰濁內伏是哮喘的病根。痰阻氣機，氣滯血瘀，致氣道痙攣，黏膜充血水腫，氣道狹窄，鼻竅壅塞，呼吸喘促，喉中痰鳴,諸症由生。過敏性鼻炎與支氣管哮喘臨床過程均可分為發作期、遷延期、緩解期。發作期以邪實為主；緩解期多為肺、脾、腎虛；遷延期乃正虛邪戀。發作期以祛邪為主，重視祛風抗敏，佐以化痰活血，但須分清寒熱；遷延期治當標本兼顧，分清主次；緩解期以治本為主。此類患者為過敏性體質，是一種慢性的氣道炎症反應，由此顯示我們對於哮喘、鼻鼽治療的長期性，仍需患者的耐心配合藥物的治療、飲食忌宜及生活模式的改變及規律的運動等，才能穫得穩固的療效。

In recent years, the rate of allergic diseases continues to increase in Taiwan because of changes in eating habits and social patterns. These diseases include bronchial asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis. Allergic rhinitis belongs to the scope of 'stuffy nose', also known as 'have a running nose' and 'have a stuff nose'. It is a disease characterized by sudden and recurrent attacks of nasal itching, sneezing, thin discharge and stuffy nose. In the past, it was considered that allergic rhinitis is a kind of upper respiratory diseases as well as asthma is a kind of lower respiratory diseases. It was thought that they are two different diseases. But now, there are more and more researches showed that allergic rhinitis and asthma have the same characters on epidemiology, etiology and histopathology. Allergic rhinitis is caused by deficiaency of lung qi, the weakness of defending force. The pathogenic of the chill will launch a sneak attack inside. The nose is the entrance of the lung, if the lung qi cannot come out once nose stops up, good and pathogenic will comb at. According to the 'Danxixinfa', asthma is said to be due to phlegm turbidity. Sputum and qi block, qi block and blood stasis cause airway spasm, congestion and edema of mucous membrane, airway narrowing, congestion in the nasal orifices, rapid breathing and retention of phlegm in throat. The clinical process of allergic rhinitis and asthma includes attack stage, chronic stage and remission stage. Excessive pathogen is the principal syndrome during the attack stage. In the chronic stage, the syndrome is related to the lung, spleen and kidney vacuities. The syndrome of lingering pathogen due to deficient vital qi occurs during the remission stage. With the principle of cold-heat pattern identification, the main treatment in the attack stage is based on expelling pathogenic factor, including expelling wind, relieving allergy, promoting blood flow and eliminating sputum. The treatment in the chronic stage focuses on relieving both primary and secondary symptoms and drawing a clear distinction between the primary and the secondary. In the remission stage, treating the root cause is the first. Allergic rhinitis and asthma occurred on these physical allergy patients is characterized by airway inflammation. The long-term treatment of allergic rhinitis and asthma needs patients to patiently receive medicine treatment proper diet, change their live pattern, and have regular exercise in order to get stable curative effect.