基于病程分期探讨儿童咳嗽中医证型分布特点及其辨治思路*
作者：钟 周，李海霞
单位：湖南省儿童医院，湖南 长沙 410007
引用：引用：钟周，李海霞.基于病程分期探讨儿童咳嗽中医证型分布特点及其辨治思路[J].中医药导报,2025,31(6):124-129.
DOI：10.13862/j.cn43-1446/r.2025.06.021
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摘要：
目的：统计分析儿童急性、亚急性与慢性期咳嗽的中医证型分布特点，论述其对应的辨治思路。方法：共收集2023年1月1日至2024年6月30日4 103例（1个月～18岁）咳嗽患儿的临床资料，统计分析各期咳嗽临床特征与中医证型分布特点，论述其对应的咳嗽辨治思路。结果：1 968例儿童急性咳嗽中，男性多见（58.79%），年龄主要集中在幼童（52.90%），临床病因以鼻炎为主（61.03%），其次为支气管炎（22.71%）；中医证型以风寒袭肺为主（41.67%）。644例亚急性咳嗽中，性别间无差异，年龄主要集中在幼童（55.12%），临床病因以鼻炎为主（46.58%），其次为咽喉炎（20.65%），中医证型以痰浊凝滞（19.41%）、风寒袭肺（19.25%）多见。1 491例慢性咳嗽中，男性多见（58.82%），年龄主要集中在幼童（57.41%），临床病因以鼻炎为主（36.08%），其次为支气管炎（28.91%），中医证型以风盛挛急（40.17%）、痰湿蕴肺（18.78%）多见。结论：儿童急性、亚急性、慢性咳嗽的年龄分布都以幼童为主，鼻炎是各期咳嗽最常见的临床病因。急性咳嗽中医证型以风寒袭肺为主，用药宜轻灵，宜根据感邪部位与体质差异来论治。亚急性咳嗽以痰浊凝滞、风寒袭肺证型多见，其病机特点是痰邪与风邪侵害机体，治疗应审症求因，知其感邪不同，辨其寒热虚实之异。慢性咳嗽以风盛挛急、痰湿蕴肺为主，风、痰、湿、热是其病理因素，应重视外感与内因的相间关系，调节脏腑气机平衡来论治。
关键词：急性咳嗽；亚急性咳嗽；慢性咳嗽；儿童；中医证型
Abstract：Objective: To analyze the distribution characteristics
of traditional Chinese medicine (TCM) syndromes in children with acute,
subacute, and chronic cough, and to discuss corresponding diagnostic and
treatment approaches. Methods: Clinical data from 4 103 pediatric patients
(aged 1 month to 18 years) with cough treated between January 1, 2023 and June
30, 2024 were collected. The clinical features and TCM syndrome distribution
patterns across different cough stages were statistically analyzed, and
corresponding treatment strategies were proposed. Results: Among 1 968 acute
cough cases, males predominated (58.79%), with toddlers being the most affected
age group (52.90%). The primary clinical etiology was rhinitis (61.03%),
followed by bronchitis (22.71%). The predominant TCM syndrome was wind-cold
invading the lung (41.67%). Of 644 subacute cough cases, no gender difference
was observed, with toddlers again being most common (55.12%). Rhinitis remained
the leading cause (46.58%), followed by pharyngitis (20.65%). The main TCM
syndromes were phlegm-turbidity stagnation (19.41%) and wind-cold invading the
lung (19.25%). Among 1 491 chronic cough cases, males were more prevalent
(58.82%), primarily toddlers (57.41%). Rhinitis (36.08%) and bronchitis
(28.91%) were the main etiologies, with wind-excess convulsive urgency (40.17%)
and phlegm-dampness accumulating in the lung (18.78%) being the dominant TCM
syndromes. Conclusion: Toddlers constitute the primary age group across all
cough stages, with rhinitis being the most common etiology. Acute cough mainly
presents as wind-cold invading the lung, requiring light and agile herbal
formulations tailored to pathogenic factors and constitution. Subacute cough often
manifests as phlegm-turbidity stagnation or wind-cold invasion, necessitating
etiology identification and differentiation of cold/heat/deficiency/excess
patterns. Chronic cough primarily involves wind-excess convulsive urgency and
phlegm-dampness accumulation, where wind, phlegm, dampness, and heat interact
as pathological factors, requiring balanced regulation of visceral qi
mechanisms while considering both external and internal causative factors.
Key words：acute cough; subacute cough; chronic cough; children; TCM syndrome
发布时间：2026-01-04
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