CN109432328B - 一种治疗支气管扩张的中药及其制备方法 - Google Patents
一种治疗支气管扩张的中药及其制备方法 Download PDFInfo
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Abstract
本发明提供了一种治疗支气管扩张的中药及其制备方法。一种治疗支气管扩张的中药,主要由以下原料制成:按重量份计,金荞麦15‑30份、鱼腥草15‑30份、桔梗5‑15份、黄芩5‑15份、芦根15‑40份、瓜蒌5‑20份、炒白术10‑40份、厚朴6‑15份、茯苓10‑30份、佛手5‑15份、党参6‑30份、山药15‑30份、桑白皮10‑20份、地骨皮10‑20份和三七3‑10份。本发明解决了传统西药对于治疗支气管扩张存在的耐药性、无法降低发病频率、疗效不佳等问题。
Description
技术领域
本发明涉及中药领域,尤其是涉及一种治疗支气管扩张的中药及其制备方法。
背景技术
支气管扩张症是各种原因引起的支气管树的病理性、永久性扩张,导致反复发生化脓性感染的气道慢性炎症,临床表现为持续或反复性咳嗽、咳痰,有时伴有咯血,可导致呼吸功能障碍及慢性肺源性心脏病,是一种常见的慢性呼吸道疾病。
目前对支气管扩张的治疗共识是:支气管扩张症患者出现急性加重合并症状恶化,即咳嗽、痰量增加或性质改变、脓痰增加和(或)喘息、气急、咯血及发热等全身症状时,应考虑使用抗菌药物,急性加重期抗菌药物治疗的最佳疗程尚不确定,建议所有急性加重治疗疗程均应为14天左右。仅有黏液脓性或脓性痰液或仅痰培养阳性不是应用抗菌药物的指征,支气管扩张症稳定期患者长期口服或吸入抗菌药物的效果及其对细菌耐药的影响尚需进一步研究,推荐采用非抗菌药物(粘液溶解剂,支气管扩张剂,糖皮质激素)治疗。
目前西医治疗支气管扩张,近期疗效尚满意,但远期疗效尚存不足,急性加重期抗菌素治疗多可获得较好疗效,但却不能控制其频繁发作。随着发作次数的增多和抗菌治疗的频繁使用,细菌耐药情况会逐渐加重,疗效逐渐下降,而且频繁使用抗生素对全身菌群生态带来巨大压力,可能造成其它部位菌群失调,引起更多问题,并且频繁的发作还会使支气过扩张病情不断进展。
另外西医的缓解期治疗措施,一方面改善临床症状疗效不佳,另一方面在稳定病情上也不理想,难以减少急性加重发生频率。患者因症状改善不良往往自行使用抗生素,进一步加重耐药发生和药物不良反应以及抗生素相关不良事件。
有鉴于此,特提出本发明。
发明内容
本发明的第一目的在于提供一种治疗支气管扩张的中药,该中药解决了传统西药对于治疗支气管扩张存在的耐药性、无法降低发病频率、疗效不佳等问题。
本发明的第二目的在于提供上述治疗支气管扩张的中药的制备方法,该制备方法可以制作汤剂,一方面避免使用药物辅料,另一方面避免了复杂的制作过程,使治疗更简单有效。
为了解决以上技术问题,本发明提供了以下技术方案:
一种治疗支气管扩张的中药,主要由以下原料制成:
按重量份计,金荞麦15-30份、鱼腥草15-30份、桔梗5-15份、黄芩5-15份、芦根15-40份、瓜蒌5-20份、炒白术10-40份、厚朴6-15份、茯苓10-30份、佛手5-15份、党参6-30份、山药15-30份、桑白皮10-20份、地骨皮10-20份、三七3-10份。
支气管扩张属于中医学“咳嗽”、“肺痈”、“咳血”等范畴,大多是外因与内因共存,研究表明肺虚为本,痰、热、瘀为标,虚实夹杂,病位在肺,且与肝、脾、胃、肾有关。
支气管扩张患者症状咳嗽、黄白痰多、胸闷胸痛主要体现本虚标实之标,故必须治标以缓解症状。因肺痈为病,痰热壅肺是其根本,故本发明采用金荞麦、鱼腥草、桔梗、黄芩、芦根、瓜蒌清肃肺气化痰热,配合泄白散桑白皮,地骨皮泄肺平喘止咳,迅速控制临床症状。
中医认为“肺为储痰之器,脾为生痰之源”。支气管扩张病痰多不除之本在于脾虚不化而致湿痰内生,甚至郁而化热。故本方采用炒白术、厚朴、茯苓、佛手、党参、山药用以健脾和中,理气化痰,以绝生痰之源,同时补益脾肺,益气扶正,使“正气存内,邪不可干”,减少急性发作,稳定病情,以求治病之本。
支气管扩张呈现慢性过程,病程缠绵,反复发作,中医理论强调“久病入络”,临床患者亦常见咯血,亦是佐证。故处方加入三七粉(或进一步加入丹参)以活血通络,使血脉得畅,有助于肺部结构性改变的改善和部分恢复,辅助以上治标固本治疗以进一步增强治疗效果。
综上,本发明的中药基于支气管扩张的本虚血瘀、痰浊壅肺的病机,主要由金荞麦、鱼腥草、桔梗、黄芩、芦根、瓜蒌、炒白术、厚朴、茯苓、佛手、党参、山药、桑白皮、地骨皮和三七配伍组成,清肺化痰,健脾益气,可用于湿性支气管扩张伴感染,急性发作或缓解期,证见咳嗽,黄白痰多,纳差,胸闷气短等症状者。
经临床试验,本发明所提供的中药用于支气管扩张患者,有效率达到100%,优效率达到76%。本方能够明显缓解支气管扩张患者临床症状、降低发作频率、显著减少抗生素使用率和使用强度。
在此基础上,本发明的中药配方还可进一步优化,具体如下。
根据患者病情的差异,可以适当增加或减少药材的含量,以增强疗效,减少副反应。例如:
优选地,还包括丹参;
优选地,按重量份计,金荞麦20-30份、鱼腥草15-25份、桔梗7-15份、黄芩5-13份、芦根20-40份、瓜蒌5-18份、炒白术15-40份、厚朴6-13份、茯苓15-30份、佛手5-13份、党参10-30份、山药15-25份、桑白皮12-20份、地骨皮10-18份、丹参5-30份、三七3-8份。
优选地,按重量份计,金荞麦20-25份、鱼腥草15-22份、桔梗7-13份、黄芩7-13份、芦根20-35份、瓜蒌10-18份、炒白术15-35份、厚朴8-13份、茯苓15-25份、佛手10-13份、党参10-25份、山药20-25份、桑白皮12-18份、地骨皮12-18份、丹参10-25份、三七3-5份。
优选地,按重量份计,金荞麦20-25份、鱼腥草15-20份、桔梗10-13份、黄芩7-10份、芦根20-30份、瓜蒌10-15份、炒白术20-30份、厚朴8-10份、茯苓20-25份、佛手10-13份、党参10-15份、山药20-25份、桑白皮12-15份、地骨皮12-15份、丹参10-15份、三七3-5份。
本发明的中药为口服给药,对于剂型没有特别限制,例如散剂、片剂、胶囊剂、丸剂或汤剂均可,或者其他可口服的剂型。
由于不同剂型的吸收特点不同,所用的辅料也有差异,以片剂为例,所述辅料包括甜味剂、填充剂、粘合剂、崩解剂和润滑剂中的一种或多种,优选填充剂、粘合剂、崩解剂和润滑剂。
优选地,所述填充剂选自淀粉、糖粉、糊精、乳糖和预胶化淀粉中的一种或多种,优选预胶化淀粉;
优选地,所述粘合剂选自淀粉、甲基纤维素和羧甲基纤维素钠中的一种或多种,优甲基纤维素;
优选地,所述崩解剂选自羧甲基淀粉钠、羟丙基淀粉和聚乙烯吡咯酮中的一种或多种,优选羧甲基淀粉钠;
优选地,所述润滑剂选自硬脂酸镁、硅胶、滑石粉、氢化植物油和十二烷基硫酸钠中的一种或多种,优选硬脂酸镁。
对于不同剂型的中药,所述辅料的重量百分含量X优选为0<X≤10%。
在以上剂型中,汤剂以制作简单、无辅料等优点而普遍适用,本发明提供了汤剂的具体煎煮方法:
按照配方取原料,按照料液重量比1:6~8的条件用水煎煮半小时以上,去除药渣。
其中,所述料液重量比优选为1:7~8。
以汤剂为例,本发明的中药用于治疗支气管扩张时的用法为:每日一剂(水煎300-400毫升),分两次口服。
综上,与现有技术相比,本发明达到了以下技术效果:
(1)采用中药代替西药治疗治疗支气管扩张,一方面避免了西药的耐药性问题,另一方面改善了药效:包括提高有效率、降低发病频率等;
(2)所提供的汤剂不需要辅料,副作用少,且制备过程简单。
具体实施方式
下面将结合具体实施方式对本发明的技术方案进行清楚、完整地描述,但是本领域技术人员将会理解,下列所描述的实施例是本发明一部分实施例,而不是全部的实施例,仅用于说明本发明,而不应视为限制本发明的范围。基于本发明中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本发明保护的范围。实施例中未注明具体条件者,按照常规条件或制造商建议的条件进行。所用试剂或仪器未注明生产厂商者,均为可以通过市售购买获得的常规产品。
实施例1
一种治疗支气管扩张的中药
配方:
金荞麦15克、鱼腥草30克、桔梗5克、黄芩15克、芦根15克、瓜蒌20克、炒白术10克、厚朴15克、茯苓10克、佛手15克、党参6克、山药30克、桑白皮10克、地骨皮20克、丹参5克、三七10克。
制备:
用7倍于药材重量的水煎煮上述药,煎煮半小时以上,去除药渣。
实施例2
一种治疗支气管扩张的中药
配方:
金荞麦30克、鱼腥草15克、桔梗15克、黄芩5克、芦根40克、瓜蒌5克、炒白术40克、厚朴6克、茯苓30克、佛手5克、党参30克、山药15克、桑白皮20克、地骨皮10克、丹参30克、三七3克。
制备:
用7倍于药材重量的水煎煮上述药,煎煮半小时以上,去除药渣。
实施例3
一种治疗支气管扩张的中药
配方:
金荞麦20克、鱼腥草25克、桔梗7克、黄芩13克、芦根20克、瓜蒌18克、炒白术15克、厚朴13克、茯苓15克、佛手13克、党参10克、山药25克、桑白皮12克、地骨皮18克、丹参10克、三七8克。
制备:
用7倍于药材重量的水煎煮上述药,煎煮半小时以上,去除药渣。
实施例4
一种治疗支气管扩张的中药
配方:
金荞麦25克、鱼腥草22克、桔梗13克、黄芩7克、芦根35克、瓜蒌10克、炒白术35克、厚朴8克、茯苓25克、佛手10克、党参25克、山药20克、桑白皮18克、地骨皮12克、丹参25克、三七5克。
制备:
用7倍于药材重量的水煎煮上述药,煎煮半小时以上,去除药渣。
实施例5
一种治疗支气管扩张的中药
配方:
金荞麦20克、鱼腥草20克、桔梗10克、黄芩10克、芦根30克、瓜蒌15克、炒白术20克、厚朴10克、茯苓20克、佛手13克、党参15克、山药25克、桑白皮15克、地骨皮15克、丹参15克、三七5克。
制备:
用7倍于药材重量的水煎煮上述药,煎煮半小时以上,去除药渣。
实施例6
一种治疗支气管扩张的中药
配方:
金荞麦15克、鱼腥草15克、桔梗10克、黄芩10克、芦根15克、瓜蒌5-20克、炒白术20g、厚朴6g、茯苓20g、佛手10g、党参10g、山药15g、桑白皮10g、地骨皮10g、三七粉3g。
制备:
用7倍于药材重量的水煎煮上述药,煎煮半小时以上,去除药渣。
临床疗效统计
统计了2014年至2017年治疗的30例湿性支气管扩张患者,其中合并肺结核18例,合并慢性阻塞性肺疾病12例,年龄平均58岁。基于支气管扩张的本虚血瘀、痰浊壅肺的病机,采用本复方为基本方,临床适当加减含量(均在实施例1至6内选择),疗程2-6个月。结果有效率达到100%,优效率达到76%。本方能够明显缓解支气管扩张患者临床症状、降低发作频率、显著减少抗生素使用率和使用强度。
本发明还列举了部分病例,具体如下。
丁某某:女,66岁,于2014年5月15日初次就诊,患者肝移植术后,服用抗排异药物,支气管扩张多年,症状加重3年,咳嗽痰量多,每日50余毫升,痰色黄,虽间断应用抗生素,但是症状控制不佳,同时伴有疲乏无力,纳食不佳,大便不成形,舌淡红苔略黄腻,脉细弦。辩证患者为肺脾气虚痰热壅肺之症,处方采用:金荞麦15g、鱼腥草15g、桔梗10g、黄芩10g、芦根15g、炒白术20g、厚朴6g、茯苓20g、佛手10g、党参10g、山药15g、桑白皮10g、地骨皮10g、三七粉3g(即实施例6),7剂水煎服。二诊则痰量减少,咳嗽好转,痰色仍黄,纳食略好,仍有乏力。前方减桑白皮,继服10剂,复诊诉痰量已减三分之二,精神体力较前明显改善,此后依症加减,调治两个月,初诊诸症均无,仅每日3-5口白痰,停药6个月未发。后于2015年4月、2015年11月、2017年3月分别因外感后出现咳嗽痰多等症,均采用本方加减治疗2-6周后收功,此间抗生素使用仅2周。
张某某:女,68岁,于2017年4月6日初诊,患者支气管扩张病史多年,近3-4年肺部感染发作频繁,主要采用抗生素治疗,但抗生素用量与日俱增,每次发作疗程逐渐延长,近一年每次消炎治疗需2月才可控制病情,抗生素用量已达极量,稳定期却仅维持1-2月,本次就诊刚刚结束8周消炎治疗,证见咳嗽不甚,白痰较多,焦虑,诉每次消炎治疗期间极度疲乏、纳差、周身酸痛,且逐次加重。考虑患者处于稳定期,治疗侧重清肺中伏邪、扶助正气减少复发,采用基本方较小剂量适当侧重肺脾气阴(实施例1),治疗3个月,病情稳定,然后给与间断服药,回访6个月未复发。
李某某:女,59岁,于2017年3月17日初诊,双肺结核,右上肺毁损,左上肺及右下肺纤维结节病灶伴支扩,证见咳嗽频繁,痰多量大,痰色黄绿,精神萎靡表情痛苦,情绪低落,悲观厌世,不与外人交流,厌食不饥,胃脘胀闷不适,胸闷气短喘憋,周身酸痛乏力,夜不能寐,舌质略红苔少,脉沉细无力。采用本方(实施例5)临症调治3个月,体力精神明显好转,可正常交流,纳食量少但正常饮食,每日痰量20-30毫升左右,白痰易咳出,每晚可睡眠3小时。后间断服药调理至今已1年余,病情稳定。
最后应说明的是:以上各实施例仅用以说明本发明的技术方案,而非对其限制;尽管参照前述各实施例对本发明进行了详细的说明,本领域的普通技术人员应当理解:其依然可以对前述各实施例所记载的技术方案进行修改,或者对其中部分或者全部技术特征进行等同替换;而这些修改或者替换,并不使相应技术方案的本质脱离本发明各实施例技术方案的范围。
Claims (11)
1.一种治疗支气管扩张的中药,其特征在于,由以下原料制成:
按重量份计,金荞麦20-30份、鱼腥草15-25份、桔梗7-15份、黄芩5-13份、芦根20-40份、瓜蒌5-18份、炒白术15-40份、厚朴6-13份、茯苓15-30份、佛手5-13份、党参10-30份、山药15-25份、桑白皮12-20份、地骨皮10-18份、丹参5-30份和三七3-8份。
2.根据权利要求1所述的中药,其特征在于,由以下原料制成:按重量份计,金荞麦20-25份、鱼腥草15-22份、桔梗7-13份、黄芩7-13份、芦根20-35份、瓜蒌10-18份、炒白术15-35份、厚朴8-13份、茯苓15-25份、佛手10-13份、党参10-25份、山药20-25份、桑白皮12-18份、地骨皮12-18份、丹参10-25份和三七3-5份。
3.根据权利要求1所述的中药,其特征在于,由以下原料制成:按重量份计,金荞麦20-25份、鱼腥草15-20份、桔梗10-13份、黄芩7-10份、芦根20-30份、瓜蒌10-15份、炒白术20-30份、厚朴8-10份、茯苓20-25份、佛手10-13份、党参10-15份、山药20-25份、桑白皮12-15份、地骨皮12-15份、丹参10-15份、三七3-5份。
4.根据权利要求1-3任一项所述的中药,其特征在于,所述中药的剂型为散剂、片剂、胶囊剂、丸剂或汤剂。
5.根据权利要求4所述的中药,其特征在于,所述片剂还包括辅料,所述辅料包括甜味剂、填充剂、粘合剂、崩解剂和润滑剂中的一种或多种。
6.根据权利要求5所述的中药,其特征在于,所述辅料包括填充剂、粘合剂、崩解剂和润滑剂。
7.根据权利要求5所述的中药,其特征在于,所述填充剂选自淀粉、糖粉、糊精、乳糖和预胶化淀粉中的一种或多种;
所述粘合剂选自淀粉、甲基纤维素和羧甲基纤维素钠中的一种或多种;
所述崩解剂选自羧甲基淀粉钠、羟丙基淀粉和聚乙烯吡咯酮中的一种或多种;
所述润滑剂选自硬脂酸镁、硅胶、滑石粉、氢化植物油和十二烷基硫酸钠中的一种或多种。
8.根据权利要求7所述的中药,其特征在于,所述填充剂为预胶化淀粉;
所述粘合剂为甲基纤维素;
所述崩解剂为羧甲基淀粉钠;
所述润滑剂为硬脂酸镁。
9.根据权利要求5所述的中药,其特征在于,所述辅料的重量百分含量X为0<X≤10%。
10.权利要求1-3任一项所述的中药的制备方法,其特征在于,包括下列步骤:
按照配方取原料,按照料液重量比1:6~8的条件用水煎煮半小时以上,去除药渣。
11.根据权利要求10所述的制备方法,其特征在于,所述料液重量比为1:7~8。
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