马桂琴教授辨治职业性尘肺病经验简介
|
摘要
职业性尘肺病是在职业活动中,长期吸入不同致病性的生产性粉尘,并在肺内潴留而引起的以肺组织弥漫性纤维化为主的一组职业性肺部疾病的统称,按照我国《职业病分类和目录》,主要包括矽肺、煤工尘肺、石棉肺等12种,目前是我国危害最严重和最常见的职业病。尘肺病的发病机制尚不明确,至今仍缺乏有效的治疗手段。近3年来,笔者跟随马桂琴教授出诊期间,发现运用中药治疗尘肺病疗效确切,通过收集病案,对其遣方用药规律进行分析整理。根据尘肺病患者反复咳、痰、喘的临床特点,中医将其纳入咳嗽、喘证、肺胀等范畴,马桂琴教授认为尘肺病的基本病机为大气下陷、肾虚、痰浊内阻、枢机不利,根据其病机,对其常用方剂升陷汤、金水六君煎、小柴胡汤、四逆散、过敏煎及辨证加减用药进行阐述。另外,"咽喉为肺胃之门户",马教授还认为,预防尘肺病亦应从咽喉着手,遏制疾病的加重或复发。通过临床观察运用中药治疗尘肺病,如方药运用恰当,抓住病机辨证施治可明显减轻患者的临床症状,提高患者的运动耐量,改善患者生活质量。
Occupational pneumoconiosis refers to a group of occupational pulmonary diseases,which is mainly characterized by diffuse fibrosis of lung tissue caused by inhalation of different pathogenic productive dust and retention in the lungs during occupational activities for a long period of time. According to the classification and catalogue of occupational diseases in China,it is mainly classified into 12 categories,such as silicosis,coal worker's pneumoconiosis,asbestos lung. At present,it is the most serious and most common occupational disease in China. The pathogenesis of pneumoconiosis is not clear,and there is still no effective therapy. In the past three years,it is found that traditional Chinese medicine is effective in the treatment of pneumoconiosis. Through collection of medical records,the regularity of the prescriptions used in the treatment of pneumoconiosis were analyzed and summarized. According to the traditional Chinese medicine theory,the clinical characteristics of recurrent cough,phlegm and asthma in patients with pneumoconiosis could be included in the categories of cough,wheezing,lung distension. Professor Ma Guiqin believes that the basic pathogenesis of pneumoconiosis is depression of the atmosphere,deficiency of the kidney,internal obstruction of phlegm,and adverse cardinality. According to its pathogenesis,the commonly used prescriptions,namely Shengxian Decoction,Jinshui Liujun Jian,Xiaochaihu Decoction,Sini Powder,Guomin Jian and syndrome differentiation-based modified medicines were expounded. In addition, " throat is the gateway to the lung and stomach",Professor Ma also believes that the prevention of pneumoconiosis should start with the throat,so as to curb the exacerbation or recurrence of the disease. Through clinical observation,if traditional Chinese medicine is properly used,and pathogenesis and syndrome differentiation-based treatment is provided,traditional Chinese medicine can relieve the clinical symptoms,and improve the exercise tolerance and the quality of life of patients with pneumoconiosis.
Occupational pneumoconiosis refers to a group of occupational pulmonary diseases,which is mainly characterized by diffuse fibrosis of lung tissue caused by inhalation of different pathogenic productive dust and retention in the lungs during occupational activities for a long period of time. According to the classification and catalogue of occupational diseases in China,it is mainly classified into 12 categories,such as silicosis,coal worker's pneumoconiosis,asbestos lung. At present,it is the most serious and most common occupational disease in China. The pathogenesis of pneumoconiosis is not clear,and there is still no effective therapy. In the past three years,it is found that traditional Chinese medicine is effective in the treatment of pneumoconiosis. Through collection of medical records,the regularity of the prescriptions used in the treatment of pneumoconiosis were analyzed and summarized. According to the traditional Chinese medicine theory,the clinical characteristics of recurrent cough,phlegm and asthma in patients with pneumoconiosis could be included in the categories of cough,wheezing,lung distension. Professor Ma Guiqin believes that the basic pathogenesis of pneumoconiosis is depression of the atmosphere,deficiency of the kidney,internal obstruction of phlegm,and adverse cardinality. According to its pathogenesis,the commonly used prescriptions,namely Shengxian Decoction,Jinshui Liujun Jian,Xiaochaihu Decoction,Sini Powder,Guomin Jian and syndrome differentiation-based modified medicines were expounded. In addition, " throat is the gateway to the lung and stomach",Professor Ma also believes that the prevention of pneumoconiosis should start with the throat,so as to curb the exacerbation or recurrence of the disease. Through clinical observation,if traditional Chinese medicine is properly used,and pathogenesis and syndrome differentiation-based treatment is provided,traditional Chinese medicine can relieve the clinical symptoms,and improve the exercise tolerance and the quality of life of patients with pneumoconiosis.
引文
[1]中华预防医学会劳动卫生与职业病分会职业性肺部疾病学组.尘肺病治疗中国专家共识(2018年版)[J].环境与职业医学,2018,35(8):677.
[2]孔平仲.孔氏谈苑[M].王恒展校点.济南:齐鲁书社,2014.
[3]张锡纯.医学衷中参西录[M].王云凯,李彬之重校.石家庄:河北科学技术出版社,2003.
[4]龚居中.红炉点雪[M].上海:上海卫生出版社,1958.
[5]马桂琴,张龙生.薛伯寿教授治疗低热经验介绍[J].世界中西医结合杂志,2018,13(3):329.
[6]杨士瀛.仁斋直指[M].北京:中医古籍出版社,2016.
[7]朱震亨.丹溪心法[M].王英,竹剑平,江凌圳整理.北京:人民卫生出版社,2017:94.
[8]张介宾.景岳全书·下[M].李继明整理.北京:人民卫生出版社,2017.
[9]熊曼琪.伤寒学[M].北京:中国中医药出版社,2003.
[10]郭玉成,赵玉堂,李秀芬.过敏煎抗过敏的药效学研究[J].承德医学院学报,2008,25(4):387.
[11]中华人民共和国国家卫生健康委员会.2017年我国卫生健康事业发展统计公报[EB/OL].(2018-06-12)[2019-03-20].http://www. nhfpc. gov. cn/guihuaxxs/s10743/201806/44e3cdfe11fa4c7f928c879d435b6a18.shtml? from=singlemessage&isappinstalled=1.
[2]孔平仲.孔氏谈苑[M].王恒展校点.济南:齐鲁书社,2014.
[3]张锡纯.医学衷中参西录[M].王云凯,李彬之重校.石家庄:河北科学技术出版社,2003.
[4]龚居中.红炉点雪[M].上海:上海卫生出版社,1958.
[5]马桂琴,张龙生.薛伯寿教授治疗低热经验介绍[J].世界中西医结合杂志,2018,13(3):329.
[6]杨士瀛.仁斋直指[M].北京:中医古籍出版社,2016.
[7]朱震亨.丹溪心法[M].王英,竹剑平,江凌圳整理.北京:人民卫生出版社,2017:94.
[8]张介宾.景岳全书·下[M].李继明整理.北京:人民卫生出版社,2017.
[9]熊曼琪.伤寒学[M].北京:中国中医药出版社,2003.
[10]郭玉成,赵玉堂,李秀芬.过敏煎抗过敏的药效学研究[J].承德医学院学报,2008,25(4):387.
[11]中华人民共和国国家卫生健康委员会.2017年我国卫生健康事业发展统计公报[EB/OL].(2018-06-12)[2019-03-20].http://www. nhfpc. gov. cn/guihuaxxs/s10743/201806/44e3cdfe11fa4c7f928c879d435b6a18.shtml? from=singlemessage&isappinstalled=1.