从《金匮要略》痰饮、水气病探讨慢性阻塞性肺病证治
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摘要
中医认为,慢性阻塞性肺疾病(COPD)不同发展阶段的病理因素痰饮、水气、血(瘀)为同源而异流,皆因肺脾肾三脏阳气受损,津液不归正化而成。从《金匮要略》痰饮病、水气病中可以看出,仲景治疗咳痰喘症状,病因病机上亦从未离开"饮"邪为患,治疗上皆是以化饮为原则,且从现代医学角度来看,COPD慢性气道黏液高分泌和纤毛功能失调,导致COPD患者痰液分泌物增多,水饮伏肺是COPD从痰饮水气病论治关键病机所在。临床治疗COPD从"饮"邪论治具有3个原则:主和其本、主和其标、标本同和。
According to traditional Chinese medicine, phlegm-fluid retention, disease with fluid-retention syndrome and blood stasis are the pathological factors of chronic obstructive pulmonary disease(COPD) at different stages of development, all of which are caused by impaired yang qi of the lung, spleen and kidney, and the absence of normalized body fluid. Based on phlegm-fluid retention and disease with fluid-retention syndrome in Jingui Yaolüe, we can find that Zhongjing had never left the fluid retention as the pathogenesis of cough, phlegm and dyspnea, and the treatment is based on the principle of resolving fluid retention. From the perspective of modern medicine, COPD chronic airway mucus hypersecretion and cilia dysfunction lead to increased sputum secretion in patients with COPD. As phlegm-fluid invading lung is the key pathogenesis of COPD, we can treat it based on phlegm-fluid retention and disease with fluid-retention syndrome. Clinical treatment of COPD has three principles: treatment of major symptoms, treatment of disease causes, treatment of causes and symptoms.
According to traditional Chinese medicine, phlegm-fluid retention, disease with fluid-retention syndrome and blood stasis are the pathological factors of chronic obstructive pulmonary disease(COPD) at different stages of development, all of which are caused by impaired yang qi of the lung, spleen and kidney, and the absence of normalized body fluid. Based on phlegm-fluid retention and disease with fluid-retention syndrome in Jingui Yaolüe, we can find that Zhongjing had never left the fluid retention as the pathogenesis of cough, phlegm and dyspnea, and the treatment is based on the principle of resolving fluid retention. From the perspective of modern medicine, COPD chronic airway mucus hypersecretion and cilia dysfunction lead to increased sputum secretion in patients with COPD. As phlegm-fluid invading lung is the key pathogenesis of COPD, we can treat it based on phlegm-fluid retention and disease with fluid-retention syndrome. Clinical treatment of COPD has three principles: treatment of major symptoms, treatment of disease causes, treatment of causes and symptoms.
引文
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[2]李建生,李彬,余学庆.清热化痰方药治疗慢性阻塞性肺疾病急性加重期痰热壅肺证69例临床观察[J].中医杂志,2011, 52(3):203-206.
[3]崔焱,梁直英,董竞成.活血化瘀方治疗慢性阻塞性肺疾病急性加重期的临床观察[J].中国中西医结合杂志, 2005,25(4):327-329.
[4]刘永生,段莉,周成鸿.痰热清注射液对COPD急性发作期患者血清IL-13、LTB-4表达和肺功能的影响[J].中国中医急症, 2011, 20(8):1297-1298.
[5]李旭.小青龙汤治疗慢性阻塞性肺疾病急性加重期38例临床观察[J].中医临床研究, 2011, 3(23):41-43.
[6]孙伟.越婢加半夏汤联合西药治疗慢性阻塞性肺疾病急性加重期随机平行对照研究[J].实用中医内科杂志, 2013,27(7):91-93.
[7]杨荣源,林燕凤,李际强.小青龙汤加减治疗慢性阻塞性肺病急性加重期临床观察[J].新中医, 2009, 41(1):43-44.
[8]谢卫红.麻杏石甘汤加味治疗慢性阻塞性肺病急性加重期[J].中国中医药现代远程教育, 2009, 7(4):101-102.
[9]张雅楠,刘宏岩.《金匮要略》水液代谢异常疾病研究[J].长春中医药大学学报, 2016, 32(3):444-445.
[10]桂诗琪,于峥,屈伸,等.《仁斋直指方论》学术思想研究[J].中国中医基础医学杂志, 2016, 22(6):744-747.
[11]全贞雪,刘玉超,李宇航.慢性阻塞性肺疾病中医诊断及相关辨证论治规律探讨[J].吉林中医药, 2012, 32(5):433-436.
[12]王敏.中医饮证与阳气的关系[J].长春中医药大学学报,2010, 26(2):171-172.
[13]王雪慧,冯军飞,刘建秋,等.慢性阻塞性肺病急性加重期的中医病因病机[J].吉林中医药, 2008(4):254-255.
[14]吴潜智.《金匮要略》痰饮、水气和湿病的辨证论治特色[J].辽宁中医药大学学报, 2013, 15(11):165-168.
[15]王庆国.伤寒论选读[M].北京:中国中医药出版社,2012.
[16]范永升,姜德友.金匮要略[M].北京:中国中医药出版社,2012.