老年风温肺热病肺脾相关病机特点探讨
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摘要
风温肺热病相当于西医的肺部感染,属中医急性外感热病的范畴,因感受风热病邪引起,以发热、咳嗽,伴或不伴胸痛等为主要临床表现,是临床常见病、多发病及难治病。与中青年人相比,老年风温肺热病具有脏腑内伤、正气亏虚,复感风热病邪、内外合邪,起病隐匿、临床症状不典型,兼夹证多、中焦湿热兼证尤为突出的病机特点。其病机特点与肺脾在生理上相互作用、病理上相互影响密切相关。老年风温肺热病病性多虚实夹杂,病位主要在肺,常兼及脾胃,治疗以扶正祛邪、肺脾同治为法。
Wind-warm disease with lung heat,which is equivalent to lung infection,is a kind of acute exogenous fever in traditional Chinese medicine. It is a common,frequently-occurring and intractable disease,caused by wind-heat and characterized by fever, cough, with or without chest pain, etc. Compared with the middle aged and young people, wind-warm disease with lung heat in the elderly often manifests as internal and excess cause,who get warm-heat evil upon weakness of viscera and deficiency of qi,which is concealed onset and has atypical clinical symptoms but several accompanied syndromes in which the damp-heat is the most common one. Its pathogenesis is closely related to the interaction of physiology and pathology of lung and spleen.Wind-warm disease with lung heat in the elderly often manifests as deficiency-excess complication, which is mainly located in lung and involved spleen and stomach sometimes. Its therapeutic principles should combine treatment of strengthening body resistance and eliminating evil,meanwhile treating lung and spleen together.
Wind-warm disease with lung heat,which is equivalent to lung infection,is a kind of acute exogenous fever in traditional Chinese medicine. It is a common,frequently-occurring and intractable disease,caused by wind-heat and characterized by fever, cough, with or without chest pain, etc. Compared with the middle aged and young people, wind-warm disease with lung heat in the elderly often manifests as internal and excess cause,who get warm-heat evil upon weakness of viscera and deficiency of qi,which is concealed onset and has atypical clinical symptoms but several accompanied syndromes in which the damp-heat is the most common one. Its pathogenesis is closely related to the interaction of physiology and pathology of lung and spleen.Wind-warm disease with lung heat in the elderly often manifests as deficiency-excess complication, which is mainly located in lung and involved spleen and stomach sometimes. Its therapeutic principles should combine treatment of strengthening body resistance and eliminating evil,meanwhile treating lung and spleen together.
引文
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[2] 曹卓,叶再挺.老年患者肺部感染临床特点观察[J].中华医院感染学杂志,2013,23(8):1797-1798,1816.
[3] 王莉.老年患者肺部感染的临床特点观察——附60例报道[J].中国医药指南,2012,10(32):223-224.
[4] 杜怀棠,周平安,董建华.风温肺热病的临床研究——附355例临床总结[J].中国医药学报,1986,1(1):18-22.
[5] 李得民,唐诗环,廖强,等.中医药防治社区获得性肺炎的文献研究[J].中国中药杂志,2017,42(8):1418-1422.
[6] 白红梅,朱林平.老年肺部感染的临床特点及危险因素分析[J].中华医院感染学杂志,2012,22(21):4733-4734.
[7] 李微,殷少军.老年肺炎的临床特点及危险因素研究进展[J].实用老年医学,2013,27(8):691-693.
[8] 王孟英.温热经纬[M].南京中医药大学温病学教研室,整理.北京:人民卫生出版社,2005.
[9] 张允岭.中医内科学[M].北京:人民卫生出版社,2015:34-41.
[10] 徐红日,姜良铎,王兰,等.基于中西医互参的风温肺热病状态论治[J].现代中医临床,2017,24(4):10-13,16.
[11] 吴瑭.温病条辨[M].南京中医药大学温病学教研室,整理.北京:人民卫生出版社,2005:63.
[12] 潘小波.老年肺部感染患者临床特征分析及诊治体会[J].基层医学论坛,2018,22(20):2765-2766.
[13] 陈孟准.老年肺部感染痰热壅肺证的证候学特点观察[D].北京:北京中医药大学,2012.
[14] 李扭扭,席宁,史利卿.老年与中青年肺部感染肺阴伤证的比较研究[J].北京中医药大学学报,2011,34(4):282-285.
[15] 史利卿,徐晓琳,马建岭,等.152例老年肺部感染中焦湿热兼证的临床观察[J].北京中医药大学学报(中医临床版),2008,15(1):20-22.
[16] 孙静,史利卿.肺部感染兼血瘀证患者的临床观察[J].世界中西医结合杂志,2012,7(9):791-793.
[17] 季坤,马建岭,史利卿.老年肺部感染中焦湿热兼证的证治特点探讨[J].北京中医药大学学报(中医临床版),2013,20(3):46-48.
[18] 朱名宸.董建华治疗温热病的学术思想[J].湖北中医杂志,2007,29(3):23-24.
[19] 白逸晨,史利卿,季坤,等.慢性咳嗽肺脾相关病机探讨[J].现代中医临床,2018,25(4):42-45.
[20] 秦伯未.清代名医医案精华[M].上海:上海科学技术出版社,1959:97.
[21] 赵术堂.医学指归[M].伊广谦,点校.北京:人民卫生出版社,1988:26.
[22] 李用粹.证治汇补[M].竹剑平,江凌圳,王英,等,整理.北京:人民卫生出版社,2006:71.