摘要
肺部感染是严重危害人类健康和生命的疾病,其发病率和死亡率始终居高不下,目前尚缺乏理想的治疗手段。肺部感染属于中医肺热证范畴,肺热证是肺经气分热证,临床以发热、咳嗽、胸痛为特点,主要由温热邪气导致。中医药在肺部感染的治疗中具有一定的优势,本文从文献研究和实验研究两个方面探讨中医学对肺热证的认识,清燥救肺汤方证特点及清燥救肺汤治疗肺热证的作用机理,为清燥救肺汤作为治疗肺热证的有效方剂提供文献和实验依据。
1、文献研究
此部分研究首先对古代医学文献中肺热证的病名、病因病机及治则进行了总结。古代文献中,与肺热证相关的病名有肺热病、风温、咳嗽、肺胀、肺炎喘嗽、马脾风等。肺热证属于温病范畴,主要由火邪或热邪导致。到清代,温病派学家对肺热证的认识进一步深入,温病派学家以“风温”命名肺热证,其发病病因为风温之邪,病变的中心在肺,属于肺经气分证。热邪为阳邪,易耗气伤阴;从肺的生理特点来看,肺为娇脏,易受邪侵,外感风温之邪,肺之气阴易受伤。气阴的损伤贯穿于肺热证发生、发展过程的始终,在肺热证的治疗中清代温病学家十分注重保护人体阴液,尤其注重胃阴的保护,因而用药常配伍甘寒之品以生津养阴。
结合肺热证的现代临床发病特点,肺热证的发病人群多为年老体弱或有基础疾病者,其共同点是正气不足,若热邪为患,热邪耗气伤阴,则气阴更虚;肺热证过程中,肺失宣降,易致痰致瘀,痰、瘀、热相互影响,更伤气阴。故肺热证过程中必有气阴损伤,肺热气逆、气阴不足是肺热证的重要病机,清热宣肺、益气养阴扶正是中医治疗肺热证的重要治法之一。
文献研究第二部分论述了清燥救肺汤的方证特点及其临床运用进展。自创制以来,清燥救肺汤在临床中使用范围很广,涉及到咳嗽、咯血、肺痿、喉痹、鼻衄等多种疾病。其所治病症大致可分为两类,一类外感所致的肺热气阴伤证,一类内伤所致的肺热气阴伤证。外感温热邪气或久病耗气伤阴;或汗、吐、下太过,津气受损,虚热内生;或其它脏腑热内传于肺,均可致肺热、气阴不足。从西医学角度,清燥救肺汤可用于内科疾病、五官科、皮科等临床各科,其中最常见的是用于治疗呼吸道疾病,涉及病种10余个,如上呼吸道感染、肺炎、慢性支气管炎急性发作等等。此方既可用于治疗慢性呼吸系统疾病,也可用于呼吸系统危急重症抢救。
清燥救肺汤的组方特点是集清、宣、润、养于一体,其中桑叶、石膏辛寒宣肺清热,麦冬、阿胶、火麻仁甘寒养阴生津,杏仁、枇杷叶味苦而质润,肃降肺气,人参、甘草培土生金复津液,具有清热不伤正,扶正不敛邪,顺应肺脏的生理特性,切合肺热证肺热气逆、气阴两伤病机特点,是一首治疗肺热证的良方,尤适用于邪盛正虚或正虚邪恋型者。
2实验研究
Pulmonary infection is severely harmful to health and life of human being,which has high morbility rate and high mortality rate,but no ideal treatment so far.In Traditional Chinese medicine(TCM),Pulmonary infection belongs to the category of“lung heat syndrome”,Chinese medicine has an advantage of treating pulmonary infection.This thesis studied the TCM mechanism of lung heat syndrome and the theories of QingZaoJiuFei decoction(QZJF),explored the protective mechanisms of QZJF of reducing immunologic injury on influenza viral FM1 infected mice.
1 The literature research
This part studied the theories of lung-heat syndrome,including the disease name and major pathogenic factors and pathogenesis,therapeutic methods of lung-heat syndrome. The disease name of lung-heat syndrome included lung-heat disease,wind-warm,cough,lung distension,pneumonia-dyspnea,infantile acute asthma and so on.In Qing dynasty,the specialists of warm school named lung-heat syndrome as wind warm,the cause of disease was wind-warm,the lesion was lung,wind-warm syndrome belonged to the qi system syndrome of lung Meridian. Pathogenic heat always impaire yin and qi.The lung is a deliceate organ,vulnerable to the attack of external influences.Febrile pathogenic factors attack the lung and impaire lung qi and lung yin , So yin-fluid impairment exists in the whole course of lung-heat syndrome.The specialist of warm school in Qing dynasty emphasized protecting the yin-fluid,especially laid much stress on protecting stomach-yin.
According to epidemiological feature of lung-heat syndrome in clinic,the most of patients are the old,young children,pregnant women,the people with chronic disease.The common of these patients is healthy energy deficiency,when pathogenic heat invaded these people,it will aggravate the qi deficiency and yin deficiency.When the lung being invaded,the lung failed to disperse and descend,then phlegm and blood stasis produced,phlegm and blood stasis combining with pathogenic heat impaired qi and yin of body hardly.So qi and yin deficiency was the important character of the pathological mechanism of the disease.On the whole,abundant pathogenic heat in the lung,qi and yin deficiency were the important pathological status of the disease,So the therapy of clearing lung-heat,supplementing qi and replenishing yin was the important treatment of the disease.
QZJF was used widely,It can be used not only in chronic disease,but also in severe case.The pathological factors of these disease can be sorted to two kinds:external pathological factors and internal pathological factors.Internal consumption of yin and qi by chronic disease,or body fluid and qi impaired by sweat,vomit or purgation,or the
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