通腑平喘辨治哮喘  

Analysis on the Treatment of Asthma through Purging Viscera

作　　者：宁博彪 李宝花 刘丽坤[3] NING Bobiao;LI Baohua;LIU Likun(Shanxi Institute of Traditional Chinese Medicine,Grade 2017,Oncology Way of Traditional Chinese Medicine and Western Medicine,Taiyuan 030012,China;Shanxi University of Traditional Chinese Medicine,Grade 2017,Ophthalmology of Traditional Chinese Medicine,Taiyuan 030000,China;Shanxi Hospital of Traditional Chinese Medicine,Oncology department,Taiyuan 030012,China)

机构地区：[1]山西省中医药研究院研究生部,太原030012 [2]山西中医药大学研究生学院,太原030000 [3]山西省中医院肿瘤科,太原030012

出　　处：《实用中医内科杂志》2019年第3期68-70,共3页Journal of Practical Traditional Chinese Internal Medicine

基　　金：山西省重点研发计划(指南)项目(201703D321021)~~

摘　　要："通腑平喘"源自"肺与大肠相表里",临床应用广泛,肺系疾病伴见腑实不通均可使用,为治标之法,须中病即止,切不可贪功滥用。哮喘为本虚标实之症,肺脾气虚为本,宿痰内伏为标,胃与大肠气血升降失常是关键。宿痰是重要的致病因素,遇诱因刺激,阻塞气道,肺气不利而成哮喘。痰是水液代谢异常的产物,责之肺、脾、肾三脏,大肠功能异常亦是宿痰重要因素。Logisitic回归分析发现中医肺脏在现代医学中主要指的是呼吸系统及相关神经系统,亦与内分泌系统、消化系统等有关联。支气管哮喘与胃肠激素相关性研究提示,哮喘患者部分兴奋性胃肠激素如GAS等含量均降低,部分抑制性激胃肠激素如CGRP的含量升高,是导致胃肠功能障碍的原因之一,造成大便不畅等。"通腑平喘"常用于哮喘出现大便干结难行等大肠通降失和,或阳明热结,腑气不通;临床不仅适用于哮喘,其他肺系疾病见到腑实内结,无禁忌症均可使用,以改善呼吸功能,缩短机械通气时间。常用承气汤、大柴胡汤、附子泻心汤。须注意立足整体辨证,分清主次;宜"通"而非"攻"不可滥用攻下;中病即止。通腑平喘为肺肠同治代表,取类比象,治疗肠系疾病时也应注意肺气宣肃对胃肠道功能的调节作用,运用整体观有助于提高疗效。附验案2则。"Purging viscera to relieve asthma", derived from "The lung and large intestine are closely related and influence each other", is widely used in clinical practice, and can be applied to cure lung diseases accompanied by Fu organ constipation. As a palliative measure, it should be stopped when the symptoms are relieved rather than being unlimitedly abused. Asthma, the syndrome of asthenia in origin and asthenia in superficiality, is based on deficiencies in lung and spleen, with phlegm and retained fluid contained in lung.The key lies in abnormal qi and blood fluctuation in stomach and large intestine. The abiding phlegm, as an important pathogenic factor, is stimulated by inducements to block the airway and causes lung-qi obstruction,which develops into asthma. Phlegm is the product of abnormal water metabolism, which is mainly caused by the dysfunction of lung, spleen, kidney and large intestine. According to Logisitic regression analysis, in modern medicine the lung of traditional Chinese medicine mainly refers to respiratory system and related nervous system, which is also related to endocrine system and digestive system. Studies on the relationship between bronchial asthma and gastrointestinal hormones suggest that one of the causes of gastrointestinal dysfunction and inhibited defecation lies in the fact that the content of some excitatory gastrointestinal hormones such as GAS in asthmatic patients is decreased while the content of some inhibitory gastrointestinal hormones such as CGRP is increased."Purging viscera to relieve asthma" is often used for asthma which shows such symptoms as the failure of Qi to descend in large intestine(like dry stool and constipation), heat concentration in yangming, fu-qi obstruction;It is not only applied to asthma, but to other lung diseases complicated by Fu organ constipation without contraindications, so as to improve respiratory function and shorten mechanical ventilation time. Commonly used are chengqi decoction, Dachaihu decoction and aconite heart-draining decoction.

关 键 词：哮喘 支气管哮喘 通腑平喘 腑实不通 本虚标实 宿痰 肺与大肠相表里 大便干结 寒热错杂 上下不通 肺气不利 痰瘀互结 承气汤 大柴胡汤 附子泻心汤 胃肠激素 

分 类 号：R256.12[医药卫生—中医内科学]