曲敬来辨证论治肺痿经验  

Qu Jing-lai′s Experience of Treating Lung Atrophy Based on Syndrome Differentiation

作　　者：熊广[1] 谢纬[1] 曲敬来[1] XIONG Guang;XIE Wei;QU Jing-lai(Shenzhen Hospital of TCM,Shenzhen,Guangdong,China,518033)

机构地区：[1]深圳市中医院,广东深圳518033

出　　处：《河南中医》2020年第8期1195-1197,共3页Henan Traditional Chinese Medicine

基　　金：广东省首批省名中医师承项目(粤中医函[2015]20号);深圳市“医疗卫生三名工程”项目(SZSM201812063)。

摘　　要：肺痿总以气阴两虚,痰瘀痹阻不通为基本病机。曲敬来教授将肺痿分为3型论治:阴虚肺燥型,以益气养阴,润肺生津,清泻肺热为治则,常用补中益气汤、沙参麦冬汤,燥热津伤重者用清燥救肺汤加减;气虚血瘀型,以益气养阴,清热化痰,活血通络为治则,常用方为温胆汤或涤痰汤加减;气虚痰瘀型,以补气养阴,活血化瘀为治则,常用补中益气汤合血府逐瘀汤加减,适当加用淫羊藿、巴戟天、菟丝子、补骨脂补肾填精,以达“治肺不离于肺,不止于肺”之效。瘀血贯穿肺痿始终,单用活血化瘀之品力量不足,多用破血逐瘀药物如水蛭、穿山甲、三棱、莪术等。曲教授认为,肺痿早期病机为痰、瘀、虚,常采用化纤饮治疗。Generally speaking,the basic pathogenesis of lung atrophy is qi-yin deficiency and phlegm stasis obstruction.Professor Qu Jing-lai divides lung atrophy into three types:For yin deficiency and lung dryness type,the treatment principle is to replenish qi and nourish yin,moisten lung and produce fluid,and purge lung heat.Center-Supplementing and Qi-Boosting Decoction,and Radix Adenophorae seu Glehniae and Ophiopogon Decoction are often used.For dryness and heat damaging fluid,Modified Dryness-Clearing Lung-Saving Decoction can be used.For qi deficiency and blood stasis type,the treatment principle is to replenish qi and nourish yin,clear away heat and resolve phlegm,promote blood circulation and dredge collaterals.Gallbladder-Warming Decoction,or Modified Phlegm-Flushing Decoction is often used.For qi deficiency and phlegm stasis type,the treatment principle is to replenish qi and nourish yin,promote blood circulation and remove blood stasis.Center-Supplementing and Qi-Boosting Decoction combined with Modified Blood Mansion Stasis-Expelling Decoction is often used.Yinyanghuo(Herba Epimedii),Bajitian(Radix Morindae Officinalis),Tusizi(Semen Cuscutae)and Buguzhi(Fructus Psoraleae)can be properly added to nourish kidney and supplement essence,and reach the efficacy of"treatment of lung not separated from lung and not only based on lung".Blood stasis runs through lung atrophy all the time,and it is not enough to only use the medicinals for promoting blood circulation and removing blood stasis,so some medicinals for breaking and expelling blood stasis such as Shuizhi(Hirudo),Chuanshanjia(Squama Manitis),Sanleng(Rhizoma Sparganii),Ezhu(Rhizoma Curcumae),etc.are often used.Professor Qu believes that the early pathogenesis of lung atrophy is phlegm,blood stasis and deficiency,so he often chooses Decoction for Removing Pulmonary Fibrosis.

关 键 词：肺痿 阴虚肺燥型 气虚血瘀型 气虚痰瘀型 化纤饮 曲敬来 

分 类 号：R256.15[医药卫生—中医内科学]