病证结合异病同治的中医药抗器官纤维化临床研究思路  

Clinical Research Thinking of Traditional Chinese Medicine Against Organ Fibrosis:Treating Different Diseases with Same Method By Combination of Disease and Syndrome

作　　者：赵志敏[1,2] 景菲 吕靖 彭渊[1] 陶艳艳[1] 刘成海[1,2,3,4] ZHAO Zhimin;JING Fei;LYU Jing;PENG Yuan;TAO Yanyan;LIU Chenghai(Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai 201203, China;Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai 201203, China;Key Laboratory of Liver and Kidney Diseases, Shanghai University of Traditional Chinese Medicine, Ministry of Education, Shanghai 201203, China)

机构地区：[1]上海中医药大学附属曙光医院·肝病研究所,上海201203 [2]上海市中医临床重点实验室,上海201203 [3]上海中医健康服务协同创新中心,上海201203 [4]肝肾疾病病证教育部重点实验室,上海201203

出　　处：《世界中医药》2020年第19期2864-2867,共4页World Chinese Medicine

基　　金：国家自然科学基金重点项目(81730109);艾滋病和病毒性肝炎等重大传染病防治专项(2018ZX10302204-001-004,2014ZX10005001);上海市三年行动计划项目(16CR1026B)。

摘　　要：“异病同治”是中医临床实践普遍现象,“病证结合”诊疗模式是异病同治理论的具体体现。从异病同治的临床治疗着手,基于疗效,既横向比较不同疾病之间更纵向观察治疗前后的“方-证”效应异同与内在机制,是揭示基本证候科学内涵的重要途径。“正虚血瘀”是慢性肝、肺、肾疾病的病机特点,存在“异病同治”补虚化瘀的理论基础,且存在方-证效应的物质基础。病证结合、精准治疗、改善预后是器官纤维化疾病治疗研究的发展趋势。因此,基于肝、肺、肾纤维化疾病“正虚血瘀”中医基本病机,通过加载扶正化瘀中药开展病证结合、异病同治的前瞻性RCT临床试验,对“方-证-效”的关联进行验证;并采用临床信息与生物样本,发现效应目标人群特征,探讨方证相应的内在原理,有利于阐明正虚血瘀的证候内涵,促进中医药在治疗重大难治性疾病领域的发展。Using same treatment for different diseases is a common phenomenon in clinical practice of traditional Chinese Medicine(TCM).The diagnosis and treatment mode of disease and syndrome combination is its embodiment.Starting from the clinical treatment of different diseases with the same treatment,based on the curative effect,it is an important way to reveal the scientific connotation of basic syndromes by comparing horizontally and vertically observing the similarities and differences of the“prescription-syndrome”effects before and after treatment and the internal mechanism between different diseases.“Positive deficiency and blood stasis”were the pathogenesis characteristics of chronic liver,lung,and kidney diseases.There is a theoretical basis for“different diseases with the same treatment”to replenish deficiency and remove blood stasis,and there is a material basis for prescription-syndrome effects.Combination of disease and syndrome,precise treatment,and improvement of prognosis are the development trends in the treatment of organ fibrotic diseases.Therefore,based on the basic pathogenesis of liver,lung,and kidney fibrosis in TCM with the“positive deficiency and blood stasis”of TCM,the prospective RCT clinical trial of combining disease and syndrome and treating different diseases with the same treatment was carried out by loading TCM for strengthening the body and removing blood stasis.”And using clinical information and biological samples to discover the characteristics of the target population and explore the corresponding internal principles of the prescriptions and syndromes will help to clarify the connotation of the syndromes of the deficiency and blood stasis,and promote the treatment of major refractory diseases in TCM.

关 键 词：器官纤维化 异病同治 病证结合 机制 证候内涵 

分 类 号：R2-03[医药卫生—中医学] R259