从“寒包火”论治类风湿关节炎相关肺间质病变  

Treatment of Interstitial Lung Disease Associated with Rheumatoid Arthritis from the Perspective of Cold Enveloping Fire

作　　者：陈凤 张伟[2] 杨公涛[2] CHEN Feng;ZHANG Wei;YANG Gongtao(School of Chinese Medicine,Shandong University of Traditional Chinese Medicine,Ji′nan 250014,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji′nan 250011,China)

机构地区：[1]山东中医药大学中医学院,济南250014 [2]山东中医药大学附属医院,济南250011

出　　处：《世界中医药》2023年第8期1122-1125,共4页World Chinese Medicine

基　　金：国家自然科学基金面上项目(81874442)。

摘　　要：类风湿关节炎相关肺间质病变早期以肺泡炎症反应为主,晚期可进展为肺纤维化,预后极差,患者常因呼吸衰竭死亡。中医药在改善该病患者的临床症状,延缓病情进展方面疗效显著。“寒包火”证在肺系疾病中尤为常见,既往所述“寒包火”理论,认为其寒热邪气多属实邪,病机多为外寒侵袭,内火郁结的实证病理状态,但实践发现既往概念不足以涵盖临床方证。现总结前人经验和临床实践,以内火不同性质分为虚火和实火,且提出虚火实火之间存在动态转化和相互兼夹的独特状态。结合类风湿关节炎相关肺间质病变的临床特点,发现风寒湿等外邪侵袭为发病原因;皮痹不已内舍于肺为发病路径;外邪侵袭,营卫不调,诸邪郁而化火,终致五脏皆伤,虚火内生,阴阳俱损为病机演变过程。治疗上应视其病位病性,以早期散寒祛湿、调和营卫,中期顺气降火、逐瘀化痰,晚期达滋温引,攻补兼施为主要治则,动态辨治,截断疾病发展,以期对临床有所裨益。The interstitial lung disease associated with rheumatoid arthritis is mainly characterized by an alveolar inflammatory reaction in the early stage and can progress to pulmonary fibrosis in the late stage,with poor prognosis effects,and patients often die from respiratory failure.Traditional Chinese medicine is effective in improving the clinical symptoms of patients and delaying the progress of the disease.“Cold enveloping fire”syndrome is particularly common in pulmonary diseases.The theory of“cold enveloping fire”mentioned in the past holds that the cold and heat evil is mostly excess pathogen,and the pathogenesis is mostly an empirical pathological state of external cold invasion and internal fire stagnation,but the practice has found that the previous idea is not enough to cover clinical prescriptions.On the basis of previous experience and clinical practice,internal fire can be divided into deficiency fire and excess fire,and the dynamic transformation and mutual interlocking between deficiency fire and excess fire are put forward.According to the clinical characteristics of the interstitial lung disease associated with rheumatoid arthritis,the invasion of exogenous pathogens such as wind,cold,and dampness is considered as the cause of the disease.The course of the disease is pulmonary obstruction.External evil invasion and Ying and Wei disharmony make all the evil depressed and transform into the fire,eventually leading to damage to five zang-organs,internal deficiency fire,and Yin and Yang loss,which are the pathogenesis evolution.The treatment should be based on the disease location and characteristics,with dissipating cold,dispelling dampness,and harmonizing Ying and Wei in the early stage.In the middle stage,it is necessary to regulate qi,reduce fire,remove blood stasis,and eliminate phlegm.In the late stage,the main principle is to treat the disease by nourishing and warming and tonification and purgation in combination.Dynamic differentiation is also required to cut off the development of the

关 键 词：寒包火 表寒里热 类风湿关节炎 肺间质病变 肺痿 肺痹 痹病 表里同治 

分 类 号：R274.9[医药卫生—中西医结合]