杨宏志纯中药治疗顽固性胸腔积液验案1则  

Treating one case of refractory pleural effusion with simple Chinese medicinal materials by YANG Hongzhi

作　　者：吴金鹏 王鹏[1,2] 杨宏志[1,2] 张紫丹[1] WU Jinpeng;WANG Peng;YANG Hongzhi;ZHANG Zidan

机构地区：[1]湖北中医药大学,湖北武汉430061 [2]湖北省中医院,湖北武汉430061

出　　处：《中医临床研究》2024年第3期108-111,共4页Clinical Journal Of Chinese Medicine

基　　金：国家中医药管理局全国名老中医药专家(王鹏)传承工作室建设项目(国中医药人教函[2022]75号);湖北省中医院昙华林名医/学子项目(鄂中医院字[2018]72号)。

摘　　要：文章报道杨宏志教授单纯中药治疗顽固性胸腔积液验案1则。顽固性胸腔积液常见于结核性胸膜炎、肺炎、心力衰竭及恶性肿瘤等,多发于老年患者。目前就缓解症状来说,西医主要用胸腔穿刺抽液或置管引流治疗,其积液常迁延缠绵。中医学主张将胸腔积液归于“悬饮”范畴,杨宏志教授认为胸腔积液是因津液代谢紊乱或敷布失常、气血循行不畅,而致痰饮、瘀血、滞气互阻于胸腔的一类全身性疾病,需从益气健脾、温阳化瘀、标本兼顾方面着手,基于整体把握病位、病性、病态和病势等,明辨标本缓急,随证治之。本案病患胸腔积液反复发作,始终未解决,积液病因尚不明确,只能通过利尿和间断胸腔穿刺抽液来缓解症状,患者十分焦虑与痛苦,中医药作为一种低毒、有效的全身治疗的手段相对容易被患者接受,杨教授采用椒目瓜蒌汤、四君子汤、玉屏风散及酸枣仁汤等方化裁治疗,遵循整体把握、病证合一、顾护脾胃、调气活血等原则,在益气健脾基础上,针对饮停血瘀之标佐以温阳活血之法,同时不忘顾护已亏之阴液,如此肺气得以宣降正常,脾胃运化得健,水饮得路而出,气血循行有常,药证合一,顽难之胸腔积液得以逐渐吸收,避免了反复胸腔穿刺抽液。期同道在诊疗中获得些许启发。The paper reports one successful case of treating intractable pleural effusion with simple Chinese medicinal materials by Professor YANG Hongzhi.Refractory pleural effusion is common in tuberculous pleurisy,pneumonia,heart failure and malignant tumor,which is mostly in elderly patients.To alleviate symptoms,Western medicine now relies mostly on chest drainage or tube drainage during treatment,which often makes the effusion prolonged.Traditional Chinese medicine holds that pleural effusion belongs to the category of “suspended fluid”.YANG Hongzhi believes that pleural effusion is a kind of systemic disease of phlegm and fluid retention,static blood and Qi(气) stagnation obstructing the chest caused by disorders of body fluid metabolism or dispersion and blocked circulation of Qi and blood,which needs to start from benefiting Qi for strengthening the spleen,warming Yang(阳) and expelling blood stasis,and treating both symptoms and the root causes.Based on the overall grasp of disease location,disease characteristic,disease state,and disease tendency,treatment is given according to the syndromes by distinguishing the symptoms and the root causes.The patient in this case has repeated episodes of pleural effusion,which has not been solved well.The cause of effusion is still unclear,and the symptoms can only be relieved by diuresis and intermittent chest perforation.The patient is very anxious and suffering.As a low toxicity and effective systemic treatment,traditional Chinese medicine is relatively easy to be accepted by patients.Following the principles of holistic control,integration of disease and syndrome,paying attention to spleen and stomach,and regulating Qi and blood circulation,Professor YANG treats the patients with different prescriptions,such as Modified Jiaomu Gualou decoction(椒目瓜蒌汤),Sijunzi decoction(四君子汤),Yupingfeng San(玉屏风散) and Suanzaoren decoction(酸枣仁汤).On the basis of invigorating Qi and strengthening spleen,the Professor additionally uses the method of warmin

关 键 词：中医药 顽固性胸腔积液 医案 

分 类 号：R256[医药卫生—中医内科学]