基于肺热论之“清”法论治慢性阻塞性肺疾病急性加重  

Treating acute exacerbation chronic obstructive pulmonary disease by the heat-clearing method of lung-heat theory

作　　者：隽则政 刘威 王富乐 刘荣奎 JUAN Zezheng

机构地区：[1]山东中医药大学,山东济南250000 [2]济南市中医医院,山东济南250000

出　　处：《中医临床研究》2024年第8期43-47,共5页Clinical Journal Of Chinese Medicine

基　　金：2019年山东省名老中医药专家传承工作室建设项目(鲁卫函[2019]92号);济南市临床医学研究中心专项(2001912011)。

摘　　要：慢性阻塞性肺疾病为一种以持续气流受限为特征的常见疾病,气流受限多呈进行性发展,临床上多表现为慢性咳嗽、咳痰及胸闷,严重者出现呼吸困难。慢性阻塞性肺疾病急性加重是加剧慢性阻塞性肺疾病患者病情恶化的主要原因之一,其多属中医“喘病”“肺胀”范畴。其病性本虚标实,病位在肺,常累及脾、肾、心。西医治疗本病多以吸氧、抗感染抗炎、化痰镇咳、扩张支气管为主,可在一定程度上控制感染并改善患者的临床症状,但易出现耐药性,有较多不良反应。中医药治疗在缓解患者症状,改善肺功能,降低血清炎症因子水平,控制急性发作,降低药物不良反应等方面有一定优势。文章基于刘荣奎教授“肺热论”探讨慢性阻塞性肺疾病急性加重的诊疗。体虚感邪,邪热郁肺为本病的始发病机。后随病情变化,热、痰、瘀互结,是急性加重病机之关键。如不加干预而病势进一步发展,热极化毒,毒热损肺,加重病情,甚至出现烦躁、嗜睡、昏迷等急危重症,危及生命。肺热贯穿急性加重的始终,因此,治疗本病当以“清热”为核心,以五法之“清”法为主,以清泄肺热为基础,然后根据病证之变化加用他法,以立足于“清法”之刘氏清热化痰方治之,临床疗效显著,并附验案,以期为中医药治疗本病提供新思路。Chronic obstructive pulmonary disease(COPD)is a common disease characterized by persistent airflow limitation,and airflow limitation is often progressive.Most of the clinical manifestations are chronic cough,expectoration and chest tightness,and dyspnea occurs in severe cases.The acute exacerbation chronic obstructive pulmonary disease(AECOPD)is one of the main reasons for the deterioration of patients with COPD,which mostly belongs to the categories of asthma and emphyysema in traditional Chinese medicine.It is the syndrome of asthenia in origin and excess in superficiality.The disease is located in the lung,often involving the spleen,kidney and heart.Western medicine mainly treats the disease by inhaling oxygen,anti-infection and anti-inflammation,resolving phlegm and relieving cough,and dilating bronchi,which can control infection and relieve the clinical symptoms of patients,but it is easy to appear drug resistance and have more adverse reactions.Traditional Chinese medicine has certain advantages in relieving patients’symptoms,improving patients’pulmonary function,reducing the level of serum inflammatory factors,controlling acute attacks,and reducing adverse reactions.This article discusses the diagnosis and treatment of AECOPD based on Professor LIU Rongkui’s theory of lung-heat.The initial pathogenesis of this disease is body deficiency and then pathogenic heat stagnation of the lung.With the change of disease,the combination of heat,phlegm and blood stasis is the key to the pathogenesis of AECOPD.When the condition is further developed without intervention,the extreme heat is transformed into poison,and the heat poison damages the lungs,the condition will be aggravated,and even irritability,drowsiness,coma and other critical and severe diseases will occur and endanger life.Lung-heat runs through the progression of AECOPD.Therefore,the treatment of this disease should take clearing heat as the core and the heat-clearing method of the five methods as the main method.On the basis of clearing away the h

关 键 词：慢性阻塞性肺疾病 肺胀 急性加重期 肺热论 清法 

分 类 号：R563[医药卫生—呼吸系统]