基于“血不利则为水”理论探究恶性胸腔积液病机及治法  

Exploration on the Pathogenesis and Treatment of Malignant Pleural Effusion in Traditional Chinese Medicine Based on the Theory of“Unsmooth Blood Circulation Resulting in Water Retention”

作　　者：赵艺涵 翟怡然 唐玉君 孙旭杭 蒋士卿[1] ZHAO Yihan;ZHAI Yiran;TANG Yujun;SUN Xuhang;JIANG Shiqing(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450099,Henan,China;Henan University of Chinese Medicine,Zhengzhou 450018,Henan,China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450099 [2]河南中医药大学,河南郑州450018

出　　处：《辽宁中医药大学学报》2024年第8期132-137,共6页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家中医药管理局科技项目-联合开放课题“张仲景传承与创新专项”(GZY-KJS-2022-038-2);河南省卫生健康委员会国家中医临床研究基地科研专项(2022JDZX083);河南省自然科学基金项目(KY-B0360-02);河南中医药大学研究生教育教学改革研究与实践项目(YJSJ2023-026)。

摘　　要：恶性胸腔积液(malignant pleural effusion,MPE)是晚期肿瘤常见的并发症,严重影响患者的预后和生活质量,目前尚无有效的根治方法。该文基于“血不利则为水”理论阐述了恶性胸腔积液形成的核心病机和中医基本治法。肺肾亏虚、中焦脾胃运化无力是“血不利则为水”的根本原因,气、血、水循环障碍导致瘀血阻络是中间环节,血溢于脉外日久为水,积聚胸腔是最终结果。活血利水法是治疗恶性胸腔积液的基本治法,应贯彻治疗全程,同时根据辨证辅以补肺健脾益肾,行气补气,温阳化饮。作者认为,治疗MPE不能拘泥于活血祛瘀、逐饮利水等对于实证的处理,应剖析发病的根本原因在于脏腑亏虚,关键病机在于气、血、水相互搏结,互为因果,造成血行不利、积液内聚,故治疗时应兼顾发病过程中的每一个重要环节,标本兼治,补泻共用,肺脾肾同调,气、血、水同治,达到保持相关脏腑功能平衡、胸水自退且少生的目的。Malignant pleural effusion(MPE)is a common complication of advanced tumors,which seriously affects the prognosis and quality of life of patients.Based on the theory of“unsmooth blood circulation resulting in water retention”,this paper expounds the core pathogenesis of malignant pleural effusion and the basic treatment of traditional Chinese medicine.The deficiency of lung and kidney and the weakness of spleen and stomach transport in middle Jiao are the root causes of“unsmooth blood circulation results in water retention”.Obstruction of Qi,blood and water circulation leading to blockage of blood is an intermediate linkage.Blood spills outside the veins and becomes water over time,the accumulation of the chest cavity is the final result.The method of promoting blood circulation and promoting diuresis is the basic treatment of malignant pleural effusion,which should be carried out in the whole course of treatment,and supplemented by supplementing lung,spleen and kidney,invigorating Qi and warming Yang.The author believes that the treatment of MPE can not be confined to the treatment of promoting blood circulation,removing blood stasis and promoting diuresis.The root cause of the disease lies in the deficiency of Zangfu organs,and the key pathogenesis lies in the mutual stroke of Qi,blood and water,causing blockage of blood flow and fluid accumulation.Therefore,the treatment should take into account every important link in the course of the disease,treat both symptoms and root causes,and share toning and draining,and the lung,spleen and kidney are in tune.The same treatment of Qi,blood and water can achieve the purpose of maintaining the function balance of related viscera,self-decreasing and less birth of pleural fluid.

关 键 词：恶性胸腔积液 血不利则为水 活血利水 

分 类 号：R246.5[医药卫生—针灸推拿学]