“在血仍可透热转气”在支气管扩张咯血治疗中的理论探析和实践  

The oretical analysis and practice of bronchiectasis hemoptysis with the Concept of“Heat Transformation through Blood”

作　　者：黄琦玢 张志敏[1] HUANG Qifen;ZHANG Zhimin(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院中医科,510120

出　　处：《环球中医药》2024年第7期1256-1260,共5页Global Traditional Chinese Medicine

基　　金：广东省广州市中医药和中西医结合科技项目(20232A011012);广东省广州市市校(院)联合资助项目基础与应用基础研究项目(202201020463);广东省广州地区中西医协同临床重大创新技术建设项目(穗卫函〔2023〕2318号)。

摘　　要：叶桂用卫分、气分、营分、血分四个层次划分疾病的不同阶段,提出治疗“在卫汗之可也,到气才可清气,入营尤可透热转气,入血则恐耗血动血,直需凉血散血”。支气管扩张咯血当属于邪入血分阶段,治疗需凉血散血。然支气管扩张咯血患者怫郁壅滞广泛存在,有形之邪与无形之邪相互交结,肺气郁闭,邪气伏于血分,治疗应不拘泥于凉血散血。笔者挖掘“透热转气”的内涵,提出“在血犹可透热转气”治疗支气管扩张咯血血分证,通过治气、治伏邪、上下焦同治的方法,化痰降浊祛瘀,开辟通道,给邪以出路,恢复气机宣畅,使得邪热从血分宣透外达,咯血自止。YE Gui categorized the progression of diseases into four stages based on defensive qi level,qi level,nutritive qi level and blood level,and advocated for different treatment strategies for each stage,such as sweating for defensive qi level,clearing heat for qi level,promoting heat of nutrient aspect through qi aspect for nutritive qi level,and cooling blood and dispersing blood for blood level.In the case of hemoptysis caused by bronchiectasis,which is considered to be at the blood stage,treatment should focus on cooling blood and dispersing blood stasis.However,patients with bronchiectasis often exhibit widespread obstruction and a combination of visible and invisible obstructions,with the pathogen lurking within the blood.Therefore,treatment should not be limited to cooling blood and dispersing blood stasis,it should also delve into the essence of“promoting heat of nutrient aspect through qi aspect”.This leads to the proposal of“even in the blood,promoting heat dissipation and transformation to qi is possible”in treating blood level in bronchiectasis-related hemoptysis.By addressing the qi,eliminating hidden pathogens,and treating both the upper and lower jiao concurrently,phlegm,dampness,and stasis can be eliminated,creating a pathway for the pathogens to exit,restoring the smooth flow of qi,and allowing the lingering heat to dissipate from the blood and reach the exterior,ultimately stopping the hemoptysis.

关 键 词：支气管扩张咯血 中医药 血分证 透热转气 理论探讨 临床应用 

分 类 号：R22[医药卫生—中医基础理论]