基于开阖枢理论分期论治进行性纤维化间质性肺病  

Discussing the Staged Treatment of Progressive Fibrosing Interstitial Lung Disease Based on the Theory of"Opening-Closing-Pivoting"

作　　者：张皓翔 王金娥 夏潇 刘俨熠 丁愈津 田英姿 夏坤 李光熙[1] ZHANG Haoxiang;WANG Jine;XIA Xiao;LIU Yanyi;DING Yujin;TIAN Yingzi;XIA Kun;LI Guangxi(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing,100053;Graduate School,China Academy of Traditional Chinese Medicine;Graduate School,Beijing University of Chinese Medicine)

机构地区：[1]中国中医科学院广安门医院,北京市100053 [2]中国中医科学院研究生院,北京市100053 [3]北京中医药大学研究生院

出　　处：《中医杂志》2024年第18期1882-1887,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82074262);国家中医药管理局医政司慢性病治未病干预方案制定项目(ZYZB-2020-196)。

摘　　要：进行性纤维化间质性肺病(PF-ILD)病因复杂,根据疾病进展过程中的不同临床表现,划分为肺痹期、痿痹夹杂期、肺痿后期,并基于开阖枢理论分析各期阴阳病机特点及用药思路。认为肺痹期以三阳不守、营卫失和为主,少阴枢折为要,治疗宜活用麻黄、桂枝组方或选用败毒散等辛散之剂开行卫阳,宣发痹邪,并佐附子、熟地黄等顾护少阴之药,扶正而不留邪;痿痹夹杂期以阳明阖折为本,气机过开为变,治以麻黄升麻汤化裁施治,开阖并重,通痹救痿;肺痿后期三阴同病,预后不良,予金水六君煎加减固气挽阴,清消痰瘀,以期提高PF-ILD患者的生活质量。Progressive fibrosing interstitial lung disease(PF-ILD)has a complex etiology,and is classified as lung impediment stage,impediment-atrophy combination stage,and lung atrophy stage according to the different clinical manifestations during the progression of disease.Based on the theory of opening-closing-pivoting to analyse the characteristics of yin and yang disease mechanism and the idea of prescriptions in the three stages.For lung impediment stage,main as three-Yang fail to keep inside,disharmony between Ying qi(营气)and Wei qi(卫气),shaoyin impairment,treatment should use Mahuang(Ephedra sinica)and Guizhi(Neolitsea cassia)flexibly to form a formula,or choose pungent-dispersing formulas like Baidu Powder(败毒散)to move qi and save yang,and diffuse and disperse impediment pathogen,meanwhile combining saving-shaoyin medicinals like Fuzi(Aconitum carmichaelii)and Shudihuang(Radix Rehmanniae Praeparata)to reinforce healthy qi and dispel pathogen;for impediment-atrophy combination stage,rooted as yangming impairment and progressed by over-movement of qi,treatment should use Mahuang Shengma Decoction(麻黄升麻汤)to resolve and decrease over-activities,emphasis on both opening and closing,and improve impediment and atrophy;for lung atrophy stage with three-Yin in a bad condition simultaneously and poor prognosis,treatment should use modified Jinshui Liujun Decoction(金水六君煎)to consolidate qi and save yin,disperse phlegm and stasis,to improve the quality of life for patients with PF-ILD.

关 键 词：进行性纤维化间质性肺病 开阖枢 肺痹 肺痿 

分 类 号：R259[医药卫生—中西医结合]