基于重症病例及现代病理生理机制的越婢加半夏汤方证条文内涵解读及其治疗重症肺部感染、慢性阻塞性肺疾病急性加重、呼吸衰竭等急危重症体会  

Interpretation of connotation of Yuebi Plus Banxia Decoction based on severe cases and modern pathophysiological mechanisms and experience of treating severe pulmonary infection,acute exacerbation of chronic obstructive pulmonary disease,and respiratory

作　　者：熊兴江[1] XIONG Xing-jiang(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《中国中药杂志》2024年第22期6235-6240,共6页China Journal of Chinese Materia Medica

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目(HLCMHPP2023081);临床科研一体化人才专项(CZ30981);京津冀基础研究合作专项(J230037);中国中医药科技发展中心(国家中医药管理局人才交流中心)联合攻关项目(CXZH202301)。

摘　　要：越婢加半夏汤出自《金匮要略》,具有宣肺泄热、降逆、止咳、平喘的功效,主治痰热壅肺导致的“肺胀”。临床多将该方用于慢性阻塞性肺疾病急性加重、急性支气管炎、肺炎、支气管哮喘、肺心病、百日咳等治疗。原文中,“肺胀”指肺气胀满不下,包括桶状胸、胸闷气促、咳嗽痰多等症状,多见于慢性阻塞性肺疾病急性加重等;“其人喘,目如脱状”提示该方主治邪热壅肺重症;“目如脱状”并非指甲状腺功能亢进症眼睛突出,而是指因咳喘较重导致的双目怒睁,以及Ⅱ型呼吸衰竭引起球结膜水肿。越婢加半夏汤指征:①疾病方面,可用于慢性阻塞性肺疾病急性加重,慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭,重症肺部感染,肺心病合并感染,间质性肺炎、支气管哮喘等;②症状体征方面,其指征包括胸闷咳喘、咳嗽咳痰、痰黄黏难咳,口干口渴、欲冷饮、烦躁,双目怒睁、球结膜水肿,大便干、小便黄,舌红、苔薄白或薄黄、质干,脉浮大滑数、有力;③病性方面,方证指征以实证为主,很少表现为虚证;④疗程方面,该方起效迅速,倘若方证对应,常1~2剂即可取效,显著缓解喘憋咳嗽症状;⑤方证鉴别方面,该方需与越婢汤、越婢加术汤鉴别;⑥药理作用方面,该方具有较好的抗炎、抗氧化、减轻支气管壁及周围间质充血水肿等作用。Yuebi Plus Banxia Decoction is derived from the Synopsis of the Golden Chamber(Jin Gui Yao Lue)by ZHANG Zhong-jing.With the effects of ventilating lung,discharging heat,descending adverse Qi,and relieving cough and asthma,this prescription is mainly used to treat pulmonary distension caused by phlegm heat obstructing the lungs.Currently,it is commonly used in clinical practice for the treatment of acute exacerbation of chronic obstructive pulmonary disease,acute bronchitis,pneumonia,bronchial asthma,pulmonary heart disease,and pertussis.In the original text,lung distension refers to the inability of lung Qi to descend,including symptoms such as barrel chest,chest tightness,shortness of breath,coughing,and phlegm accumulation,and it is often seen in acute exacerbation of chronic obstructive pulmonary disease.The description of"the patient is panting and their eyes are likely to dislodge"indicates that Yuebi Plus Banxia Decoction is used to treat severe cases of pathogenic heat obstructing the lungs.The description of"the eyes are likely to dislodge"does not refer to hyperthyroidism with sunken orbits,but to the enlarged eye opening caused by severe coughing and asthma as well as chemosis caused by typeⅡrespiratory failure.The disease indications of this prescription include acute exacerbation of chronic obstructive pulmonary disease,chronic obstructive pulmonary disease combined with typeⅡrespiratory failure,severe pulmonary infection,pulmonary heart disease combined with infection,interstitial pneumonia,and bronchial asthma.The symptom and sign indications of this prescription include chest tightness,wheezing,cough,expectoration,yellow and sticky phlegm,difficult cough,dry mouth/thirst,desire for cold drinks,irritability,enlarged open of eyes,chemosis,dry stool,yellow urine,red tongue,thin white or yellow tongue coating,dry tongue coating,and floating and slippery powerful pulse.In terms of the disease nature,the indications of this prescription are mainly excess syndromes and rarely include deficiency syndro

关 键 词：越婢加半夏汤 肺部感染 慢性阻塞性肺疾病急性加重 呼吸衰竭 《金匮要略》 急危重症 

分 类 号：R259[医药卫生—中西医结合]