从“诸气膹郁”与“诸湿肿满”探讨恶性胸腔积液病机与治疗  

Exploring Pathogenesis and Traditional Chinese Medicine Treatment of Malignant Pleural Effusion from Perspectives of“All Qi Stagnation and Chest Tightness Syndrome”and“All Dampness Syndromes with Swelling and Fullness”

作　　者：葛杉 亓润智 许海慧 花宝金[2] 蒋树龙[3] 施展[1] GE Shan;QI Runzhi;XU Haihui;HUA Baojin;JIANG Shulong;SHI Zhan(Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Jining Medical College,Jining 272000,Shandong,China)

机构地区：[1]中国中医科学院中医临床基础医学研究所,北京100700 [2]中国中医科学院广安门医院,北京100053 [3]济宁市第一人民医院,山东济宁272000

出　　处：《辽宁中医杂志》2024年第12期39-41,共3页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(82074410,82205226);中国中医科学院科技创新工程项目(C12021B017-04);中国中医科学院优秀青年科技人才培养专项项目(ZZ15-YQ-026);北京市自然科学基金项目(7232310)。

摘　　要：恶性胸腔积液是胸部恶性肿瘤的常见并发症,严重影响患者生存时间与生活质量。当前中医肿瘤理论认为恶性胸腔积液的发病与中焦运化、津液代谢失常密切相关,主要病理改变离不开肺、脾两脏,与《黄帝内经》病机十九条“诸湿肿满,皆属于脾”“诸气膹郁,皆属于肺”的理论相符,而不是单一脾脏病变所主导。肺、脾之间不仅存在“亢害承制”关系,还共同调节肿瘤患者机体的津液代谢、气机升降、气血运行以及邪正盛衰,密切影响恶性胸腔积液的形成与反复蓄积。临证中诸多医家也以肺脾同治、扶正祛邪为基本法则。文章基于“诸湿肿满,皆属于脾”“诸气膹郁,皆属于肺”中医经典理论,从津液代谢、气机升降、气血运行以及邪正盛衰等方面探讨恶性胸腔积液病机,以及对恶性胸腔积液临床治疗的指导,以期为临证提供有益参考。Malignant pleural effusion(MPE)is a common complication of chest malignant tumors,and interferes severely with the survival time and quality of life of the patients.According to the current tumor theory of traditional Chinese medicine,the incidence of MPE is closely related to the disorder of the transportation and transformation of middle-Jiao and metabolism of body fluid,and the main pathological changes are inseparable from lung and spleen,and it is consistent with the theory that“all dampness syndromes with swelling and fullness are ascribed to spleen”and“all Qi stagnation and chest tightness syndromes are ascribed to lung”in the 19 pathogenesis theories of Inner Canon of Yellow Emperor,rather than being dominated by a single spleen lesion.The relationship between lung and spleen is not only characterized by“unrestrained excess and controlled harmony”but also regulates the metabolism of body fluids,the rise and fall of Qi,the circulation of Qi and blood,and healthy energy-evil struggle in tumor patients,closely affecting the formation and repeated accumulation of MPE.Many doctors in clinical practice also adhere to the basic principle of treating lung and spleen together,strengthening the body resistance to eliminate pathogenic factors.Based on the classic theory of traditional Chinese medicine that“all dampness syndromes with swelling and fullness are ascribed to spleen”and“all Qi stagnation and chest tightness syndromes are ascribed to lung”,this article explored the pathogenesis of MPE from the aspects of body fluid metabolism,Qi movement,Qi and blood circulation as well as prosperous pathogen with healthy Qi deficiency,and provided guidance for clinical treatment of MPE,in order to provide useful references for clinical practice.

关 键 词：恶性胸腔积液 诸湿肿满 诸气膹郁 病机十九条 中医药 

分 类 号：R273[医药卫生—中西医结合]