基于“两寒相感,枢机不利”论治肺结节  

Treatment of Pulmonary Nodules based on the Theory of"Two Colds Interacting,and Disturbance of Pivots"

作　　者：王景锐 段可欣 黄俊杰 王舒憬 陈芝强 王莹 李晏龙 綦向军 林丽珠[3] WANG Jingrui;DUAN Kexin;HUANG Junjie;WANG Shujing;CHEN Zhiqiang;WANG Ying;LI Yanlong;QI Xiangjun;LIN Lizhu(The First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou,510405;The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine;The First Affiliated Hospital of Guangzhou University of Chinese Medicine)

机构地区：[1]广州中医药大学第一临床医学院,广东省广州510405 [2]广州中医药大学第四临床医学院 [3]广州中医药大学第一附属医院

出　　处：《中医杂志》2024年第23期2487-2491,共5页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82305340);国家重点研发计划(2022YFC3500203);广州市科技计划项目(2023B01J1016,2023A03J0300);广州中医药大学中医学学科中医基础理论研究“揭榜挂帅”项目。

摘　　要：基于《黄帝内经》相关论述,在病程方面提出“结”是肺结节产生的初始阶段,而“积”是肺结节的最终形态;在病机方面提出“形寒”及“寒饮”代表的“两寒相感”是肺结节产生的先决条件,而“厥”代表的“气机逆乱”是肺结节产生的核心,具体表现为少阳或少阴枢机不利以致寒热错杂,进而痰、瘀骤生,抟为结节。故治疗应以斡旋枢机、化痰散瘀为治则,视寒热错杂程度不同,少阳枢机不利者运用柴胡桂枝汤、柴胡桂枝干姜汤或柴胡陷胸汤;少阴枢机不利者以麻黄附子细辛汤或升降散加减治疗。Based on the discussions in the The Inner Canon of Yellow Emperor(《黄帝内经》),it is proposed that in the course of the disease,"bind"represents the initial stage of pulmonary nodules,while"accumulation"repre⁃sents the final form.In terms of the pathogenesis,"two colds interacting"represented by"body cold"and"cold fluid retention"are the prerequisites for the formation of pulmonary nodules,while"disorder of qi"represented by"faint⁃ing"is the core of the formation.The specific manifestation is the disturbance of pivot of shaoyang(少阳)or shaoyin(少阴),resulting in a complex of cold and heat,and then phlegm and stasis are suddenly generated and further formed into nodules.Therefore,the treatment principle should be to regulate the cardinal mechanism,dissolve phlegm and blood stasis.Depending on the complex degree of cold and heat,it is suggested to use Chaihu Guizhi Decoction(柴胡桂枝汤),Chaihu Guizhi Ganjiang Decoction(柴胡桂枝干姜汤),or Chaihu Xianxiong Decoction(柴胡陷胸汤)for disturbance of shaoyang pivot,while for shaoyin pivot dysfunction,modified Mahuang Fuzi Xixin Decoction(麻黄附子细辛汤)or Shengjiang Powder(升降散)can be used.

关 键 词：肺结节 少阴 少阳 枢机 化痰散瘀 

分 类 号：R259[医药卫生—中西医结合]