从“极热伤络”探讨脓毒症毛细血管渗漏综合征的病机与治疗  

Discussion on the Disease Mechanism and Treatment of Sepsis-Associated Capillary Leakage Syndrome Based on the Theory of“Extreme Heat Injuring Collaterals”

作　　者：许一飞 孙莉莉 梁明昊 黄迪 靳敏燕 陈宪海[3] 邱占军[3] XU Yifei;SUN Lili;LIANG Minghao;HUANG Di;JIN Minyan;CHEN Xianhai;QIU Zhanjun(The First Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250355,China;College of Traditional Chinese Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,China;The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250355 [2]山东中医药大学中医学院,山东济南250014 [3]山东中医药大学附属医院,山东济南250014

出　　处：《山东中医杂志》2025年第2期145-150,共6页Shandong Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(编号:82274320);国家自然科学基金面上项目(编号:82374379);山东省自然科学基金项目(编号:ZR2020MH392);山东省自然科学联合基金项目(编号:ZR2021LZY027)。

摘　　要：多种危险因素导致毛细血管内皮屏障破坏是脓毒症毛细血管渗漏综合征(CLS)的主要病理特点。毛细血管属络脉范畴,络脉“溢奇邪、通营卫”,具有沟通内外,调控机体气血、水液输布等作用。“极热伤络”是由《金匮要略》所提出的发病学概念,言明邪气伤人,在经在络的寒热属性倾向之分,为后世医家辨治络脉相关疾病提供了重要的病因学依据。结合脓毒症CLS病理演变规律,认为“极热暴至,络脉受损”是其核心病机。强调极热为毒、痰、瘀、饮诸邪生成之源,络损为气、血、阳、津灌注传输失衡之本。脓毒症CLS的分期论治原则:提倡前驱期以舒达邪热、祛邪速出为主;渗漏期以活血利水、消痰涤饮为要;恢复期以廓清络脉、温阳益气为本。Disruption of the capillary endothelial barrier due to multiple risk factors is the main feature of sepsis associated capillary leakage syn-drome(SACLS).The collaterals are“overflowed with extraordinary evils,and communicate nutrient qi and defensive”,with the function of communicating inside and outside,regulating qi and blood,and distribution of body fluids in the body.The concept of“extreme heat injuring collaterals”is a pathoge-netic concept put forward in Synopsis of the Golden Chamber,stating that when evils attack body,and there would be the tendency of cold and heat attributes in the meridians and collaterals,which provides an important etiological basis for the treatment of collaterals and collaterals-related diseases for the later generations.According to the pathological evolution of SACLS,we propose that“extreme heat arrives violently and damages the collaterals”is the core mechanism of the disease,and extreme heat is the source of poison,phlegm,blood stasis,and rheum.Damage to the collaterals is the source of imbalance in the circulation of qi,blood,yang,and body fluids.The therapeutic principle for different stages is listed as follows:in the pre-leakage stage,dispelling the evil heat should be applied mainly,which should be quick;in the leakage stage,activating blood and promoting diuresis,eliminating phlegm and rheum should be applied primarily;in the recovery stage,clearing collaterals and warming yang qi should be applied for the root.

关 键 词：“极热伤络” 脓毒症 毛细血管渗漏综合征 络脉 

分 类 号：R278[医药卫生—中医学]