基于慢性阻塞性肺疾病急性加重危险窗的袪邪扶正序贯辨证治疗策略

Sequential Syndrome Differentiation by Eliminating Pathogen and Strengthening Vital Qi on the Basis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Risk Window

慢性阻塞性肺疾病(COPD)是严重危害公众健康的重大疾病,COPD急性加重(AECOPD)是影响COPD进程的主要因素,加强AECOPD的治疗至为关键。"AECOPD危险窗"是在AECOPD缓解后至稳定期前的时期内,病情极不稳定,主要以症状虽然改善但持续存在、肺功能尚未恢复到稳定期水平、炎症反应持续存在等为特征,极易再次发生急性加重而导致住院率和病死率增高。AECOPD当以祛邪为主辨证治疗,当病情减轻后进入"AECOPD危险窗"时,当以扶正为主辨证治疗。"AECOPD危险窗"概念的提出为防治COPD提供新的思路与策略,即此期以虚证为主,多为正虚邪恋,以气虚、气阴两虚为主,涉及肺脾肾而以肺肾虚损为主,常兼以痰瘀,当以补虚扶正为主、佐以化痰活血而立法组方辨证治疗。

Chronic obstructive pulmonary disease（COPD） remains a severe public health problem.Acute exacerbation of COPD（AECOPD） is a major factor that influences the process of COPD.Strengthening the treatment of AECOPD is very essential.AECOPD risk window（AECOPD-RW） refers to the period from AECOPD remission to the time before the stable phase.The condition is very unstable.Symptoms are relieved but continually exist.The lung function has not restored to the levels of the stable phase.The inflammatory reactions continually exist.In this period patients are most liable to suffer from AECOPD,resulting in higher hospital admission rate and higher mortality.Dispelling pathogens should be taken as the main principle for AECOPD treatment.However,when it transforms from AECOPD to AECOPD-RW,strengthening the body resistance should be taken as the main principle.The proposal of AECOPD-RW has provided new thoughts and strategies for COPD.In this period deficiency syndrome dominates,most being lingering pathogens due to deficient vital qi.Qi deficiency and qi-yin deficiency are the most common syndromes,involving Fei,Pi,and Shen.Deficiency of both Fei and Shen dominates,complicated with phlegm and stasis.Therefore,the treatment principle of AECOPD-RW should focus on tonifying the deficiency and strengthening the body resistance,assisted with dissipating phlegm and activating blood circulation.