论支气管哮喘“发时治肺兼顾肾,平时治肾兼顾肺”

Discussion Therapeutic Thought of“Focus Lung while consider Kidney at asthma onset,focus Kidney while consider Lung at stable times”

哮喘是临床常见的气道炎症性疾病,中医称为"哮病"。中医认为哮病"在肺为实,在肾为虚",强调"急则治其标,缓则治其本""发时治肺""平时治肾"。但研究发现,哮喘发作期不仅存在气管炎症过度、气道痉挛和痰液高分泌等肺实的表现,还存在以HPA轴和免疫功能紊乱等为代表的机体内在抗炎能力低下之类肾虚的表现;缓解期不仅存在机体内在抗炎能力低下等肾虚的表现,还存在气道慢性炎症、气道高反应、气道重塑等肺实的表现。结合上述关于"肺气实"和"肾气虚"内涵的研究,我们认为肾虚为哮喘患者的基本体质,哮喘患者无论临床上有无肾虚见症,皆存在"隐匿性肾虚"证。哮喘发作期不仅存在"肺实",还伴有一定程度的"肾虚";哮喘缓解期不仅存在"肾虚",还伴有一定程度的"肺实"。在哮喘发作期采用清肺平喘结合补肾益气法治疗,疗效优于单纯的清肺平喘法;而在哮喘缓解期采用补肾益气法结合清肺平喘等治法,可使气道反应性进一步降低,气道重塑等得以减轻。哮喘的治则不能单纯地"发时治肺""平时治肾",而应推行"发时治肺兼顾肾"、"平时治肾兼顾肺"的治则治法。

Asthma is a common chronic inflammatory disorder of the airways,which is called＂Xiao bing＂in Traditional Chinese Medicine （TCM） . According to the theory of TCM,the pathogenesis of asthma is＂Lung excess＂and＂Kidney deficiency＂. Per the principle of＂Treating symptoms under emergency and treating causes when disease stabilizes＂,the principle of treating asthma is＂treating Lung at an asthma attack and treating Kidney at the asthma remission＂. But research finds that during an asthma attack,there are not only the presence of Lung excess symptoms shown as excessive airway inflammation,airway spasm and mucus secretion,but also Kidney deficiency symptoms shown as dysfunction of hypothalamic-pituitary-adrenal axis （HPAA） and immunity system which represents the de- creased inherent anti-inflammatory capacity in the body. On the other hand,during the remission phase,besides Kidney deficiency symptoms like decreased inherent anti-inflammatory capacity,patients also show Lung excess symptoms such as chronic airway inflammation and airway remodeling. Therefore,asthma is associated with Kidney deficiency or potential Kidney deficiency no matter whether patients manifest Kidney deficiency symptoms or not. In other words,there are both the presence of Lung excess and Kidney deficiency during an asthma attack and remission phase. Therefore,at asthma attack,＂clearing Lung and relieving breathing＂with＂tonifying Kid- ney and benefiting Qi＂is more effective than simply＂clearing Lung and relieving breathing＂,during stable period,the multiple treatments can further decrease airway hyper-responsiveness and relieve airway remodelin. In conclusion,principle of asthma treatment should be focusing on Lung while taking Kidney into account at asthma onset,focusing on Kidney while taking Lung into account during stable period.