王法德主任医师辨证施治卒中相关性肺炎经验总结

A summary of experiences of chief physician Wang Fade in treating patients with stroke-associated pneumonia based on syndrome differentiation

王法德主任医师是全国第三、第四批名老中医学术经验继承工作指导老师,擅长治疗中风病及相关病症.卒中相关性肺炎(SAP)是指原来没有肺部感染的卒中患者罹患感染性肺实质炎症,其发病群体为卒中患者.中医学并无SAP的病名,王法德主任认为SAP可归属于中医"咳证""喘证"范畴.从病因学方面分析,SAP既不属于外因,亦不属于内因,属于不内外因.严格讲SAP是属于外因.SAP病机是因误吸和坠积,邪毒直中于肺,肺气壅遏,化热生痰,痰热交阻,气机不畅,肺失清肃,而出现咳喘、咳痰、发热等证.SAP病位虽然主要在肺,波及脾、胃、肝、肾、大肠等脏腑.根据临床经验,中医学将SAP分为痰热壅肺型、痰湿阻肺型、肺阴亏虚型型.治疗急性期以祛邪为主,如清热、化痰、祛湿、降气等;中后期则以祛邪与扶正并举,根据正与邪的孰轻孰重,或以祛邪为主兼以扶正,或以扶正为主兼以祛邪.

Chief physician Wang Fade is involved in the third and fourth batches of instructors to inherit the academic experiences of veteran Chinese medicine in China,and he is good at treating stroke and related diseases.The stroke-associated pneumonia(SAP)refers to the stroke patients originally without pulmonary infection contract the pulmonary parenchymal inflammatory infection,and the stroke patients are in the SAP onset crowd group.There is no name of SAP in traditional Chinese medicine(TCM).Chief physician Wang Fade believes that SAP belongs to the categories of"cough syndrome"or"asthma syndrome"in TCM.From the etiological analysis,SAP is neither due to external cause nor internal cause,but belongs to not internal and external cause.Strictly speaking,SAP is due to an external cause.The pathogenesis of SAP is due to the mistake of inhalation and accumulation,evil toxins directly enter into the lungs,obstructing the lung qi,transforming into heat and production of phlegm,phlegm and heat together forming obstruction of Qi mechanism,inducing loss of lung clearance,leading to the occurrence of cough,asthma,phlegm,fever and other syndromes.Although the location of SAP is mainly in the lungs,the spleen,stomach,liver,kidney,large intestine and other visceral organs can also be involved.According to clinical experiences,SAP can be divided into 3 types of syndrome:phlegm-heat obstructing the lung,phlegm-dampness obstructing the lung and lung-yin deficiency.In the treatment of acute stage,eliminating pathogens is the main method,such as clearing heat,resolving phlegm,eliminating dampness and depressing qi,etc,while in the middle and late stages,eliminating pathogens and strengthening qi are combined.According to which being the priority,the healthy energy or the evil,the following measures can be used:when evil being significant in the disease and the patient's health basically alright,eliminating evil is the main therapy and promoting the healthy energy secondary;when the evil is not very obvious in the disease,and the patient's general condition is relatively weak,consolidating the healthy energy is the main therapy,and eliminating evil secondary.