肺痿、肺痹与肺间质纤维化证候认识

Scussion on the Understanding of the Relationship between Feiwei(Feibi) and Pulmonary Fibrosis

弥漫性肺间质疾病是一类以弥漫性肺泡炎症和肺间质纤维化为基本病理改变的疾病总称,其中特发性肺间质纤维化是一类慢性进展、预后差、病死率高的特发性间质性肺炎。结缔组织疾病亦可造成肺损伤而出现肺间质纤维化的表现,症状均以咳、痰、喘等为主。现代中医学者认为肺间质纤维化当归属于中医学的肺痹、肺痿、喘证等范畴。古代文献中对肺痿的认识基于《金匮要略》,其证候特点以肺胃气阴两虚为主,亦可见肺气虚冷;肺痹则是尊崇《内经》中"五脏痹"的理论,主要证候特点为肺气闭阻;而肺间质纤维化的现代研究则表明其证候特点多以气虚为本、瘀血为标。因此,二者分别代表了肺纤维化的不同阶段和(或)不同证候特点,即肺纤维化患者表现出气阴两虚、虚热灼肺或肺气虚冷的证候特点可参照肺痿论治,若表现为肺气闭阻之实证特点则当以肺痹论治。

Diffuse pulmonary interstitial disease is a kind of disease with diffuse alveolar inflammation and pulmonary interstitial fibrosis as the basic pathological changes.Idiopathic pulmonary interstitial fibrosis is a kind of idiopathic interstitial pneumonia with chronic progress,poor prognosis and high mortality.Connective tissue disease can also cause lung injury and pulmonary interstitial fibrosis.Symptoms are mainly cough,sputum,asthma,etc.Modern Chinese medicine scholars believe that pulmonary interstitial fibrosis belongs to traditional Chinese medicine such as Feiwei,Feibi,wheezing syndrome and so on.Knowledge of pulmonary impotence in ancient literature based on synopsis of Golden Chamber.The syndrome characteristics are qi and yin deficiency of lung and stomach and deficiency of lung qi with cold.Feibi is known by the theory of the"Five Zang Bi"in Neijing.The main syndrome characteristic is pulmonary atelectasis.But the modern research of pulmonary interstitial fibrosis shows that its syndrome characteristics are mostly based on qi deficiency and blood stasis.Therefore,they represent the different stages of pulmonary fibrosis and/or the characteristics of different syndromes.lung fibrosis patients show deficiency of both qi and yin,deficiency heat cauterization of lung or lung qi deficiency and cold syndrome characteristics can refer to the treatment of Feiwei.If the manifestation of lung-qi obstruction of the empirical characteristics,it should be treated with Feibi.