从脾胃论治干燥综合征合并间质性肺病探析

Analysis of Treatment of Interstitial Lung Disease Associated with Sjogren's Syndrome from Spleen and Stomach

[目的]探讨从脾胃论治干燥综合征合并间质性肺病。[方法]从《黄帝内经》运气标本中气理论以及三焦理论出发,逐层剖析、明确干燥综合征合并间质性肺病相关问题如"燥""间质"的中医内涵以及"间质性肺病"发生的中医病因病机,提出并探讨从脾胃论治干燥综合征合并间质性肺病。[结果]阳明从中气太阴湿土,燥湿互济,燥湿本源于寒热,由少阳三焦相火主导,而少阳三焦相火的来源在脾胃。"间质"为三焦腑腠理,间质性肺病发生的根本病机为少阳三焦功能失调。干燥综合征合并间质性肺病多属于虚损性疾病,临床多见脾胃虚弱同时伴有阴火致燥热或兼有湿邪,即阳虚三联征。本病的基本病机为脾胃气虚。治疗当以健运脾胃为本,脾胃健运则阳生阴长,而不能一味养阴润燥;病久累及下焦,当用甘润、温润之品补益精血;阴血亏久必致瘀血停滞,则当养血活血。[结论]干燥综合征合并间质性肺病的中医病本在脾胃,治疗当以健运脾胃为本。

[Objective]To discuss the treatment of interstitial lung disease associated with Sjogren’s syndrome from spleen and stomach.[Method]Based on the Biaoben Zhongqi theory and the three-Jiao theory in Huangdi Neijing,this paper analyzes the TCM connotation of the"dryness"and"interstitial"and the etiology and pathogenesis of the"interstitial lung disease",and puts forward and discusses the treatment of Sjogrens syndrome combined with interstitial lung disease from the perspective of spleen and stomach.[Results]Yangming belongs to the middle-Qi Taiyin wet soil,which is mixed with dryness and dampness.Dryness and dampness originally come from cold and heat,and are dominated by the fire of Shaoyang Sanjiao,while the fire of Shaoyang Sanjiao comes from spleen and stomach.The Chinese medicine positioning of"interstitial"is the Couli,the fundamental pathogenesis of interstitial lung disease is Shaoyang Sanjiao dysfunction.Sjogren’s syndrome combined with interstitial lung disease mostly belongs to asthenia disease,whose clinical manifestations are mostly weakness of spleen and stomach accompanied by dryness and fever caused by Yin-fire or dampness,namely the triple syndrome of Yang deficiency.The basic pathogenesis of this disease is Qi deficiency of spleen and stomach.The treatment should be based on strengthening the spleen and stomach,Yinqi will grow with Yangqi,but not blindly nourishing Yin and moistening dryness;Using sweet,warm Chinese medicine to nourish the essence of blood when illness involving the lower Jiao;Yin blood loss for a long time will lead to stasis of blood,treatment should be nourishing and activating blood.[Conclusion]The nature of Sjogren’s syndrome combined with interstitial lung disease is fundamentally in the spleen and stomach,treatment should be based on strengthening the spleen and stomach.