基于“左升右降”探讨胸闷变异性哮喘的治疗

Explore the Treatment of Chest Tightness Variant Asthma Based on Left Ascending and Right Descending

胸闷变异性哮喘(chest tightness variant asthma,CTVA)是一种以胸闷为唯一或主要症状的哮喘亚型,其具有气道高反应性、可逆性气流受限,但无典型支气管哮喘症状,吸入糖皮质激素或长效β2受体激动剂等相关治疗可有效控制及缓解症状。该文基于"左升右降"理论,结合现代医学相关知识探讨胸闷变异性哮喘的治疗。"左升右降"源自《素问·刺禁论》的"肝生于左,肺藏于右"之说。肝生于左,主升发,肺降于右,主肃降,二者生理病理相互联系,在气机运行上存在着相互制约、相互协调的关系,肝升肺降相因,处于动态平衡之中,共同调节人体气机,维持脏腑气机的协调运转,二者最忌内郁外邪忤犯,若"左升太过,右降不及"则气机失调发为病态。结合临床经验,CTVA发病的根本机理为肺气郁闭,气机失调,治疗上应重视疏通气机,通过药物的性味升降来舒理肝气、降逆肺气,从而使左升右降得复,疾病得愈。

Chest tightness variant asthma (CTVA) is a subtype of asthma,which with chest tightness as its sole or main symptom.It has airway hyperresponsiveness and reversible airflow limitation,but there were no typical symptoms of bronchial asthma.Inhalation of glucocorticoid (ICS) or long-acting beta 2 receptor agonist (LABA) can effectively control and relieve the symptoms of CTVA.This paper is based on the theory of "left ascending and right descending",combined with modern medical knowledge to explore the treatment of chest tightness variant asthma."left ascending and right descending" originates from the theory that "liver is born on the left,lung is hidden on the right".The liver is born on the left,mainly rising,the lung is falling on the right,mainly descending.Their physiologically and pathologically are interrelated.There is a relationship of mutual restriction and coordination in the operation of the Qi mechanism.Liver ascending and lung descending are mutual causes and keep balance.They jointly regulate the Qi mechanism of the human body and maintain the coordinated operation,emphasis dredging Qi activity,the most taboo of the two viscera is the invasion of Qi stagnation and pathogenic factor.If "too much left ascending,too little end right descending",the Qi activity will be maladjusted and develop into morbid.Combined with clinical experience,the basic mechanism of CTVA is stagnation of lung Qi and maladjustment of Qi mechanism.Through the rise and fall of the nature and taste of traditional Chinese medicine to soothing and regulating liver Qi,clearing and carrying downward lung Qi,so that left ascending and right descending can be restored,and the disease can be cured.