探析从风论治结缔组织病相关间质性肺疾病

Explore the Treatment of the Combination of Connective Tissue Disease-associated Interstitial Lung Disease from the Wind

[目的]探析从风论治结缔组织病相关间质性肺疾病(connective tissue disease-associated interstitial lung disease,CTD-ILD)的辨证思路,以期提高临床疗效。[方法]基于风邪致病特点"风为百病之长,善行数变,有内外之分",结合古籍文献及现有文献资料,考究风邪致病源流,从风邪致病的角度分析CTD-ILD病因病机,研究风药的有效性,并探讨对CTD-ILD的论治。[结果]CTD-ILD的临床症状、病情发展与风邪特点相契合,风邪是CTD-ILD的重要致病因素",外风犯肺"兼"内风伏肺"为疾病始动环节,内外风共同起病。疾病本质为虚,风与虚、痰、瘀、毒为病机演变的关键。临床和实验研究均证明风药治疗此病有效。病程可分为早、中、晚三期,进行分期论治,早期以疏风为主,中期以搜风为宜,晚期以息风为要,治疗时应针对病情急缓、病性虚实、正气强弱,有侧重地选用风药。[结论]"风邪致病"贯穿CTD-ILD整个病程,治疗应抓住早、中、晚三期风邪致病特点,根据虚、痰、瘀、毒等辨证施用风药。

[Objective] To explore the differentiation thinking of treating connective tissue disease-associated interstitial lung disease(CTD-ILD) from the perspective of wind,so as to improve the clinical efficacy. [Methods] Based on the pathogenic characteristics of wind pathogen,"wind is the leader of all diseases,good at wandering,changeable,there are internal and external distinctions",combined with ancient and existing literatures,the source of wind pathogen was investigated,and the etiology and pathogenesis of CTD-ILD were analyzed from the perspective of wind pathogen,the effectiveness of wind-drug was studied,and the treatment of CTD-ILD was discussed. [Results] The clinical symptoms and disease development of CTD-ILD are consistent with the characteristics of wind pathogens. Wind is an important pathogenic factor of CTD-ILD. "External wind invades the lung"with"internal wind incubates in the lung"is the initial link of the disease,and the internal wind and external wind jointly lead to disease. The root cause of the disease is deficiency. Wind,deficiency,phlegm,blood stasis,and toxic are the keys of the evolution of pathogenesis. Studies have proved that wind drug is effective in treating CTD-ILD. The course of disease can be treated in three stages: Early,middle and late,and treatment can be carried out by stages. In the early stage,the treatment is mainly to disperse wind;in the middle stage,it is better to remove the wind;and in the late stage,dispelling the wind should be emphasized. The wind drug should be selected according to the acute and slow condition,deficiency and excess of disease nature,and the strength of healthy Qi. [Conclusion] "Wind pathogen"runs through the entire stage of CTD-ILD. The treatment should focus on the pathogenic characteristics of wind pathogen based on the early,middle and late stages,and use wind-drug according to the syndrome differentiation of deficiency,phlegm,blood stasis and toxic.