张之文辨治特发性肺纤维化经验探析

Discussion on ZHANG Zhi-wen's experience in the treatment of idiopathic pulmonary fibrosis

首届全国名中医张之文教授认为,特发性肺纤维化属虚实夹杂、本虚标实疾病。本虚从寒热来看,分虚热与虚寒两类,病位在肺,主要涉及脾、胃、肾等脏腑;标实早期以肺络瘀阻为主,继续发展则表现为痰瘀阻滞证候,晚期出现瘀毒内盛证候;瘀血为患贯穿本病始终,化瘀宜早不宜迟。本病早期可见肺胃两虚兼络脉受损证型,继续发展可见肺脾气虚兼痰瘀互结证型,晚期多见肺肾虚衰兼瘀毒为患证型。文章总结张教授治疗特发性肺纤维化临证经验及用药特色,通过典型病案分析张教授的证治思路。

In the view of professor ZHANG Zhi-wen, the first national famous doctors of traditional Chinese medicine, idiopathic pulmonary fibrosis(IPF) is a disease with intermingled deficiency and excess, the pathogenesis of which is deficiency in origin and excess in superficiality. Based on the differences of cold-syndrome and heat-syndrome, the deficiency is divided into two types: deficiency-heat syndrome and deficiency-cold syndrome. The site of IPF is lung, and related closely with spleen, stomach and kidney. Excess is mainly of collaterals in the lung in the early stage of symptom. With the development of the disease, it was manifested as the syndrome of blockade of phlegm and static blood, and later appeared as the internal exuberance of stasis-toxin syndrome. Blood stasis persists throughout the disease, and measures of promoting blood circulation to remove blood stasis should be taken as early as possible. In the early stage of the disease, the syndrome of deficiency of lung and stomach and collateral damage can be seen. The syndrome of qi deficiency of lung and spleen and phlegm-blood stasis can be seen with the development of the disease. Deficiency of lung and kidney and stasis-toxin were more common in the late stage. This paper summarized professor ZHANG’s clinical experience and medication characteristics in the treatment of IPF, and discussed professor ZHANG’s thoughts in symptom and treatment through typical medical records.