范永升教授治疗系统性红斑狼疮相关肺动脉高压经验

Experience of Professor FAN Yongsheng in Treating Systemic Lupus Erythematosus-pulmonary Arterial Hypertension

[目的]总结首届全国名中医范永升教授治疗系统性红斑狼疮相关肺动脉高压的学术经验。[方法]通过整理、回顾、分析范永升教授诊治系统性红斑狼疮相关肺动脉高压相关医案,从中医病因病机、治则治法、用药特色、辨证论治等方面,全面总结归纳范永升教授诊治系统性红斑狼疮相关肺动脉高压的学术经验,并列举医案1则予以佐证。[结果]范永升教授认为系统性红斑狼疮临床表现复杂多样,可出现多系统、多脏器损伤,而系统性红斑狼疮合并肺动脉高压为系统性红斑狼疮累及心、肺的特殊类型,可属于中医“五脏痹”“胸痹”“厥证”范畴,并认为引起系统性红斑狼疮的中医病因在于“肾虚、热毒、血瘀”,其病机在于患者先天禀赋之不足,加之热毒、血瘀及痰浊等病理因素的参与,最终引起心肺受损,宗气不足,肺脉痹阻,肺气失宣,心肺气血运行不畅而导致肺动脉高压。根据本病的病因病机及临床特点分为初期气阴亏虚证,慢性期气滞血瘀证、寒凝脉络证、热毒痰瘀证和终末期阳虚脉痹证共5个证型,进行分期、分证型辨证论治,分别予以益气养阴、疏肝行气、温阳通络、解毒祛瘀、活血利水治疗。所举医案中患者处于疾病慢性期,证属寒凝脉络,治拟益气温阳、散寒通络,方用黄芪桂枝五物汤合当归四逆汤加减,临床疗效令人满意。[结论]范永升教授将系统性红斑狼疮相关肺动脉高压分为3期、5型进行辨证施治,并灵活借鉴现代医学研究成果,能改善患者临床症状,其学术经验值得同道借鉴。

[Objective]To summarize the academic experience of the first national famous traditional Chinese medicine(TCM)doctor Professor FAN Yongsheng in treating systemic lupus erythematous-pulmonary arterial hypertension(SLE-PAH).[Methods]Through sorting,reviewing and analyzing the medical records of Professor FAN Yongsheng in the diagnosis and treatment of SLE-PAH,the academic experience of Professor FAN Yongsheng was summarized and presented comprehensively in the article from several aspects such as etiology and pathogenesis,principles and methods in treatment,characteristics of medication,syndrome differentiation and treatments,and one medical case was listed as evidence.[Results]Professor FAN believes that the clinical manifestations of SLE are complex and diverse,with multiple systems and organs injured.SLE-PAH is a special type of SLE involving the heart and lung,which belongs to the concept of“impediments of the five viscera”“thoracic obstruction”and“syncope syndrome”in TCM.He believes that the etiology of SLE in TCM is“kidney deficiency,heat toxin,blood stasis”.Its pathogenesis is due to lack of birth endowment in patients accompanied with the participation of pathological factors such as heat toxin,blood stasis and phlegm turbidity,which eventually leads to the heart and lung injury,deficiency of pectoral Qi,occlusion of pulmonary vascular,obstruction of lung Qi,and impede circulation of Qi and blood in the heart and lung,results in PAH.According to the etiology,pathogenesis and clinical characteristics of the disease,it can be divided into 5 syndromes:The syndrome of deficiency of Qi and Yin in the initial stage;the syndrome of Qi stagnation and blood stasis,the syndrome of blood coagulation caused by cold pathogen,the syndrome of heat toxin,phlegm and blood stasis in the chronic stage,and the syndrome with Yang deficiency and pulse obstruction in the end stage.According to the different periods and syndromes,carry out different treatment to invigorate Qi and nourish Yin,soothe the liver and regulate Qi,warm Yang and promote blood circulation,clear away heat toxin and blood stasis,promote blood circulation and diuresis respectively.In the medical records,the patient belonged to the chronic stage of the disease,and the syndrome was blood coagulation caused by cold pathogen,and the treatment of invigorating Qi and warming Yang,dispersing cold and dredging collaterals was adopted.The prescription was Huangqi Guizhi Wuwu Decoction and Danggui Sini Decoction,and the clinical result was encouraging.[Conclusion]Professor FAN Yongsheng divides SLE-PAH into 3 stages and 5 syndromes by syndrome differentiation and treatment,and flexibly uses modern medical research achievements for reference,which can relieve clinical symptoms of patients,and the effect is encouraging,his academic experience is worthy of reference.