基于“气络”“血络”理论探析肺小血管炎病机与治则

Analysis on Pathogenesis and Treatment Principle of Small Pulmonary VasculitisBased on Theory of “Qi Collaterals” and “Blood Collaterals”

以“久病入络”为基础,结合“气络”“血络”的络病学说,进一步根据缪希雍“降气以降火”、李东垣“升阳举陷”理论整体构建肺小血管炎辨证论治的理法方药体系。肺小血管炎患者以肺肾血络受损的器质性改变为基本病理变化,卫气虚弱,肺气上逆,脾气不升,元气虚陷,肺脾肾气络功能失调则是推动肺小血管炎临床症状产生的重要原因。外邪侵袭,气络失调,由气入血,血随气行,血络受损——气络失调,血络不通为肺小血管炎基本病机。临床应重视调理肺脾肾气血,润肺阴养肺气,健脾气益脾阳,滋肾阴温肾阳,清通和补肺肾血络,共达“升阳降气,清络和血”之功。

Based on the theory of “prolonged illness invading the collaterals”,combined with “qi collaterals”and “blood collaterals” of collateral theory,referring to LIAO Xiyong’s theory of “lowering qi to reduce fire”,LI Dongyuan’s theory of “elevating yang and raising the drooping”,this paper has constructed the principle-method-recipe-medicinal system for syndrome differentiation and treatment of small pulmonary vasculitis. In patients with small pulmonary vasculitis,the basic pathological changes are the organic changes of lung and kidney blood collateral damage.Defensive-qi deficiency,lung qi ascending counterflow,failure of spleen qi to ascend,deficiency and collapse of primordial qi,dysfunction of qi collaterals of lung,spleen and kidney are important driving forces for the clinical symptoms of small pulmonary vasculitis. Exte rnal pathogens invade the body,causing dysfunction of qi collaterals,entering blood from qi,blood following qi movement,damaging blood collaterals. Dysfunction of qi collaterals and disturbance of blood collaterals are the basic pathogenesis of small pulmonary vasculitis. Clinically,we should attach importance to regulating qi and blood in the lung,spleen and kidney,moistening lung yin and nourishing lung qi,invigorating spleen qi and spleen yang,nourishing kidney yin and warming kidney yang,clearing,dredging,harmonizing and tonifying blood collaterals in lung and kidney to achieve the effects of “elevating yang and lowering qi,clearing collaterals and harmonizing blood”.