从“肺络微型癥瘕”探讨特发性肺纤维化的中医治疗

Theory and Treatment of IPF Based on the "Micro-accumulation in Lung Collaterals"

立足于从宏观到微观的"肺络微型癥瘕"观治疗特发性肺纤维化,提出邪入络郁、痰瘀阻络、络虚癥成,虚实转化的基本病机,此病机特点与肺纤维化多种损伤因子致胶原蛋白沉积,微血管网损伤、变形,最终纤维化瘢痕形成的病变特点,存在高度相关性和一致性。治疗当标本兼治,通补兼施,燮理阴阳,调畅气血,以补肾益肺、缓消癥瘕为基本治则,欲补虚损,重在气阴,益气重在肺肾,当以"甘温"之品养气,养阴重在补肾精,投"甘润"之品复阴,欲消癥瘕,首化痰瘀,畅肺络,以辛润之品缓通络滞。此外,癥瘕沉锢,难消难化,酿生热毒,败坏机体,故伍清热解毒、软坚散结之味以助药效,则可虚复、痰消,瘀除、癥消、瘕散。

Based on the macro to micro view of " micro-accumulation in lung collaterals" theory to treat idiopathic pulmonary fibrosis(IPF),this paper puts forward the basic pathogenesis of pathogen entering collaterals depression, phlegm and blood stasis blocking collaterals, formation of accumulation by collaterals deficiency and transformation of deficiency and excess.The characteristics of this pathogenesis are highly correlated and consistent with the pathological characteristics of multiple injury factors of pulmonary fibrosis, collagen deposition, microvascular network injury and deformation, and finally fibrotic scar formation.Treatment should treat both symptoms and root causes, both promote and supple, regulate yin and yang, regulate qi and blood.The basic treatment principle is to tonify the kidney and lungs and relieve symptoms and pains.In order to tonify deficiency and damage, on li and yin should be focused.Supplementing qi focuses on the lung and kidney.We should nourish qi with "sweet and warm" medicine.Nourishing yin focuses on tonifying kidney essence and restoring yin with "sweet and moist" medicine.In order to eliminate accumulation, we should first remove phlegm and blood stasis and unblock the pulmonary collaterals.We should use pungent and moist medicine to slow down the obstruction of collaterals.In addition, the accumulation is stagnant, difficult to eliminate and transform, which brews heat and poison, and damages the body.Therefore, it is combined with drugs for clearing heat and detoxification and softening, firmness and dispersing knots to help the efficacy.In this way, it can restore deficiency, eliminate phlegm, remove blood stasis, eliminate accumulation.