基于“伏痰外损”论治支气管哮喘气道黏液高分泌

Discussion on Treatment of Airway Mucus Hypersecretion in Bronchial Asthma Based on“Latent Phlegm and Exogenous Damage”

气道黏液高分泌是支气管哮喘的主要病理特点之一,在支气管哮喘发生发展中,其与中医学“伏痰外损”具有一定相关性。清代医家吴澄首次提出“伏痰”概念,并创外损学说。“伏痰外损”是支气管哮喘的核心病机,其中伏痰是发病基础,外损是伏痰的临床结局。外损作为伏痰的临床结局,具有虚证、损伤两种表现。其中,虚证是基础表现,于肺主要表现为气虚或气陷,这与黏液过度分泌导致气道阻塞、增加气道阻力(表现为喘息、气短、呼吸困难)并加速肺功能下降相通;损伤则与气道黏液高分泌导致气道结构病理改变相通。基于“伏痰外损”理论,可从“生痰之源”脾脏切入,采用理脾阴法治疗支气管哮喘气道黏液高分泌。

Airway mucus hypersecretion is one of the main pathological features of bronchial asthma.In the development of bronchial asthma,it has some correlation with“latent phlegm and exogenous damage”.In traditional Chinese medicine,WU Cheng,a doctor in the Qing Dynasty,first proposed the concept of“latent phlegm”and innovated the theory of“exogenous damage”.“Exogenous damage caused by latent phlegm”is the core pathogenesis of bronchial asthma,among which the latent phlegm is the basis of the pathogenesis,and the exogenous damage is the clinical outcome of the latent phlegm.As the clinical outcome of latent phlegm,exogenous damage has two manifestations:deficiency syndrome and damage.Among them,the former(deficiency syndrome)is the basic manifestation,which in the lung mainly presents as qi deficiency or qi sinking.It is interlinked with excessive secretion of mucus,which leads to airway obstruction,increases airway resistance(manifesting as wheezing,shortness of breath,and dyspnea)and accelerates the decline of lung function.The later(damage)is related to pathological changes of airway structure caused by airway mucus hypersecretion.Based on the theory of“exogenous damage caused by latent phlegm”and from the angle that spleen is“the source of phlegm production”,the method of regulating spleen yin can be used to treat airway mucus hypersecretion in bronchial asthma.