中医对老年人共病的认识与治疗探析

Discussion on Recognition and Treatment of Senile Multimorbidity in Chinese Medicine

共病是两种或多种慢性疾病并存的状态,而老年人的共病状况非常普遍。中医药因其“整体观念”“辨证论治”“善治未病”等特点,对于老年人共病的调治具备一定的优势。中医理论认为老年人的脏腑阴阳、气血精津液、形神都具有虚衰的生理特点;病理上则有易多脏受损、易阴阳俱虚、易生痰瘀风、易生积滞、易情志异常等特征。笔者据此将共病病机总结为:脾肾虚衰、痰瘀互结、心气不足、肝郁气滞等几个方面。相应地,在治疗上则强调补益先天、调补后天、活血化瘀、祛湿化痰、养心疏肝、行气解郁,并且在临床上有较好的疗效。因此本文基于文献论述共病的概念、分类和中医对老年共病的生理、病理及治疗的认识,以期为相关研究以及临证治疗提供思路。

Multimorbidity is the coexistence of two or more chronic diseases,and multimorbidity is very common in the elderly.Chinese medicine has certain advantages in the regulation and treatment of multimorbidity in the elderly due to its characteristics of"overall concept","treatment based on syndrome differentiation",and"being good at treating before disease".According to the theory of Chinese medicine,elderly people have the physiological characteristics of deficiency of Yin-Yang of Zang-Fu organs,Qi,blood,fluid,and body and spirit;Pathologically,they are prone to multiple organ damage,deficiency of both Yin and Yang,production of phlegm and wind stagnation,stagnation,and abnormal emotions.Accordingly,the author summarizes the pathogenesis of multimorbidity as follows:pattern of spleen-kidney deficiency,pattern of combined phlegm-static blood,pattern of insufficiency of heart Qi,and pattern of liver depression and Qi stagnation.In terms of treatment,the emphasis is on tonifying kidney and spleen,activating blood and resolving stasis,removing dampness and phlegm,tonifying heart and soothing liver,and resolving Qi and depression.It is clinically effective.Therefore,this article discusses the concept and classification of multim or bidity and Chinese medicine's understanding of the physiology,pathology,and treatment of multimrobidity in the elderly based on the literature,with a hope to provide ideas for future research and clinical applications.