基于“清浊相干”理论探讨慢性阻塞性肺疾病频繁加重表型的防治

Prevention and Treatment of Frequent Exacerbation Phenotype of Chronic Obstructive Pulmonary Disease Based on the Theory of“Mutual Interference between the Clear and the Turbid”

慢性阻塞性肺疾病(COPD)患者每年出现≥2次的中度急性加重或≥1次的重度急性加重属于COPD“频繁加重表型”。认为“清浊相干”是COPD频繁加重表型的中医基本病机,宗气下陷是其初始病机阶段,营卫不和是其关键病机环节。宗气下陷,营卫气弱,致外邪频犯机体,卫气逆行,清浊不相顺接而津液气血输布受阻,进一步导致痰瘀互结、复伤正气。因此,对COPD频繁加重表型的中医基本防治原则为:在COPD频繁加重表型未形成时,以培土生金、升补宗气、益气固表,阻断“清浊相干”的病机进程,减缓COPD频繁加重表型的形成速度;在COPD频繁加重表型已形成时,则在补益虚损的基础上以清化内浊为治疗原则,旨在清除“清浊相干”带来的主要病理产物,降低COPD纵向及横向传变风险。COPD频繁加重表型的形成、传变以及方药干预的动态生物标志物和生物学机制是未来需要进一步探索的方向。

The frequent exacerbation phenotype of chronic obstructive pulmonary disease(COPD)is defined as occurrence of more than two moderate exacerbations or one severe exacerbation per year.It is believed that“mutual interference between the clear and the turbid”is the basic pathogenesis in traditional Chinese medicine(TCM),while sinking of pectoral qi(gathering qi or ancestral qi)is the initial stage,and disharmony between ying(营)and wei(卫)qi is the key stage of pathological mechanism.As the pectoral qi sinks,and ying and wei qi were weak,the external pathogens invade the body frequently,leading to wei qi counterflow and disorder of the clear and the turbid connection;the transport and distribution of the fluids,essence,qi,and blood are then affected,which produces the binding of phlegm and stasis,and damage of healthy qi once again.Therefore,the basic prevention and treatment principle for frequent exacerbation phenotype of COPD is to block the progression of“mutual interference between the clear and the turbid”before the formation of frequent exacerbation phenotype of COPD,and to slow down the formation by banking up earth to generate metal,up-regulating and supplementing pectoral qi,and boosting qi to consolidate the exterior;after the frequent exacerbation phenotype of COPD is formed,the treatment principle should be clearing and removing internal turbidity together with supplementing and boosting the deficiency,which is aimed at eliminating the main pathological products of“mutual interference between the clear and the turbid”,and reducing the vertical and horizontal transmission risk of COPD.Further researches are warranted regarding the formation and transmission of the frequent exacerbation phenotype of COPD,the dynamic biomarkers and the underlying biological mechanismsin the future.