摘要
支气管扩张症以反复气道感染、进行性炎症反应加重、肺功能持续下降为主要特点,气道重塑是其病理关键。运用中医学“伏邪”致病理论及“久病入络”理论阐释支气管扩张症发生气道重塑的动态演变过程具有重要意义。肺络细小而微,有运行气血、渗灌濡养之能,痰、瘀、热等伏邪有潜藏深远、自我积聚、蓄作有时、日久入络的致病特点。邪气伏藏,肺络功能结构因而改变,与支气管扩张症的细菌定植引起慢性炎症的过程密切相关。基于此,认为支气管扩张症急性期病机为外因触发,伏邪内动,痰火气急,邪壅络伤;稳定期病机为伏邪内潜,久病络损,肺虚络瘀,络息成积,“邪伏肺络”为支气管扩张症病机核心,伏痰贯穿整个病程始终。临证治疗应依据“络以通为用”辨证施治,急性期当辛以通络,剔络透邪;稳定期当补虚通络,扶正祛邪,以期为指导临床治疗提供新思路。
Bronchiectasis is characterized by recurrent airway infections,a progressive inflammatory response,and persistent decline in lung function.Airway remodeling is the key to its pathology.It is of great significance to explain the dynamic evolution of airway remodeling in patients with bronchiectasis using the theory of“latent pathogen”and“chronic diseases affecting the collaterals”,which are essential pathogenesis theories of traditional Chinese medicine.Lung collaterals are small and microscopic,and they allow the flow of qi and blood to infiltrate and nourish the lungs.Phlegm,blood stasis,heat,and other latent pathogens can hide deep and distantly,causing self-accumulation and aggregation,timedelayed attacks,and long-term affecting the collaterals.The process by which the functional structure of the lung collaterals is changed due to the accumulation of evil qi is closely related to the process of chronic inflammation caused by bacterial colonization in bronchiectasis.Based on the above,our team believed that the pathogenesis of the acute stage of bronchiectasis is triggered by external factors,the internal hidden pathogens are activated,phlegm and fire mutually cause immediate qi activity,and the latent pathogens accumulate to damage the lung collaterals.The pathogenesis in the stable stage differs,in that the latent pathogens move inward,and the lung collaterals are damaged after prolonged disease,with lung deficiency and collateral stasis.Furthermore,pathogens from masses in collaterals due to longterm retention,and“pathogenic qi in the lung collaterals”is the core of the pathogenesis of bronchiectasis,and latent phlegm is present through the entire course of the disease.The clinical treatment of our team is based on the syndrome differentiation and treatment of“dredging collaterals to make it work”,which is mainly treated with a pungent drug.In the acute phase,pungent drugs should be used to dredge collaterals,clear collaterals,and remove pathogens,while the patient in the stable period should be treated by a tonifying deficiency,dredging collaterals,and supporting the healthy qi to dispel the pathogen.This approach provide new ideas for guiding clinical treatment.
作者
翟婷
王盼
王源
黄东晖
孟玉凤
王慧贤
ZHAI Ting;WANG Pan;WANG Yuan;HUANG Donghui;MENG Yufeng;WANG Huixian(Guangzhou University of Chinese Medicine,Guangzhou510006,China;Suzhou Hospital of Integrated Traditional Chinese and Western Medicine,Suzhou 215000,China;Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine,Zhuhai 519000,China;Peking University People’s Hospital,Beijing 100044,China;Guangdong Provincial Hospital of Chinese Medicine Zhuhai Branch,Zhuhai 519015,China)
出处
《北京中医药大学学报》
CAS
CSCD
北大核心
2023年第6期853-858,共6页
Journal of Beijing University of Traditional Chinese Medicine
基金
国家自然科学基金项目(No.82074345)
广东省中医药管理局科研项目(No.20221362)。
关键词
支气管扩张症
气道重塑
肺络
伏邪
祛邪通络
bronchiectasis
airway remodeling
lung collaterals
latent pathogen
dispelling pathogen and dredging collaterals