基于《金匮要略》“干血”治则分期论治放射性肺损伤

Study on the staged treatment of radiation induced lung injury based on the treatment principle of dried blood in Synopsis of the Golden Chamber

记载于《金匮要略》中的“干血”为“久瘀之血”,是由气血津液亏虚,气血不行,瘀血内生,血凝干结而形成。这一理论在《血证论》中得到继承并发扬,干血阻络则新血不生,唐容川基于此提出“祛瘀生新”治则。放射性肺损伤起于射线热毒,热邪耗气伤津,日久瘀血内生;加之肺络自身狭小易瘀,热邪煎灼血行不畅,瘀血阻络日久则化为干血,日久肺叶失荣。瘀血贯穿于放射性肺损伤发生发展的始终,初则瘀热,渐而瘀阻,末则干血,根据《金匮要略》“干血”治则所提出的“三期三法”理论,是将祛瘀生新灵活运用于疾病治疗的全过程,初期热盛瘀浅,治以清热解毒辅以凉血活血;中期热退瘀盛,治以养阴润肺辅以清化痰瘀;末期瘀久则干,治以祛瘀生新,辅以固本培元。从“干血”治则论治放射性肺损伤,是对传统经典理论的继承和创新,且临床具有良好疗效。

The term"dried blood"recorded in"Synopsis of the Golden Chamber"refers to"long term static blood",which is formed by the deficiency of fluid,abnormal qi-blood circulation,endophytic blood stasis,and the formation of blood coagulation.This theory is inherited and developed in the"A Treatise on Blood Troubles".If dried blood blocks the collaterals,new blood will not be generated.Based on this,Tang Rongchuan proposed the treatment principle of"removing blood stasis for promoting tissue regeneration".Radiation induced lung injury originates from radiographic heat-toxicity,which heat pathogen consumes qi and injures fluid,and over time,endogenous blood stasis occurs;In addition,the lung collaterals themselves are narrow and prone to blood stasis,causing heat pathogen to burn and obstruction of blood circulation.If blood stasis obstructs the collaterals for a long time,it will turn into dried blood,and wither complexion of the lung lobes occurs over time.Blood stasis runs through the occurrence and development of radiation induced lung injury,with initial stagnated heat,gradual stagnation of blood stasis,and final dried blood.According to the"Three Stages and Three Methods"theory proposed by the"dried blood"treatment principle in the"Synopsis of the Golden Chamber",removing blood stasis for promoting tissue regeneration is flexibly applied throughout the entire process of disease treatment.In the initial stage,heat is exuberance and blood stasis is shallow,and the treatment is to clear heat and remove toxicity,supplemented by cooling blood and promoting blood circulation;In the mid-term,heat is relieved and blood stasis is excessive,and the treatment should be based on nourishing yin and moistening the lungs,supplemented by clearing phlegm and static blood;In the late stage,if the blood stasis lasts for a long time,it will dry up,and the treatment is to remove blood stasis for promoting tissue regeneration,supplemented by strengthening primordial qi and nourishing the vitality.The treatment of radiation induced lung injury based on the principle of"dried blood"inherits and innovates traditional classical theories,and has good clinical efficacy.