张念志教授辨证治疗肺结节病1例及文献复习

Treating 1 case of pulmonary sarcoidosis by Professor ZHANG Nianzhi and the literature review

结节病是一种以非干酪样上皮样细胞性肉芽肿为特征性病理改变的多系统累及性疾病,其中肺内结节病的发病率较高,90%以上的结节病均发生于胸内。结节病的发病原因不明,可能与遗传、环境、免疫等因素相关。西医多以糖皮质激素为首选药物治疗该病,但长期使用激素类药物不仅不良反应大、价格昂贵,疗效也难以保证,具有一定的局限性。近年来,随着中医药在间质性肺疾病中的广泛应用,医学界发现中医学在治疗该病方面具有优势,为临床治疗肺结节病提供了新的思路和方法。张念志教授为江淮名医,从医30载,临证经验丰富,在运用传统中医中药治疗肺系疾病方面具有独到的见解。文章通过分析恩师中医药辨证治疗肺结节病的典型案例,并回顾性分析中医治疗该病相关文献,总结出该病的病因病机为肺气亏虚,痰气瘀毒郁结于肺,肺络痹阻,日久形成结节,治疗总以化痰行瘀,解毒散结为要,同时兼顾正气,为进一步探索和广泛应用中医药治疗肺结节病提供参考。

Sarcoidosis is a multiple systems involved disease characterized by the pathological change of non-caseous epithelioid granuloma.The incidence of intra-pulmonary sarcoidosis is high,with more than 90%of sarcoidosis occurring in the chest.The pathogenesis of sarcoidosis is unknown and may be related to genetic,environmental and immune factors.Western medicine usually takes glucocorticoid as the first choice to treat this disease,but long-term application of hormone medicines not only shows great adverse reactions,but also is expensive,and the efficacy is difficult to guarantee,with certain limitations.In recent years,with the extensive application of TCM in the treatment of interstitial lung diseases,TCM has shown its advantages in the treatment of this disease,providing a new idea and method for the clinical treatment of sarcoidosis.Professor ZHANG Nianzhi is a famous physician in Jianghuai area.He has been practicing medicine for 30 years,and has rich clinical experience.He has unique insights in the treatment of lung diseases in TCM.In this paper,through the analysis of typical cases of treating pulmonary sarcoidosis by the professor based on TCM syndrome differentiation,and the retrospective analysis of relevant literature on TCM treatment of the disease,it is concluded that the etiology and pathogenesis of the disease were Qi(气)deficiency of lung,phlegm,blood stasis and toxin stagnation in the lung,and pulmonary collaterals obstruction,resulting in nodule formation after a long time.The treatment methods of this disease are mainly to remove phlegm and blood stasis,and detoxification to disperse nodules,and give consideration to healty Qi at the same time,providing a reference for further exploration and widely application of TCM in the treatment of pulmonary sarcoidosis.