李旭成从肺脾同病理论论治重症肺炎经验

LI Xucheng’s experience in treating severe pneumonia from the theory of lung and spleen comorbidit

重症肺炎是病原体感染人体后,肺组织炎症发展到一定疾病阶段,恶化加重形成的疾病状态,是重症监护室常见的感染性疾病。本病患者可能进展为脓毒症,出现意识障碍、弥散性血管内凝血、休克、多器官功能衰竭等急危重症,治疗困难,病死率高。在常规西医治疗的基础上配合中药治疗能减轻病原体毒力、调节患者免疫力、减少抗生素的使用剂量及天数、保护重要脏器的功能,因此中医药在重症肺炎的治疗过程中发挥着重要作用。中医认为本病属于“风温肺热病”的范畴,基本病机总属邪毒蕴肺,正虚络瘀。患者或因外感六淫毒邪、疫疠之气,或因新感引动伏邪,导致本病发生。热、痰、毒、瘀等是其重要病理基础。由于本病后期易发动风、厥证、脱证等危象,故本病贵乎早治。本病正虚邪盛并见,在治疗时应注意标本兼顾,补虚泻实。李旭成教授基于本病的病因病机将本病早期特点总结为“肺脾同病”,指出本病初起以肺、脾二脏病变为主,在治疗上也以肺、脾二脏为中心,在常规西医治疗的基础上运用活血通络、通腑降浊、泻肺平喘、健脾益气、清热化痰、润肺生津等方法处方。文章从李旭成教授对重症肺炎中医病因病机的认识、辨证论治思路进行经验总结,并予以临床验案加以佐证。

Severe pneumonia is a disease state in which the inflammation of lung tissue develops to a certain stage and worsens after the pathogen infects the human body.It is a common infectious disease in intensive care unit.Patients with this disease may progress to sepsis,present with consciousness disturbance,DIC,shock,multiple organ failure and other acute critical illness,which is with difficult treatment and high fatality rate.On the basis of conventional Western medicine,treatment combined with traditional Chinese medicine can reduce pathogen virulence,regulate the immunity of patients,reduce the dosage and days of antibiotics,and protect the function of important organs.Therefore,traditional Chinese medicine plays an important role in the treatment of severe pneumonia.Traditional Chinese medicine believes that this disease belongs to the category of“warm wind leads to lung fever”.The basic pathogenesis is poison accumulating in the lung,deficiency of healthy Qi(气)and collaterals and blood stasis.It is either caused by six external pathogens,epidemic,or the exogenous pathogen initiates hidden pathogens.Heat,phlegm,poison and blood stasis are the important pathological bases.Because in the late stage of the disease,it is easy to trigger crises such as stroke,syncope,prostration syndrome and so on,early treatment is the most important for this disease.The root of this disease is deficiency of healthy Qi and excess of pathogenic factors,it is important to target both the symptoms and the root causes,and reinforce deficiency and reduce the excess.Based on the etiology and pathogenesis of the disease,Professor LI Xucheng summarizes the early characteristics of the disease as“lung and spleen comorbidity”.The professor points out that the disease is mainly caused by the lesions of the two viscera of the lung and spleen at the beginning,and the treatment of the two viscera of the lung and spleen is also centered on the treatment of the lung and spleen.On the basis of conventional Western medicine treatment,methods such as promoting blood circulation,removing meridian obstruction,regulating Fu-organs(腑)and reducing turbidity,purging the lung and relieving asthma,invigorating the spleen and replenishing Qi,clearing heat and eliminating phlegm,and moistening the lung and producing fluid are used.The paper summarizes the experience of Professor LI Xucheng in the understanding of the etiology and pathogenesis of severe pneumonia in traditional Chinese medicine and the treatment ideas based on syndrome differentiation,and provides clinical evidence to support it.