从肝肺相关理论探讨肺结节的诊疗思路

Discussion on diagnosis and treatment of pulmonary nodules based on the theory of correlation of the lung and liver

近年来,临床肺结节检出量呈上升趋势,随访时间长、良恶性判断困难是肺结节临床治疗中的难点。肝肺相关理论是藏象学说中五脏相关理论的重要组成部分,肝肺生理联系紧密、病理相互影响,二者在气机升降、气血运行方面互相影响、协同作用。中医古籍并无肺结节之说,根据其病变有形之特点及病情发展规律等,将其归属于“肺积”范畴,肝气郁滞、肺气受损致肝肺气机失调、气血运行不畅,是肺结节发生发展的关键环节之一。针对肺结节病灶本身的治疗,以疏肝理肺、调畅气机为主,辅以针对肺积的软坚散结、化瘀解毒、扶正祛邪等法。针对肺结节临床症状的治疗,尤需注意宣畅肺气、疏理肝气,恢复机体气机升降出入之平衡,使全身气血运行畅达,并注重对患者的心理疏导。结合临床验案对从肝肺相关理论治疗肺结节进行介绍。

In recent years,the detection of clinical pulmonary nodules has shown an increasing trend,and the long follow-up time and the difficulty of judging whether the nodules are benign and malignant are the primary difficulties.The theory of liver and lung correlation is an important part of the five viscera theory,and the two are closely related both physiologically and pathologically.They affect each other and synergize in the ascending or descending movement of qi and the flow of qi and blood.Pulmonary nodules are not recorded in ancient books of traditional Chinese medicine,but they can be categorized into“fei ji”(lung accumulation)since they are tangible lesions that follow a specific law of development.The key to its generation and progression is constraint of liver qi and damage of lung qi leading to disorder of qi movement and blood in the liver and lung.For the treatment of pulmonary nodules,the main methods are to soothe the liver,rectify the lung and promote qi movement,supplemented by softening hardness and dissipating mass,resolving stasis and toxin,and strengthening the resistance to eliminate pathogenic factors.For the treatment of clinical symptoms of pulmonary nodules,it is necessary to pay special attention to diffusing and restoring the smooth movement of lung qi,soothing the stagnated liver qi,restoring the balance of ascending and descending functional activities of qi,so that the whole qi-blood circulation can function smoothly,and paying attention to psychological counseling for patients.Combined with clinical cases,the treatment of pulmonary nodules from the theory of correlation of lung and liver is introduced.