从“毒损肺络”探讨肺“结癌转化”的防治思路

Preventing and treating"nodules-cancer transformation"of lung based on"toxin damaging lung collaterals"

肺结节归属于中医学“肺积”“积聚”范畴,病机为肺络气郁痰瘀。基于中医学对肺结节的认识,深入探析毒邪与肺络的生理病理关系,认为“结癌转化”是一个不断蓄积、动态变化的过程,是由气络病变向血络病变转化的过程。“结癌转化”以肺络气滞为先,痰、湿、瘀蓄积肺络,发为肺积,病久入血络,酿生癌毒,相互胶结,阻络损络。其中,邪气蓄积是毒邪内生的前提,毒邪是始动因素,毒损是关键环节,毒损肺络是“结癌转化”的病理状态,“气郁痰瘀互结,酿生癌毒”是“结癌转化”的核心病机。治疗上未病先防:形神相俱则结无以成;已病防传:解毒通络则结无以传,并佐以消痰解毒、化湿解毒、祛瘀解毒。为中医药防治肺结节以及有效延缓甚至阻断肺“结癌转化”提供新思路。

Pulmonary nodules belong to the category of"masses in the lung""amassment and accumulation"in Chinese medicine.The pathogenesis is qi and phlegm stagnation in lung collaterals.Based on the understanding of pulmonary nodules in TCM,the paper explores the physiological and pathological relationships between toxin and lung collaterals.It is believed that"nodules-cancer transformation"is a process of constant accumulation and dynamic change,and it is also the process of transformation from pathological changes of qi collaterals to pathological changes of blood collaterals."Nodules-cancer transformation"starts with qi stagnation of lung collaterals;then the phlegm,dampness,and stasis accumulate in lung collaterals;and masses in the lung finally form,entering blood collaterals over time,generating cancer toxin,which cement each other,obstructing and damaging collaterals.Among them,the accumulation of pathogenic qi is the premise of endogenic toxin;toxin is the starting factor;toxic damage is the key;"toxin damages lung collaterals"is the pathological state of"nodules-cancer transformation";"qi and phlegm stagnation intermingle,generating cancer poison"is the core pathogenesis of"nodules-cancer transformation".In treatment,"nodules-cancer transformation"should be prevented before it arises,that is to keep both body and mind well to prevent pulmonary nodules from forming;it should be prevented from transmission after its onset,that is to remove toxins and unblock collaterals by transforming phlegm,drying dampness,and transforming stasis to prevent pulmonary nodules from transmitting.In conclude,the paper provides new ideas for the prevention and treatment of pulmonary nodules and effectively delaying or even obstructing"nodules-cancer transformation"of lung with Chinese medicine.