从免疫紊乱角度探讨脓毒症与“阴阳交”的相关性

Correlation between Sepsis and“Interaction of Yin and Yang”from the Perspective of Immune Disorder

脓毒症发病率和死亡率很高,是临床的急危重症。免疫紊乱是其关键机制。近年来,中医药在脓毒症免疫调节方面成为新兴的研究热点。基于免疫紊乱这一现代微观机制,从病机认识、临床表现及传变脏腑三方面探讨了脓毒症与“阴阳交”的相关性,认为可将脓毒症归属于中医“阴阳交”的疾病范畴,并提出了“泻其热”“实其阴”的两大治疗原则,从疾病传变、正气虚实、病理产物的堆积等方面综合考虑,以清热解毒、益气养阴为主,兼顾痰瘀等病理因素,且全程需固护胃气,慎用苦寒之品。

Sepsis is a critical emergency in clinic characterized by high morbidity and mortality rate.The major pathogenesis is immune disorder.In recent years,traditional Chinese medicine(TCM)applied for immunomodulation in sepsis has become a emerging hotspot.Based on the modern micro-mechanism of immune disorders,in this paper the correlation between sepsis and interaction of yin and yang in TCM were explored from three aspects:pathogenesis,clinical manifestations and transmission in viscera.Sepsis can be classified into the category of interaction of the yin and yang in TCM.Two major treatment principles,“purging heat”and“supplementing yin”,were proposed.Based on comprehensive assessment of disease transmission,deficiency and excess of healthy qi,and accumulation of pathological products,clearing heat and detoxification,tonifying qi and nourishing yin are the major principle,assisted with treating other pathological factors such as phlegm and stasis.Throughout the treatment process,it is essential to protect stomach qi and the bitter and cold medicinals should be applied cautiously.