气血津液视域下肺结节立体化辨证体系的构建

Construction of a Three-dimensional Syndrome Differentiation System for Pulmonary Nodules under the Perspective of Qi,Blood and Fluids

基于气血津液理论,结合肺结节“郁→痰→瘀→结”的病机演变进程,试从时间、空间维度构建肺结节立体化辨证体系。肺结节发病之初期、中期、后期的时间进程反映了气血津液代谢失常之“郁→痰→瘀”的病理变化趋势;肺结节大小、密度、形态等空间结构反映了气血津液代谢失常之久暂、程度、主次的病理状态。根据时间进程提出初期当散邪复用以截生长之势、继而化浊消痰以降凝结之度、后期则消结散形以除异常之态的治则,根据空间结构提出善用风药、多法治痰、行瘀破结等治法,以期为肺结节中医系统性诊疗提供理论参考。

Based on the theory of qi,blood and fluids,and taking into account of the pathogenesis evolution process from constraint to phlegm,stasis and then mass in pulmonary nodules,an attempt has been made to construct a three-dimensional differentiation system for pulmonary nodules from the dimensions of time and space.The temporal progression of the early,middle,and late stages of pulmonary nodules reflects the pathological changes from constraint to phlegm and then stasis in the metabolism disorders of qi,blood and fluid.The spatial structures such as size,density,and morphology of pulmonary nodules reflect the pathological states of the duration,severity,and primary and secondary conditions of qi,blood and fluid metabolism disorders.Based on the temporal progression,the therapeutic principles have been proposed,which are dispelling pathogenic factors and promoting the use of beneficial factors to interrupt the growth momentum in the early stage,removing turbidity and dispersing phlegm to reduce the degree of nodules in the middle stage,and dispersing nodulation and eliminating abnormalities in the late stage.Based on the spatial structures,the suggested therapeutic methods are using wind herbs,employing multiple approaches to treat phlegm,and promoting blood circulation to resolve stasis,so as to provide theoretical reference for the systematic diagnosis and treatment of pulmonary nodules in traditional Chinese medicine.