从“养胃阴”论治干燥综合征相关性间质性肺疾病

Treatment of Interstitial Lung Disease Associated with Sjögren’s Disease Based on“Nourishing Stomach Yin”

干燥综合征相关性间质性肺疾病以口咽干燥、腮腺肿大、关节疼痛、进行性呼吸困难等为主要临床表现。脾胃为气机升降之枢纽,为本病病机演变中的核心脏腑。然脾胃升降喜恶各有不同,在温补脾气的同时,亦要强调顾护胃阴的重要性。胃阴与本病的相关性表现在:肺胃经络相同,气机同降,喜恶相似,同气相求,故干燥综合征常累及至肺;胃主通降,胃阴亏损,胃气不降大肠失濡而易见便秘;起初多为肺胃津伤,病久多累及肾液,且因女子经带胎产等生理特点易耗伤津血,故多发于绝经前后妇女;胃阴衰则阳明经无以滋养筋骨关节而见关节屈伸不利。根据胃阴耗伤程度及分期特点,早期甘凉濡润,中期甘寒滋养,晚期滋肾增液。

The major clinical manifestations of interstitial lung disease(ILD)associated with Sjögren’s Disease(SjD)(SjD-ILD)are dry throat,parotid gland swelling,joint pain,progressive dyspnea as.Spleen and stomach are the core organs for the evolution of the disease mechanism.However,spleen and stomach are different in the ascending and descending,favor and disfavor.While warming and tonifying spleen,we should also emphasize the importance of taking care of the stomach yin.The correlation between stomach yin and SjD-ILD is shown as follows:lung and stomach are similar in the meridians and collaterals,shares the same qi movement,have the same favor and disfavor,and are the same in the property,so that SjD often involves the lung;stomach dominates the descending,and therefore when the stomach yin is deficient and stomach qi could not descend,there is no moisture in the large intestine usually manifesting as constipation;at first,lung and stomach are usually injured on fluids,and kidney fluid is often involved after a long time,and the body fluid and blood are easily consumed due to the physiological characteristics of women with fetal birth,so it mostly occurs in women before and after menopause;in the case of stomach yin failure,yangming meridian cannot nourish the muscles and joints manifesting as inhibited bending and stretching.According to the degree of stomach yin damage and the characteristic in each stage,sweet and cool medicinals for moistening should be applied in the early stage,sweet and cold medicinals for nourishing should be applied in the middle stage,and medicinals for nourishing kidney and supplementing fluid should be applied in the late stage.