从“肺虚络瘀”探讨补气活血法在社区获得性肺炎恢复期“瘥后防复”中的作用

Role of Supplementing Qi and Activating Blood in Preventing Relapse After Recovery of Community-acquired Pneumonia with Syndrome of Lung Deficiency and Collateral Stasis

社区获得性肺炎(CAP)是呼吸道感染疾病,短期内临床症状缓解后,仍需较长时间才能完全恢复,长期影响着患者的身体健康和生活质量,可呈反复发作,与机体炎症、免疫及凝血功能等相关。肺气虚络瘀是CAP恢复期的关键病机,在CAP发展期间气的生成减少,消耗增加,致使肺气虚,同时热邪迫血妄行,耗气伤津,致使肺络瘀,肺气虚与肺络瘀互为因果,彼此影响,至CAP恢复期肺气亏损,正气已虚,机体免疫功能存在障碍,防御功能减弱,然邪气尚存,存在凝血功能的变化和血栓的形成,部分凝血因子与CAP的预后相关。补肺益气中药可匡扶正气,筑其根基,调控机体炎症免疫反应,活血化瘀中药可通畅肺络,涤荡邪气,改善机体微血管循环障碍,抑制炎症反应,补气活血法扶正与驱邪并用,可调节机体免疫,抑制机体炎症反应等,改善肺炎临床症状,促进肺炎的康复向愈。该文从肺气虚络瘀出发,总结补气活血法在CAP恢复期瘥后防复中的应用,补充其科学内涵,为临床使用补气活血法辅助治疗CAP恢复期的瘥后防复提供思路与参考。

Community-acquired pneumonia(CAP)is a respiratory infection which takes a long time to fully recover after clinical symptoms are alleviated in the short term.It affects the physical health and quality of life of the patients in the long term and can occur repeatedly,which is related to inflammation,immunity,and the coagulation function.Lung Qi deficiency and collateral stasis are the key pathogenesis of CAP at the recovery stage.The development of CAP is accompanied by the decreased production and the increased consumption of Qi,which results in lung Qi deficiency.At the same time,heat pathogen forces the blood to move improperly,which depletes Qi and damages fluid,resulting in lung collateral stasis.Lung Qi deficiency and collateral stasis are causal and influence each other.The patients at the recovery stage of CAP generally present deficient lung Qi and healthy Qi,impaired immune function,and weakened defense function.However,pathogenic Qi,coagulation function changes,and thrombosis exist,and some coagulation factors are associated with the prognosis of CAP.The Chinese medicines for tonifying lung and supplementing Qi can help replenish healthy Qi,consolidate the body foundation,and regulate the inflammation.The Chinese medicines for activating blood and resolving stasis can dredge the lung collaterals,clear the pathogenic Qi,improve the microvascular circulation,and inhibit the inflammatory response.The Chinese medicines for supplementing Qi and activating blood can replenish healthy Qi and dispel pathogen to regulate immunity,inhibit inflammation,and alleviate the clinical symptoms,thus promoting the recovery from pneumonia.From lung Qi deficiency and collateral stasis,this paper summarizes the application and explains the scientific connotation of supplementing Qi and activating blood in preventing relapse after recovery of CAP,providing ideas for using this method to assist in preventing relapse after recovery of CAP.