基于“络以通为用”探讨马钱子在特发性肺纤维化治疗中的应用

On the application of nux vomica in the treatment of idiopathic pulmonary fibrosis based on the theory of "collaterals functioning normally when unblocked"

特发性肺纤维化属于“肺痹”“肺痿”范畴,其发病核心病机为顽痰瘀血阻于肺络,导致肺络痹阻不通。叶天士提出“络脉以通为用”,在特发性肺纤维化急性发作期应用通络药物可疏通肺络,减轻急性发作。马钱子走窜通络,善剔除沉积于肺络中痰瘀之邪。李光熙认为,马钱子虽有毒性,但其疏通络脉之力迅猛,临床多用于治疗痰瘀阻络证,在安全剂量内应用马钱子治疗特发性肺纤维化急性发作可明显改善患者临床症状,降低发作频率。从“络以通为用”论述特发性肺纤维化急性发作的病机,并从中西医角度讨论马钱子对于特发性肺纤维化急性发作的作用机理及临床应用马钱子的注意事项,以其为临床治疗特发性肺纤维化提供新的思路。

Idiopathic pulmonary fibrosis belongs to the categories of "lung bi" and "lung fl accidity" in traditional Chinese medicine,whose core pathogenesis features chronic phlegm and blood stasis blocking lung collaterals,leading to lung collaterals blockage.Ye Tianshi proposed a theory that "collaterals only function normally when unblocked",under which the application of drugs for removing obstruction in collaterals during the acute phase of idiopathic pulmonary fibrosis can dredge the pulmonary collaterals and alleviate acute attacks.Nux vomica turns out to be effective in eliminating the pathogens of phlegm and blood stasis accumulated in the lung collaterals.Li Guangxi found in clinic that although the herb has toxicity,it can dredge collaterals powerfully and rapidly,and is often used to treat the syndrome of phlegm and blood stasis obstructing collaterals.Accordingly,applying nux vomica in a safe dose to treat acute attacks of idiopathic pulmonary fibrosis can significantly improve the clinical symptoms of patients and reduce the frequency of attacks.In this paper,the pathogenesis of acute onset of idiopathic pulmonary fibrosis is discussed,and the mechanism of action of nux vomica on acute onset of idiopathic pulmonary fibrosis is discussed from the perspective of traditional Chinese medicine and western medicine,as well as the precautions for its clinical application,in order to provide new ideas for the clinical treatment of idiopathic pulmonary fibrosis.