从正气亏虚论治肺结节研究进展

A review on treating pulmonary nodules from deficiency of healthy Qi

肺结节是肺内常见的类圆形或不规则病灶,直径小于或等于3 cm。其在影像学上表现为密度增高的阴影,随着低剂量CT筛查的普遍发展,肺结节被发现的概率日益增高,通常在体检或治疗其他疾病时被偶然发现,多数患者无明显临床症状。肺结节属于临床难治性疾病,西医对其发病机制尚未有明确的认识,治疗上根据其风险程度的不同采取不同的治疗方法。对于风险较低的肺结节主要通过定期复查胸部CT来密切关注其变化,目前尚未提出系统的内科治疗方法;对于风险较高的肺结节则通过穿刺活检来确定是否需要手术切除治疗。中医学对本病的病因病机及治疗有着独到的见解。该病属于中医“肺积”的范畴,中医学认为肺结节病位在肺,基本病机为正气亏虚、痰瘀互结,其中以正气亏虚为本,痰瘀互结为标。在治疗上强调以扶正为本,兼以化痰祛瘀。中医学通过对人体气、血、阴、阳亏虚辨证论治,提出了不同的治疗方法。气虚者重在补益肺脾之气,佐以化痰祛瘀;血虚者强调养血健脾,因血不独生,赖气以生之,故在养血的基础上加以益气之品;阴虚者以益气养阴为主,兼以化痰祛瘀;阳虚者重在温阳散结,佐以活血通络。文章列举现代中医学家论治肺结节的经验,旨在为临床辨证论治肺结节提供思路。

Pulmonary nodules are common circular or irregular lesions in the lung with diameters less than or equal to 3 cm.It appears radiographically as a shadow of increased density,with the widespread development of low-dose CT screening,the probability of pulmonary nodules being detected is increasing day by day.Pulmonary nodules are usually found accidentally during physical examination or treatment of other diseases,and most patients have no obvious clinical symptoms.Pulmonary nodules are clinically refractory diseases,and Western medicine has not yet had a clear understanding of their pathogenesis.Different treatment methods are adopted according to their different risk levels.For pulmonary nodules with low risk,the changes of these nodules should be closely monitored through regular review of chest CT.No systematic medical treatment has been proposed.For lung nodules at higher risk,a needle biopsy is performed to determine whether surgical removal is required.Traditional Chinese medicine has unique insights into the etiology,pathogenesis and treatment of this disease.This disease belongs to the category“pulmonary accumulation”in traditional Chinese medicine.Traditional Chinese medicine believes that pulmonary sarcoidosis is located in the lung,the basic pathogenesis is the deficiency of healthy Qi(气),phlegm and blood stasis mutual junction,which is based on the deficiency of healthy Qi,accompanited by the combination of phlegm and blood stasis.In terms of treatment,the emphasis is placed on supporting the healthy Qi,and at the same time,eliminating phlegm and blood stasis.Traditional Chinese medicine puts forward different treatment methods through differentiation and treatment of Qi,blood,Yin(阴)and Yang(阳)deficiency in human body.For those with Qi deficiency,the treatment is mainly tonifying lung and spleen Qi,combined with removing phlegm and eliminating blood stasis;For those with blood deficiency,the treatment emphasizes nourishing blood and invigorating spleen,because blood depends on Qi to function,so Qi is supplemened on the basis of nourishing blood;For those with Yin deficiency,the treatment mainly focuses on invigorating Qi and nourishing Yin,simultaneously eliminating phlegm and removing blood stasis;For those with Yang deficiency,the treatment focuses on warmingYang and dispersing knot,accompanied by activating blood and clearing collaterals.The article enumerates the experience of modern traditional Chinese medicine practitioners in treating pulmonary nodules,aiming to provide ideas for clinical treatment of pulmonary nodules based on syndrome differentiation.