从肺主治节探讨低氧性肺动脉高压的中医辨治思路

Discussion on Traditional Chinese Medicine Differentiation and Treatment of Hypoxic Pulmonary Hypertension from the Perspective of Lung Being Responsible for Regulating Visceral Activities

低氧性肺动脉高压(hypoxic pulmonary hypertension,HPH)是临床的常见症,也是急危重症之一,中医药在其治疗上具有一定优势。通过分析中医理论中肺对气、血、水的治节作用,并结合低氧性肺动脉高压的发病基础、症状及病理生理特征等,认为HPH的病程演变即是肺对气、血、水的治节逐步失职的过程。HPH患者发病以气虚为基础,气虚、血瘀、水停为其重要病机。HPH早期以气虚为主,病位在肺,兼有瘀血痰浊内生,治疗重在益气,恢复肺对“气”的治节作用;晚期以血瘀、水停为主,由肺及心,以水饮泛溢为急,亦兼有气虚,治疗以活血化瘀、利水逐饮为主,重在恢复肺对“血、水”的治节作用。临证应重视肺对气、血、水的治节作用,把握患者病程演变中的气虚、血瘀、水停病机间的动态演变,分期、辨证施治以恢复肺主治节之职,提高低氧性肺动脉高压的临床疗效。

Hypoxic pulmonary hypertension(HPH) is common and is one of the critical diseases in clinic,and traditional Chinese medicine(TCM) has certain advantages in the treatment of HPS.By analyzing the regulatory effect of lung on qi,blood and water in the field of TCM,and based on the pathogenesis,symptoms and pathophysiological characteristics of HPH in the field of modern medicine,it is considered that the evolution of HPH is the process of lung's gradual dereliction of duty in the regulation of qi,blood and water.Qi deficiency is the fundamental pathogenesis of HPH patients,and qi deficiency,blood stasis and fluid retention contribute to the important pathogenesis of HPH.HPH in the early stage is due to qi deficiency,affects the lung,and is complicated with endogenous blood stasis and phlegm turbidity,which can be treated mainly by therapy of replenishing qi to restore the function of lung in regulating qi.HPH in the late stage is due to blood stasis and fluid retention,affects the heart from the lung,manifests as the acute syndrome of overflow of fluid retention complicated with qi deficiency.The treatment for HPH in the late stage can be achieved mainly by the methods of activating blood to remove stasis,promoting urination and expelling fluid retention,thus to restore the function of lung in regulating blood and water.In clinical practice,attention should be paid to the recovery of the function of lung in regulating qi,blood and water,and the dynamic evolution of qi deficiency,blood stasis and fluid retention in the course of disease should be mastered,and then staging treatment and treatment based on syndrome differentiation can be performed to restore the role of lung in regulating visceral activities,thus to improve the clinical efficacy of hypoxic pulmonary hypertension.