“辛以润之”辨治特发性肺纤维化

Treat Idiopathic Pulmonary Fibrosis by“Moistening with Pungent Herbs”

[目的]总结晏军主任“辛以润之”辨治特发性肺纤维化的临证经验。[方法]通过跟师学习,整理相关医案,归纳总结晏师对特发性肺纤维化病因病机的认识,阐述晏师运用补肾益肺消癥方治疗特发性肺纤维化的理论基础和临床用药经验,并附临床案例加以验证。[结果]晏师认为,特发性肺纤维化的病机为肺肾两虚,阴津不足,肺叶失养,而致肺痿;肺叶萎弱,宣降失司,气机壅滞,行水不能,痰饮内停,气滞血瘀,痰瘀内结,痹阻肺络而发肺痹,肺痹日久,功能失用,痿证加剧,肺痿肺痹相互影响、相互转化,其病理特点为气、血、痰互结。辛药能散能行,辛以入肺,辛通玄府,调气机,散血瘀,逐痰结,与特发性肺纤维化治则相合。晏师在临床中根据“辛以润之”创立补肾益肺消癥方,临床疗效良好。验案中特发性肺纤维化患者,辨证为肺肾两虚、痰瘀内蕴,以补肺益肾、化痰祛瘀法治之,方用补肾益肺消癥方加减,取得良好疗效。[结论]晏师运用“辛以润之”辨治特发性肺纤维化疗效显著,对临床具有较好的指导意义,值得学习和传承。

[Objective Objective]To summarize the clinical experience of Professor YAN Jun in treating idiopathic pulmonary fibrosis(IPF)with the principle of“moistening with pungent herbs”.[Methods Methods]Through attending the outpatient work and collating the relevant medical records,Professor YAN’s understanding of the etiology and pathogenesis of IPF was analyzed,and the theoretical basis,the clinical medication experience of Professor YAN in treating IPF by using Bushen Yifei Xiaozheng Formula were explained and verified with one clinical case.[Results Results]According to Professor YAN,the pathogenesis of IPF is deficiency of lung and kidney,deficiency of Yin and fluids,loss of nourishment of the lung lobes,resulting in lung impotence;the lung lobes are weak,dysfunctional in declaring and descending,leading to stagnation of Qi movement,inable to move water,phlegm and drink stopping,Qi stagnation and blood stasis,internal accumulation of phlegm and blood stasis,resulting in paralytic obstruction of the lung channels and the occurrence of lung paralysis,and the lung paralysis for a long period of time results in lung dysfunction and the aggravation of impotence.Pungent medicine can disperse and move,enter the lung,promote through the Xuanfu,regulate Qi,disperse blood stasis,expel phlegm and accumulated nodules,and is consistent with the treatment rule of IPF.Based on the principle of“moistening with pungent herbs”,Professor YAN creates Bushen Yifei Xiaozheng Formula.The cited IPF patient was deficiency of the lungs and kidneys,phlegm and blood stasis syndrome,the rule of tonifying the lungs and benefiting the kidneys,eliminating phlegm and removing blood stasis was applied,using Bushen Yifei Xiaozheng Formula,which had a good therapeutic effect in clinic.[Conclusion Conclusion]The efficacy of using“moistening with pungent herbs”in the treatment of IPF is remarkable,and it has a good significance for clinical guidance,which is worth studying and passing on.