论“虚、痰、瘀、毒”对老年共病衰弱的辨证思考

Syndrome Differentiation Thinking of Deficiency,Phlegm,Blood Stasis and Toxin in Senile Patients with Multimorbidity and Frailty

共病严重威胁着老年人的健康和生存年限,是衰弱的独立危险因素,共病合并衰弱导致老人机体脆弱性增加,失能、多重感染、多脏器功能衰竭、病情恶化快、病死率高,是一个世界性的公共卫生问题,多学科就诊、多重用药、药物相关性消化道出血或肝肾功能损伤给治疗带来极大挑战。根据中医学辨证体系,老年衰弱基本病机是元气亏虚、形神耗损,而共病患者病程漫长,病理产物堆积,仍兼杂有“痰、瘀、毒”,除补益之外仍需配合不同治法,从整体改善患者身体机能。临床实践显示,中医药治疗能够明显减少共病衰弱患者药物不良反应发生率,改善日常生活方面的质量,降低其具体的住院率以及病死率,充分体现了中医药辨证治疗的优势。

Multimorbidities seriously threaten the health and life span of the elderly and are independent risk factors for frailty.Multimorbidities combined with frailty lead to increased vulnerability,disability,multiple infections,multiple organ failure,rapid deterioration of the disease and high mortality,which is a global public health problem.Multidisciplinary visits,multiple medications,drug-related gastrointestinal bleeding or liver and kidney function impairment pose great challenges for treatment.According to the syndrome differentiation system of traditional Chinese medicine,the basic pathogenesis of senile frailty is the deficiency of vitality,the depletion of physical and mental function,while multimorbidities have a long course of disease and the accumulation of pathological products,and are still mixed with“phlegm,blood stasis and toxin”.In addition to tonifying,different treatment methods are still needed to improve the overall physical function of the patients.Clinical practice shows that traditional Chinese medicine treatment can significantly reduce the incidence of adverse drug reactions in patients with multimorbidities,improve the quality of life and reduce the hospitalization rate and fatality rate,which fully reflects the advantages of traditional Chinese medicine syndrome differentiation.