基于古代文献探讨肺、胃相关胸痹辨治及其临床意义

A study on the differentiation and treatment of chest impediment related to lung and stomach and its clinical significance based on ancient literature

目前,在国家指南、行业标准的引导下,众多医家将胸痹等同于冠状动脉粥样硬化性心脏病(简称冠心病),并围绕冠心病这一特定病种对中医胸痹进行理论体系构架,指出心脉痹阻是胸痹的主要病机,而活血化瘀法为胸痹最主要的治法,这在一定程度上限制了中医对胸痹的认知与治疗。中医所述之胸痹是一大类病症,其主证症状相似,如胸闷如窒、胸痛彻背、短气不足息等,发病部位在胸廓、心下胃脘及以上。笔者通过梳理古代文献发现,与心系病相关之胸痹仅占一部分,另外还包括肺、胃相关疾患,且不在少数,而且与心系病的病机治则不同的是,与肺、胃系疾病相关之胸痹与两者的生理功能特点密切相关。肺位于上焦的胸廓之内,胃居中焦,在横膈之下,肺气主宣肃,胃气主通降,胸膈中气机的正常运转不离肺、胃两脏之调达,二者均以气为用,易生痰浊而阻滞气机升降,若病胸痹之症,其病机总不离阳虚、气郁、浊聚,病理产物围绕痰、气展开,病理过程中以虚、郁、闭并见为特点,后期均可见病情深入,由气及血,由经入络。本研究通过检索古代文献中“肺、胃相关胸痹”的有关内容,对肺、胃相关胸痹的病机与代表方药进行归纳总结与分类论述,指出在胸痹发生中肺、胃的中医学生理病理方面的关联性,揭示肺、胃相关胸痹治疗的共性,充分发挥中医异病同治的优势,从而拓宽临床应用,启发教学、科研。

At present,under the guidance of national guidelines and professional standards,many doctors equate chest impediment of traditional Chinese medicine with coronary heart disease of Western medicine,construct a theoretical framework for TCM chest impediment around the specific disease of coronary heart disease,and point out that heart vessel obstruction is the main pathogenesis of chest impediment,and that the method of promoting blood circulation to remove blood stasis is the most important treatment method for chest impediment,which to some extent limits the recognition and treatment of chest impediment in TCM.Chest impediment in TCM is a major type of diseases with similar main symptoms,such as chest tightness,chest pain penetrating the back,shortness of breath,etc.,and the onset site is in the thorax and upper abdomen.Through reviewing ancient literature,the author found that chest impediment related to heart diseases only accounts for a portion,and chest impediment diseases also include lung and stomach related diseases,and such diseases are not uncommon.Additionally,different from the pathogenesis and treatment of heart diseases,chest impediment related to lung and stomach diseases is closely related to their physiological functional characteristics.The lungs are located in the upper energizer and chest,while the stomach is located in the middle energizer and below the diaphragm.The lung Qi(气)is responsible for activating the flow of Qi,while the stomach Qi is responsible for keeping Qi flowing downward.The smooth operation of Qi in the chest and diaphragm is inseparable from the regulation of the lungs and stomach,both of which rely on Qi and are prone to producing phlegm and impeding the rise and fall of Qi.When the disease is caused by chest impediment,the pathogenesis is always related to Yang(阳)deficiency,Qi stagnation,and turbidity accumulation.Pathological products revolve around phlegm and Qi.The pathological process is characterized by a combination of deficiency,depression,and closure.In the later stage,the disease is aggravated,enters the blood from Qi and the collaterals from the meridians.By searching the relevant contents of“chest impediment related to lung and stomach”in ancient literature,this study summarizes and categorizes the pathogenesis and representative prescriptions of chest impediment related to lung and stomach,points out the physiological and pathological correlation between the lungs and stomach in the occurrence of chest impediment in TCM,reveals the commonalities in the treatment of chest impediment related to lung and stomach,so as to fully leverage the advantages of TCM in treating different diseases by the same mothod,thereby expanding clinical applications and inspiring teaching and research.