从《外科正宗》肺之“疮疡”探讨支气管扩张症的分期论治

Treatment of Bronchiectasis Based on the Theory of“Sores and Ulcers”in the Lungs from Orthodox Manual of External Diseases

从中医外科“疮疡”理论出发,认为“肺气亏虚,痰热伏聚,内外合邪”为支气管扩张症发生发展之潜在病因,“热入营血,痰瘀互结,酿脓蚀肺”为支气管扩张症急性加重期之病机,“脾胃虚弱,邪伏肺络,正虚邪恋”为支气管扩张症稳定期之病机。治疗上以陈氏《外科正宗》“疮疡”内治思想为纲领,以“消、托、补”为大法分期论治,早期以“消法”解表、化痰、清热,以期扭转截断,不使痰热闭肺;急性加重期“消”“托”并用,以清热解毒、通络透邪、托毒排脓、托里清中为法,减轻炎症损伤,促脓痰排出;稳定期当以补为主,以健脾补肺、益气养阴、阴阳同调为法,促进肺功能恢复,提高患者生活质量。

From the perspective of the theory of“sores and ulcers”in traditional Chinese surgical practice,it is believed that“deficiency of lung qi,accumulation of phlegm-heat,and the combination of internal and external pathogens”are the underlying causes of bronchiectasis development.“Heat entering the nutrient-blood,phlegm and stasis entangling,and pus formation eroding the lungs”represent the pathogenesis during the acute exacerbation phase of bronchiectasis.“Spleen and stomach deficiency,pathogens lingering in the lung network,and deficiency of healthy qi with lingering pathogens”represent the pathogenesis during the stable phase of bronchiectasis.Treatment is guided by the internal treatment principles of“sores and ulcers”outlined in Mr.Chen's Orthodox Manual of External Diseases,using the methods of“dispersing,supporting,and tonifying”for different stages of the disease.In the early stage,the“dispersing method”is employed to resolve exterior symptoms,dissolve phlegm,and clear heat,aiming to prevent the closure of the lungs by phlegm-heat.During the acute exacerbation phase,“dispersing and supporting”methods are combined to clear heat and detoxify,penetrate the network to expel pathogens,promote pus and toxin discharge,and support the interior to clear the middle,reducing inflammatory damage and promoting the expulsion of pus and phlegm.During the stable phase,“tonifying”is the primary approach,focusing on strengthening the spleen and lungs,invigorating qi and nourishing yin,and harmonizing yin and yang to promote recovery of lung function and improve the quality of life for patients.