大承气汤治疗卒中相关性肺炎临证思辨

The Clinical Reasoning for Major Purgative Decoction for Treating Stroke-Associated Pneumonia

大承气汤出自张仲景的《伤寒论》,是下法的代表方剂,主要用于治疗阳明腑实、里热实证及热结旁流等,临床多用于治疗急腹症、肠梗阻与胃肠道功能障碍等疾病,在卒中相关性肺炎的治疗中也凸显了经方辨证施治的疗效和优势。大承气汤治疗卒中相关性肺炎时,运用“肺与大肠相表里”理论指导临床,不见咳治肺,不见肺治肺,而是通降腑气以清泄肺浊,充分体现了中医辨病论治和辨证论治的统一性。此外,辨标本缓急在治疗危急重病时尤为重要,复杂疾病的发展变化,常矛盾重重,需医者分清标本,审时度势,适时攻下。今后,还需要进一步加强临床研究和实践探索,挖掘大承气汤的治疗潜力,并探究其作用机制,为卒中相关性肺炎的治疗提供更加有效和安全的方法。

Major Purgative Decoction,originating from Zhang Zhongjing′s Treatise on Cold Damage Diseases,is a representative formula for purgative method,primarily used to treat yang brightness organ excess,interior heat excess syndrome,and heat accumulation binding with fluid retention.Clinically,it is often applied in cases of acute abdominal diseases,intestinal obstruction,and gastrointestinal dysfunction,while also demonstrating therapeutic efficacy in stroke-associated pneumonia(SAP).In treating SAP,Major Purgative Decoction is guided by the principle of"interior-exterior relationship between the lung and large intestine."Rather than directly targeting the lung,this approach focuses on unblocking and descending bowel qi to clear pulmonary toxins,thereby showing the unity of disease differentiation and syndrome differentiation in TCM.Furthermore,distinguishing primary and secondary factors and assessing urgency is crucial in managing complex,severe conditions,as treatment requires precise judgment and timely intervention.In the future,further clinical research and practice are needed to fully explore the therapeutic potential and mechanisms of Major Purgative Decoction,offering safer and more effective options for SAP treatment.