胸闷变异性哮喘(chest tightness variant asthma, CTVA)为支气管哮喘的特殊类型,因该病临床特征不明显,故极其容易误诊、漏诊,西医认为CTVA的发病可能是气道炎症、肺通气功能障碍、小气道功能障碍以及气道高反应,CTVA的患者呼出一氧化...胸闷变异性哮喘(chest tightness variant asthma, CTVA)为支气管哮喘的特殊类型,因该病临床特征不明显,故极其容易误诊、漏诊,西医认为CTVA的发病可能是气道炎症、肺通气功能障碍、小气道功能障碍以及气道高反应,CTVA的患者呼出一氧化氮水平明显增高,可作为辅助诊断,该病按哮喘治疗有效。文章基于“肝肺气机升降循环”理论,结合现代医学的相关知识共同探讨CTVA的诊治。“肝肺气机升降循环”理论最早来源于《素问·刺禁论》云:“肝生于左,肺生于右。”肝与肺一升一降、一生一杀,肝肺在气机运行方面相互协调、相互制约,肝升肺降如同一个动态回环,上下相召,左升右降,如环首尾,两者功能正常,才能共同维持机体的协调运转。“气机失常,百病由生”,肝肺升降失调可出现气滞、痰瘀及肺卫不固的表现,从而出现胸闷。本文基于CTVA患者的不同体质,辨证施治,总体以调理气机为主,使肝肺气机升降得复,胸闷症状得以减轻或消失,减少发病次数。Chest tightness variant asthma (CTVA) is a special type of bronchial asthma, because the clinical features of the disease are not obvious, therefore, it is extremely easy to misdiagnosis and miss diagnosis. The onset of Western medicine think CTVA may be airway inflammation, may be airway inflammation, lung ventilation dysfunction and airway hyperresponsiveness and small airway dysfunction, the level of exhaled nitric oxide in CTVA patients is significantly increased, which can be used as an auxiliary diagnosis, and the disease is effectively treated by asthma. This paper discusses the diagnosis and treatment of CTVA on the basis of the theory of “liver, lung and qi machinery lifting and circulation”, combined with the relevant knowledge of modern medicine. The theory of the rise and fall cycle of the liver and lung qi machinery was originally derived from the “Plain Question · Thorn Ban” cloud: “The liver is born on the left, the lung is born on the right.” Liver and lung rise and fall, a life kill, liver and lung in the operation of qi mutual coordination, mutual restriction, liver rise and lung fall like a dynamic loop, up and down, left rise and right fall, such as the ring head and tail, both function normally, in order to jointly maintain the coordinated operation of the body.” Qi machine disorder, all diseases from birth”, liver lung rise and fall disorder can appear qi stagnation, phlegm stasis and lung wei is not solid performance, resulting in chest tightness. In this paper, based on the different constitutions of CTVA patients, the treatment of syndrome differentiation is mainly to regulate the qi machinery, so that the liver and lung qi machinery can be restored, the symptoms of chest tightness can be alleviated or disappeared, and the frequency of incidence can be reduced.展开更多
目的:系统评价宽胸气雾剂干预院前胸闷痛病人的临床疗效和安全性。方法:检索中文数据库[中国生物医学文献服务系统(SinoMed)、维普(VIP)、中国知网(CNKI)和万方]和英文数据库(the Cochrane Library、EMbase、PubMed、Web of Science)从...目的:系统评价宽胸气雾剂干预院前胸闷痛病人的临床疗效和安全性。方法:检索中文数据库[中国生物医学文献服务系统(SinoMed)、维普(VIP)、中国知网(CNKI)和万方]和英文数据库(the Cochrane Library、EMbase、PubMed、Web of Science)从建库至2022年8月1日发表的宽胸气雾剂治疗胸闷痛的随机对照试验研究(RCT)。主要观察指标包括胸闷痛缓解率、心电图改善率和不良反应发生率。采用RevMan 5.3软件进行偏倚风险评价、Meta分析、敏感性分析和发表偏倚分析。结果:共纳入19项RCT,涉及2487例病人。Meta分析结果显示,宽胸气雾剂组(试验组)胸闷痛缓解率高于对照组,差异有统计学意义[RR=1.15,95%CI(1.06,1.25),P=0.001];心电图改善率与对照组相比差异无统计学意义[RR=1.04,95%CI(0.99,1.10),P=0.14];应用宽胸气雾剂不良反应发生率较应用硝酸甘油等常规药物低,差异有统计学意义[RR=0.41,95%CI(0.33,0.52),P<0.00001]。纳入的19项研究中仅有2项提及盲法(单盲),纳入文献质量偏低。结论:现有证据表明,宽胸气雾剂能提高胸闷痛缓解率,降低不良反应发生率,但心电图改善不明显。本研究纳入文献的方法学质量相对较低,仍然需要严格的、大样本的随机双盲试验加以验证宽胸气雾剂的临床疗效。展开更多
文摘胸闷变异性哮喘(chest tightness variant asthma, CTVA)为支气管哮喘的特殊类型,因该病临床特征不明显,故极其容易误诊、漏诊,西医认为CTVA的发病可能是气道炎症、肺通气功能障碍、小气道功能障碍以及气道高反应,CTVA的患者呼出一氧化氮水平明显增高,可作为辅助诊断,该病按哮喘治疗有效。文章基于“肝肺气机升降循环”理论,结合现代医学的相关知识共同探讨CTVA的诊治。“肝肺气机升降循环”理论最早来源于《素问·刺禁论》云:“肝生于左,肺生于右。”肝与肺一升一降、一生一杀,肝肺在气机运行方面相互协调、相互制约,肝升肺降如同一个动态回环,上下相召,左升右降,如环首尾,两者功能正常,才能共同维持机体的协调运转。“气机失常,百病由生”,肝肺升降失调可出现气滞、痰瘀及肺卫不固的表现,从而出现胸闷。本文基于CTVA患者的不同体质,辨证施治,总体以调理气机为主,使肝肺气机升降得复,胸闷症状得以减轻或消失,减少发病次数。Chest tightness variant asthma (CTVA) is a special type of bronchial asthma, because the clinical features of the disease are not obvious, therefore, it is extremely easy to misdiagnosis and miss diagnosis. The onset of Western medicine think CTVA may be airway inflammation, may be airway inflammation, lung ventilation dysfunction and airway hyperresponsiveness and small airway dysfunction, the level of exhaled nitric oxide in CTVA patients is significantly increased, which can be used as an auxiliary diagnosis, and the disease is effectively treated by asthma. This paper discusses the diagnosis and treatment of CTVA on the basis of the theory of “liver, lung and qi machinery lifting and circulation”, combined with the relevant knowledge of modern medicine. The theory of the rise and fall cycle of the liver and lung qi machinery was originally derived from the “Plain Question · Thorn Ban” cloud: “The liver is born on the left, the lung is born on the right.” Liver and lung rise and fall, a life kill, liver and lung in the operation of qi mutual coordination, mutual restriction, liver rise and lung fall like a dynamic loop, up and down, left rise and right fall, such as the ring head and tail, both function normally, in order to jointly maintain the coordinated operation of the body.” Qi machine disorder, all diseases from birth”, liver lung rise and fall disorder can appear qi stagnation, phlegm stasis and lung wei is not solid performance, resulting in chest tightness. In this paper, based on the different constitutions of CTVA patients, the treatment of syndrome differentiation is mainly to regulate the qi machinery, so that the liver and lung qi machinery can be restored, the symptoms of chest tightness can be alleviated or disappeared, and the frequency of incidence can be reduced.
