基于火郁发之理论治疗慢性阻塞性肺疾病

Treatment of Chronic Obstructive Pulmonary Disease Based on the Theory of Expelling Stagnated Fire

摘要:

慢性阻塞性肺疾病（简称慢阻肺） 具有起病缓慢、慢性迁延、偶伴急性加重的特点，符合中医学慢性虚损性疾病的特征。笔者认为，火热内郁是慢阻肺驱动之病机核心；元气不升所致宗气不足与阴火内郁是慢阻肺形成之枢纽；内在伏火与营卫化源不足是急性加重发作之契机。若宗气不足，而阴火燔灼上焦，肺失清肃而宣降失司，则发为咳喘；营卫气血敷布失和，火炼液为痰，痰阻而血瘀，痰瘀互结，邪愈胶固，则使病程迁延。基于此观点，慢阻肺治疗可分期而行：稳定期升阳益气、泻阴火以固本，去菀陈莝以治标，从而改善症状、降低急性加重频率、减缓肺功能下降速度；急性加重期解散外邪，宣散火热，清肃肺气，根据外邪阻遏类型制定相应攻邪策略，速予火热实邪出路，在治疗中兼顾攻邪与扶正的平衡，改善其长期预后。

Abstract:

Abstract： Chronic obstructive pulmonary disease （COPD） is characterized by insidious onset， chronic progression， and occasional acute exacerbations， which aligns with the features of chronic consumptive diseases in traditional Chinese medicine （TCM）. The authors propose that internal stagnation of fire-heat is the core pathogenesis of COPD； insufficiency of pectoral qi due to impaired ascent of original qi along with internal stagnation of yin fire constitutes the pivotal mechanism in the formation of COPD；and latent internal fire together with insufficient generation of nutrient qi and defensive qi serves as the trigger for acute exacerbation of COPD. When pectoral qi is insufficient，yin fire flares in the upper energizer， impeding the purifying and descending function of the lung， leading to cough and dyspnea. When the distribution of nutrient qi，defensive qi，blood，and body fluids is impaired，fire scorches fluids into phlegm； phlegm obstructs and leads to blood stasis； phlegm blends with blood stasis， making the pathogenic factor more stubborn and the disease course protracted. Based on this perspective，this artical proposed that COPD can be treated in stages： during the stable phase， the approach is to elevate yang and boost qi， purging yin fire to consolidate the root，and remove stagnant pathogenesis to treat the branch，thereby alleviating symptoms，reducing the frequency of acute exacerbations，and slowing the decline in lung function. During the acute exacerbation phase，the approach is to dispel external pathogens， ventilate and disperse fire-heat， clear and purge lung qi， formulate pathogen-elimination strategies according to the type of external pathogen obstruction，promptly remove pathogenic fireheat， thereby maintaining a balance between eliminating pathogens and supporting healthy qi throughout long-term management and ultimately improving prognosis.