从“主客交”论慢性阻塞性肺疾病急性加重期之病机与治则

Exploration on the Pathogenesis and Treatment Principles of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Based on "Host-Guest Interaction" Theory

摘要:

慢性阻塞性肺疾病急性加重期（AECOPD） 是导致患者病情恶化与死亡的关键阶段，目前西医治疗虽能控制部分症状，但对其反复发作、缠绵难愈的深层病理环节干预有限。吴又可《温疫论》所创“主客交”理论，深刻阐释了正气内虚与邪气痼结的复杂病机。基于该理论，AECOPD的核心病机可阐释为宗气不足为本，外邪引动伏痰、痰热瘀毒交结为标，进而提出“扶正补虚以固其主，祛邪开痹以除其客，通络透邪以解其交”的辨治框架，其治本在于益气培元、调补肺脾肾，治标在于降气化痰、逐瘀解毒，以期为AECOPD的中医诊疗提供新的理论视角与临证思路。

Abstract:

Abstract： Acute exacerbation of chronic obstructive pulmonary disease （AECOPD） is a critical stage leading to disease deterioration and mortality of patients. While current western medical treatments can partially control symptoms， their intervention in the underlying pathological mechanisms of recurrent and persistent exacerbations remains limited. The theory of "host-guest interaction，" proposed by WU Youke in Wen Yi Lun （Treatise on Warm-Heat Pestilence）， profoundly elucidates the complex pathogenesis involving deficiency of healthy qi and entrenched pathogenic factors. Based on this theory，the core pathogenesis of AECOPD can be interpreted as congenital qi deficiency as the root cause， with external pathogens triggering latent phlegm and the intertwining of phlegm， heat， stasis， and toxins as the manifestations. Accordingly，a diagnostic and therapeutic framework is proposed："supporting healthy qi and tonifying deficiency to consolidate the host；eliminating pathogens and removing impediment to dispel the guest；and unblocking the collaterals and expelling pathogens to resolve their interaction." The fundamental treatment focuses on supplementing qi，nurturing the primordial qi，and regulating the lung，spleen，and kidney. The symptomatic treatment emphasizes directing qi downward，resolving phlegm，dispelling stasis，and removing toxins. This approach aims to provide a new theoretical perspective and clinical insights for the traditional Chinese medicine diagnosis and treatment of AECOPD.