CJI (Traditional Chinese Medicine)
“治未病”在支气管扩张症稳定期的运用
剡雄,王琦
中国中医科学院望京医院,北京 100102摘要:支气管扩张症稳定期临床症状虽不明显,但患者体内仍存在气滞、痰阻、血瘀和肺脾气虚的病理因素,处于“已病未病”状态。本文阐述了运用中医“治未病”思想进行干预治疗,未病先防,已病防变:防虚邪贼风、防气郁化火、防痰郁于肺、防久病入络,以预防支气管扩张症急性发作,改善患者肺功能,提高其生活质量。关键词:支气管扩张症;稳定期;治未病;中医疗法
DOI:10.3969/j.issn.1005-5304.2017.10.032
中图分类号:R259.622.2 文献标识码:A 文章编号:1005-5304(2017)10-0120-02
YAN Xiong, WANG Qi (Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China)
Abstract: Although the symptom of stable bronchiectasis is not significant, the four pathological factors including qi stagnation, sputum obstruction, blood stasis and lung-spleen qi vacuity still exist inside patients’ bodies, making them in the state of “both healthy and ill”. This article discussed the application of the idea of “preventive treatment” to intervene and treat, which could prevent the emergence of new diseases and the changing of existing diseases. It could prevent vacuity evil and bandit wind, depressed qi transforming into fire, phlegm depressed in the lung and channel obstruction caused by long-term diseases. It can effectively prevent the acute attack of bronchiectasis and improve the patients’ lung function and life quality.
Key words: bronchiectasis; stable phase; preventive treatment; TCM therapy
Application of “Preventive Treatment” for Stable Bronchiectasis
支气管扩张症是多种原因引起的支气管树病理性、永久性扩张,导致反复发生化脓性感染,感染和炎性病变恶性循环,使病情反复发作缠绵难愈,临床以慢性咳嗽、咳大量脓痰和反复咯血为主要特征[1]。西医在急性加重期以抗感染、止血等治疗为主,但在稳定期的有效治疗方法并不多。支气管扩张症稳定期的治疗目的在于抑制感染与炎症的恶性循环,减少急性加重次数,提高患者生活质量。
本病属中医学“咳嗽”等范畴。其稳定期虽然症状消失或轻微,但邪气未尽,正气未复,气血未定,阴阳未平。体内处于已有病因但尚未发病的状态,即“已病未病”或“欲病”状态。临床运用“治未病”理论,在支气管扩张症稳定期根据其病因病机特点给予提前干预治疗,做到“未病先防,防病于先;已病早治,防其传变;瘥后调摄,防其复发”。防治结合,防重于治,重视“治未病”,以期达到有效控制病程进展、防止急性发作、提高患者生活质量的目的。
1 扶正固表,防“虚邪贼风”
外感是诱发支气管扩张症急性加重的主要原因, 通讯作者:王琦,E-mail:2587705846@qq.com 《素问•至真要大论篇》云:“少阳司天,火淫所胜,则温气流行,金政不平,民病头痛……疮疡咳唾血。”说明外邪侵袭可致咳血。《素问•上古天真论篇》曰: “夫上古圣人之教下也,皆谓之虚邪贼风,避之有时。”《素问•风论篇》云:“风者善行而数变……故风者百病之长也。”一旦正气有所虚衰,首先伤人的就是风邪。风邪犯肺是诱发本病急性发作的关键,“治未病”第一要务是防“虚邪贼风”。临床上时刻嘱咐患者要“虚邪贼风,避之有时”“饮食有节,起居有常,不妄作劳”“精神内守,病安从来”。避免接触烟尘雾霾,戒除烟酒等不良嗜好,顺应季节气候变化,适时增减衣物,预防外感,可有效预防支气管扩张症急性发作。
“邪之所凑,其气必虚”“正气存内,邪不可干”。《灵枢•五变》云:“肉不坚,腠理疏,则善病风。”《素问•上古天真论篇》有“真气从之,精神内守,病安从来”,说明风邪致病的关键是正气虚弱,防御能力下降。现代医学认为,免疫功能缺陷是支气管扩张症形成的原因之一,也是反复急性加重的关键因素。免疫功能缺陷、气道防御功能下降、清除微生物能力下降,使微生物定植于气道内,产生长期慢性感染,运