摘要
慢性阻塞性肺疾病(COPD)的演变呈渐进式过程,围绕COPD不同阶段疾病特点和关键环节,采取分期、分级的防治策略与方法,可充分发挥中医药优势并提高临床疗效。在系统分析COPD分期、分级的临床特征与防治目标及中医病机与证候规律的基础上,提出中医药防治COPD分期、分级的防治策略与目标。1)根据疾病分期:稳定期的防治策略与目标是缓解症状、预防疾病进展、降低急性加重发生的风险,治疗应以"缓则治其本"为原则,法宜扶正(补肺、健脾、益肾)为主,佐以化痰、活血;急性加重期重在使本次急性加重的影响最小化、减轻临床症状、降低死亡风险,治疗应遵"急则治其标"原则,法宜清化宣降为主,包括清热化痰、燥湿化痰、温化寒饮、活血化瘀、宣降肺气等;急性加重危险窗期重在防止再次急性加重的发生、促进恢复进入稳定期,治疗当祛邪(化痰、活血)扶正(补益肺气、补肺健脾、补益肺肾等)并重。2)根据肺功能(气流受限严重程度)分级:GOLD 1、2级COPD患者重在保护肺功能、延缓疾病进展,治疗以扶正(补肺、健脾辅以益肾)为主,佐以化痰、活血;GOLD 3、4级患者重在减少急性加重、提高生存质量,治疗宜扶正(补肺、益肾辅以健脾)为主,佐以化痰、活血;晚期患者应注重合并疾病的防治、降低死亡风险、提高生存质量,尤其要注意降低慢性呼吸衰竭病死率,治疗应以益气、活血、化痰为主。
The evolution of chronic obstructive pulmonary disease(COPD)is a gradual process.Focusing on the characteristics and key links of different stages of COPD,adopting staged grading prevention strategies and methods is of great practical significance for giving full play to the advantages of traditional Chinese medicine(TCM)and improving clinical efficacy.Based on the systematic analysis of the clinical characteristics,prevention and treatment goals of COPD,and the pathogenesis and syndromes,this paper put forward the prevention and treatment strategies and goals of TCM prevention and treatment of COPD:(1)According to the stage of the disease:the prevention and treatment strategy and goal of the stable period is to relieve symptoms,prevent disease progression,and reduce the risk of acute exacerbation.The treatment should follow the principle of"treating the root causes for slow onset",and the methods should be enforcing healthy qi(tonifying the lung,invigorating the spleen,benefiting the kidney),accompanied by resolving phlegm and improving blood circulation.For the acute exacerbation period,it is to minimize the impact of this acute exacerbation,reduce clinical symptoms,and reduce the risk of death.The treatment should follow the principle of"treating the symptoms for acute onset",and the methods should be clearing,resolving,ventilating,and descending,including clearing heat and resolving phlegm,drying dampness and resolving phlegm,warming and resolving cold fluids,promoting blood circulation and removing blood stasis,and ventilating and descending lung qi.For the critical window of acute exacerbation,it is to prevent the occurrence of acute exacerbation and promote recovery into a stable period.The treatment should both eliminate pathogens(resolving phlegm and promoting blood circulation)and enforce healthy qi(tonifying and benefiting lung qi,replenishing the lung and strengthening the spleen,replenishing the lung and kidney,etc.).(2)According to the function of lung function(severity of airflow limitation):for COPD patients with Global Initiative for Chronic Obstructive Lung Disease(GOLD)level 1 and 2,the treatment should protect against the decrease of lung function and delay the progression of the disease.The treatment is based on enforcing the healthy qi(reinforcing the lung,invigorating the spleen,and replenishing the kidney),accompanied with resolving phlegm and promoting blood circulation;for patients of GOLD level 3 and 4,should focus on reducing acute exacerbation,improving quality of life,and the treatment should enforce the healthy qi(reinforcing the lung,benefiting the kidney,and invigorating the spleen),accompanied by resolving phlegm and promoting blood circulation;for advanced patients,should pay attention to the prevention and treatment of combined diseases,reduce the risk of death,improve the quality of life,especially pay attention to reducing the mortality rate of chronic respiratory failure,and the treatment should be based on replenishing vital energy,promoting blood circulation,and removing phlegm.
作者
李建生
余学庆
LI Jiansheng;YU Xueqing(Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan&Education Ministry of P.R.China/Henan Key Laboratory of Chinese Medicine for Respiratory Disease,Henan University of Chinese Medicine,Zhengzhou 450046;The First Affiliated Hospital of Henan University of Chinese Medicine)
出处
《中医杂志》
CSCD
北大核心
2019年第22期1895-1899,共5页
Journal of Traditional Chinese Medicine
基金
国家自然科学基金(81830116)
国家中医药管理局中医药行业科研专项(201507001-01)
国家重点研发计划(2018YFC1704800)
关键词
慢性阻塞性肺疾病
中医防治策略
分期防治
分级防治
chronic obstructive pulmonary disease
traditional Chinese medicine prevention and treatment strategy
staging prevention and treatment
grading prevention and treatment
