世界中医药
文章摘要
引用本文:王雨菡,于河,张文静,王振东,李勋欣,谷晓红.基于六维辨证观拆解慢性阻塞性肺疾病辨治体系[J].世界中医药,2024,(09):.  
基于六维辨证观拆解慢性阻塞性肺疾病辨治体系
Syndrome Differentiation and Treatment System for COPD:Interpretation Based on Six-dimensional Syndrome Differentiation Theory
投稿时间:2022-08-09  
DOI:10.3969/j.issn.1673-7202.2024.09.011
中文关键词:  六维辨证观  慢阻肺  急性加重期  稳定期  本虚标实  痰瘀互结  脏腑虚损  扶正祛邪
English Keywords:Six-dimensional syndrome differentiation theory  COPD  Acute exacerbation  Stable period  Asthenia in origin and sthenia in superficiality  Combination of phlegm and blood stasis  Weakness of the Zang-fu organs  Strengthening body resistance and eliminating pathogenic factors
基金项目:国家重点研发计划项目(2018YFC1704100,2018YFC1704101)——“道术结合”思路与多元融合方法的名老中医经验传承创新研究;名老中医经验挖掘与传承的方法学体系和范式研究
作者单位
王雨菡,于河,张文静,王振东,李勋欣,谷晓红 北京中医药大学北京100029 
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中文摘要:
      六维辨证观是综合多种辨证思维所提出的辨证观念,旨在从病因、病位、病期、病性、病势、病理等6个维度对疾病证态进行系统辨析,有利于临床把握整体,抓住机要。慢性阻塞性肺疾病(COPD)是一种以进行性气流受限和持续的呼吸道症状为特征的呼吸系统疾病,发病多责之于肺气本虚,内外感召或他脏及肺,常有慢性肺系疾病迁延日久或先天不足因素。病位主要在肺,最常波及脾肾,病久可牵连心肝及六腑,是典型的多系统复杂疾病。基本病机是本虚标实,即肺脾肾虚损,痰瘀互结成积,除见气虚气滞、阴阳虚损等病理状态外,还最常见痰饮瘀及微型癥瘕等病理产物。本病分期明确,卫气同病、气分期和气营同病阶段病情寒热之性及邪正之势多变,可因病邪性质、季节地域、体质等因素表现不一,需要谨慎判断和用药;气血同病阶段寒热错杂、虚实并见,治疗棘手,恰是中医药发挥优势的大好时机。
English Summary:
      The six-dimensional syndrome differentiation theory is a concept that integrates various syndrome differentiation approaches to systematically analyze disease syndrome states from six dimensions:etiology,location,stage,nature,trend,and pathology.This theory aids clinicians in comprehensively understanding diseases and identifying key aspects for treatment.Chronic obstructive pulmonary disease(COPD) is a respiratory disease characterized by progressive airflow limitation and persistent respiratory symptoms.Its onset is often attributed to an underlying deficiency of lung qi,combined with external and internal factors,or involvement of other organs affecting the lungs.COPD typically results from chronic lung diseases that persist over time or from congenital deficiencies.The primary location of the disease is the lungs,but it often affects the spleen and kidneys and can extend to the heart,liver,and six Fu organs with prolonged illness,making it a typical multi-system complex disease.The basic pathogenesis of COPD is characterized by asthenia in origin and sthenia in superficiality,specifically involving deficiencies in the lungs,spleen,and kidneys,along with the accumulation of phlegm and blood stasis.Pathological states such as qi deficiency,qi stagnation,and yin-yang depletion are observed,with phlegm,retained fluids,stasis,and micro masses being the most common pathological products.COPD has clear stages.In the stages where the protective qi and the qi level are affected,and in the stages where the qi and nutrient levels are involved,the nature of the disease(cold or heat) and the strength of the pathogenic and healthy qi vary widely.These variations depend on factors such as the nature of the pathogenic factors,seasons,regions,and individual constitution,requiring careful assessment and medication.In the stage where both qi and blood are affected,the condition involves a mix of cold and heat,and deficiency and excess are present simultaneously,making treatment challenging.This stage presents a prime opportunity for traditional Chinese medicine(TCM) to demonstrate its advantages.
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