刘建秋教授运用麻杏二三汤化裁治疗痰浊阻肺型慢性阻塞性肺疾病临证经验(1)
[摘要] 本文介绍刘建秋教授运用麻杏二三汤化裁治疗痰浊阻肺型慢性阻塞性肺疾病的经验缬菁。刘教授认为，慢性阻塞性肺疾病的发病机制为“正虚”与“邪实”相互作用，共同为病，而对于本病的治疗亦指出应先辨病之虚实。在多数情况下，慢性阻塞性肺疾病的稳定期常为虚证表现，而在其急性发作期则常为实证表现，且其“实”的发生多以“虚”为前提，本病即多以痰浊触动本虚而发。故治疗上先攻其“标”，进而兼顾其“本”，以此达到宣肺化痰、降气平喘之功。麻杏二三汤化裁即为刘教授根据本病的发病特点及相应症状，结合药物功效和配伍特点以及多年临床经验总结而得，且经多年实践应用，取得较满意疗效，值得临床进一步探究与应用。
[关键词] 慢性阻塞性肺疾病;痰浊阻肺;麻杏二三汤化裁;刘建秋教授
[中图分类号] R256.1 [文献标识码] A [文章编号] 1673-7210(2019)08(b)-0168-05
[Abstract] This paper introduces Professor Liu Jianqiu′s experience in treating chronic obstructive pulmonary disease with syndrome of turbid phlegm obstructing lung by Modified Maxing Ersan Decoction. Professor Liu believes that the pathogenesis of chronic obstructive pulmonary disease is the interaction between "vital qi deficiency" and "pathogen excess"， both are involved in the development of disease. And for the treatment of this disease， Professor Liu also points out that we should first distinguish deficiency syndrome and reality syndrome of the disease. In most cases， the stable period of chronic obstructive pulmonary disease is usually characterized by deficiency syndrome， while in its acute attack stage， it is characterized by excess syndrome， and the occurrence of its "excess" syndrome is mostly based on the premise of "deficiency"， the disease is mainly caused by phlegm turbid touching the deficiency of the original. Therefore， it is necessary to treat the "manifestation" first and then take into account the "root cause"， so as to achieve the effect of ventilating lung qi for dissipating phlegm and descending qi to relieve asthma. Modified Maxing Ersan Decoction was made by Professor Liu according to the characteristics and the corresponding symptoms of this disease， combined with the efficacy and compatibility of drugs and years of clinical experience. It has been applied for many years and achieved satisfactory results， which is worthy of further exploration and application in clinic.
[Key words] Chronic obstructive pulmonary disease; Turbid phlegm obstructing lung; Modified Maxing Ersan Decoction; Professor Liu Jianqiu
慢性阻塞性肺疾病為一种病情不断加重且气流受阻不完全可逆的肺部疾病，其多由吸烟、环境污染等因素所致，具有高病发率、反复发作的特点，给患者带来严重的心理负担，并使其生存质量下降[1-2]。刘建秋教授采用麻杏二三汤化裁治疗慢性阻塞性肺疾病(痰浊阻肺型)已然20余年，且已取得较显著的疗效，因此将其总结如下，以伺临床借鉴与推广。
1 病因病机
慢性阻塞性肺疾病即中医之“肺胀”“喘证”，而肺胀之病名早在《内经》中即有记载，并指出病因病机及其证候表现。《灵枢·胀论》记载：“肺胀者，虚满而喘咳。”而《金匮要略》则指出：“咳而上气，此为肺胀，其人喘，目如脱状。”其病因病机如下：
1.1 从肺论
肺胀之病变先责于肺。《灵枢·经脉》即有记载：“肺手太阴之脉……是动则病肺胀满膨膨而喘咳。”刘教授认为肺乃娇脏，主气，开窍于鼻，外合皮毛，故风寒湿等外邪侵袭人体，必先袭肺，进而影响肺之宣降，其气上逆而发为咳，升降失常而发为喘。正如《诸病源候论》记载：“肺胀则气逆，而肺本虚，气为不足，复为邪所乘，壅痞不能宣畅，故咳逆，短乏气也。”而肺疾反复发作，迁延不愈，可引起肺气虚衰，进而影响气之升降出入，肺气胀满于肺间，失于敛降，终发为肺胀。, 百拇医药(王雪慧 马莹 李竹英)
[关键词] 慢性阻塞性肺疾病;痰浊阻肺;麻杏二三汤化裁;刘建秋教授
[中图分类号] R256.1 [文献标识码] A [文章编号] 1673-7210(2019)08(b)-0168-05
[Abstract] This paper introduces Professor Liu Jianqiu′s experience in treating chronic obstructive pulmonary disease with syndrome of turbid phlegm obstructing lung by Modified Maxing Ersan Decoction. Professor Liu believes that the pathogenesis of chronic obstructive pulmonary disease is the interaction between "vital qi deficiency" and "pathogen excess"， both are involved in the development of disease. And for the treatment of this disease， Professor Liu also points out that we should first distinguish deficiency syndrome and reality syndrome of the disease. In most cases， the stable period of chronic obstructive pulmonary disease is usually characterized by deficiency syndrome， while in its acute attack stage， it is characterized by excess syndrome， and the occurrence of its "excess" syndrome is mostly based on the premise of "deficiency"， the disease is mainly caused by phlegm turbid touching the deficiency of the original. Therefore， it is necessary to treat the "manifestation" first and then take into account the "root cause"， so as to achieve the effect of ventilating lung qi for dissipating phlegm and descending qi to relieve asthma. Modified Maxing Ersan Decoction was made by Professor Liu according to the characteristics and the corresponding symptoms of this disease， combined with the efficacy and compatibility of drugs and years of clinical experience. It has been applied for many years and achieved satisfactory results， which is worthy of further exploration and application in clinic.
[Key words] Chronic obstructive pulmonary disease; Turbid phlegm obstructing lung; Modified Maxing Ersan Decoction; Professor Liu Jianqiu
慢性阻塞性肺疾病為一种病情不断加重且气流受阻不完全可逆的肺部疾病，其多由吸烟、环境污染等因素所致，具有高病发率、反复发作的特点，给患者带来严重的心理负担，并使其生存质量下降[1-2]。刘建秋教授采用麻杏二三汤化裁治疗慢性阻塞性肺疾病(痰浊阻肺型)已然20余年，且已取得较显著的疗效，因此将其总结如下，以伺临床借鉴与推广。
1 病因病机
慢性阻塞性肺疾病即中医之“肺胀”“喘证”，而肺胀之病名早在《内经》中即有记载，并指出病因病机及其证候表现。《灵枢·胀论》记载：“肺胀者，虚满而喘咳。”而《金匮要略》则指出：“咳而上气，此为肺胀，其人喘，目如脱状。”其病因病机如下：
1.1 从肺论
肺胀之病变先责于肺。《灵枢·经脉》即有记载：“肺手太阴之脉……是动则病肺胀满膨膨而喘咳。”刘教授认为肺乃娇脏，主气，开窍于鼻，外合皮毛，故风寒湿等外邪侵袭人体，必先袭肺，进而影响肺之宣降，其气上逆而发为咳，升降失常而发为喘。正如《诸病源候论》记载：“肺胀则气逆，而肺本虚，气为不足，复为邪所乘，壅痞不能宣畅，故咳逆，短乏气也。”而肺疾反复发作，迁延不愈，可引起肺气虚衰，进而影响气之升降出入，肺气胀满于肺间，失于敛降，终发为肺胀。, 百拇医药(王雪慧 马莹 李竹英)