基于复合病机理论探讨肺结节中医辨治思路

郁文越; 朱佳

doi:10.14148/j.issn.1672-0482.2023.0001

基于复合病机理论探讨肺结节中医辨治思路

doi: 10.14148/j.issn.1672-0482.2023.0001

郁文越^{1, 2,},
朱佳^1, ,

1.
南京中医药大学附属医院，江苏南京 210029
2.
南京中医药大学第一临床医学院，江苏南京 210023

基金项目:

国家中医药管理局第七批全国老中医药专家学术经验继承工作项目国中医药人教函〔2022〕76号

第四批江苏省名老中医药专家传承工作室建设项目苏中医科教〔2021〕7号

详细信息

作者简介:
郁文越，男，硕士研究生，E-mail：nzyywy@126.com

通讯作者:
朱佳，男，主任中医师，教授, 主要从事中医肺系病临床的研究，E-mail：jsnjzj@163.com

中图分类号: R256.19
计量
- 文章访问数: 105
- HTML全文浏览量: 5
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-04-19
- 网络出版日期: 2023-01-18
- 发布日期: 2023-01-10

Exploring the Idea of Chinese Medicine Treatment for Pulmonary Nodule Based on the Theory of Compound Pathogenesis

YU Wen-yue^{1, 2
,},
ZHU Jia^{1
, ,}

1.
The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
2.
The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China

摘要

摘要: 肺结节是临床上较为常见的疾病之一。根据国医大师周仲瑛教授复合病机理论，认为虚、郁、痰、瘀是肺结节形成的基本病因，痰瘀热郁、毒聚络损是肺结节癌变的关键因素；并根据复合病机理论从辨五脏以多脏兼顾、辨兼夹以多法并举、辨标本以扶正祛邪、辨转归以阻截传变四个方面探讨复法制方的基本思路，以期为肺结节中医辨治及组方提供借鉴和参考。
- 复合病机 /
- 周仲瑛教授 /
- 肺结节 /
- 辨治思路
Abstract: Pulmonary nodule is one of the common diseases in clinical practice. According to the theory of compound pathogenesis by Professor Zhou Zhong-ying, a master of Chinese medicine, he believes that deficiency, depression, phlegm, and stasis are the basic causes of pulmonary nodules. Besides, heat obstruction caused by phlegm and stasis, combined with collateral damage caused by toxin accumulation are the key factors for the canceration of pulmonary nodule. In addition, Professor Zhou also discusses the basic ideas of compound formulae based on the theory of compound pathogenesis from four aspects: differentiation of the five organs to consider multiple organs, differentiation of concurrent syndromes to combine various methods, differentiation of the root and symptoms to eliminate the pathogenic factors, and differentiation of the prognosis to avoid the disease deterioration, which provide reference for the differentiation and treatment of pulmonary nodules in Chinese medicine and the related formula prescription.
- compound pathogenesis /
- Professor Zhou Zhong-ying /
- pulmonary nodule /
- differentiation and treatment ideas

HTML全文

参考文献(32)

[1]	中华医学会呼吸病学分会肺癌学组, 中国肺癌防治联盟专家组. 肺结节诊治中国专家共识(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(10): 763-771. doi: 10.3760/cma.j.issn.1001-0939.2018.10.004 Lung Cancer Group of Chinese Medical Association of Respiratory Medicine, Expert Group of Chinese League against Lung Cancer. China expert consensus on diagnosis and treatment of pulmonary nodules (2018 edition)[J]. Chin J Tuberc Respir Dis, 2018, 41(10): 763-771. doi: 10.3760/cma.j.issn.1001-0939.2018.10.004
[2]	张晓梅, 姜良铎, 肖培新. 肺结节病因病机探讨[J]. 环球中医药, 2019, 12(3): 435-437. doi: 10.3969/j.issn.1674-1749.2019.03.032 ZHANG XM, JIANG LD, XIAO PX. Discussion on pathogenesis of pulmonary sarcoidosis[J]. Glob Tradit Chin Med, 2019, 12(3): 435-437. doi: 10.3969/j.issn.1674-1749.2019.03.032
[3]	潘越, 江启成. 健康体检人群肺结节检出情况及影响因素分析[J]. 预防医学情报杂志, 2020, 36(3): 356-359, 364. https://www.cnki.com.cn/Article/CJFDTOTAL-YFYX202003020.htm PAN Y, JIANG QC. Analysis of the detection of pulmonary nodules and its influencing factors in physical examination population[J]. J Prev Med Inf, 2020, 36(3): 356-359, 364. https://www.cnki.com.cn/Article/CJFDTOTAL-YFYX202003020.htm
[4]	朱丽娜, 刘丽坤. 中医治疗孤立性肺结节思路探讨[J]. 亚太传统医药, 2019, 15(2): 79-81. https://www.cnki.com.cn/Article/CJFDTOTAL-YTCT201902023.htm ZHU LN, LIU LK. Discussion on TCM treatment of solitary pulmonary nodules[J]. Asia Pac Tradit Med, 2019, 15(2): 79-81. https://www.cnki.com.cn/Article/CJFDTOTAL-YTCT201902023.htm
[5]	洪海都, 刘城鑫, 吴鹏, 等. 刘小虹辨治肺结节中医特色探析[J]. 中国中医基础医学杂志, 2020, 26(4): 539-541. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202004039.htm HONG HD, LIU CX, WU P, et al. Analysis of Liu Xiaohong's TCM characteristics in treating pulmonary nodules[J]. Chin J Basic Med Tradit Chin Med, 2020, 26(4): 539-541. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202004039.htm
[6]	高伟, 武维屏. 浅谈中医药干预肺部结节结癌转化进程[J]. 中华中医药杂志, 2021, 36(1): 217-220. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202101054.htm GAO W, WU WP. Preliminary analysis of nodules-cancer transformation of lung nodules based on traditional Chinese medicine intervention[J]. China J Tradit Chin Med Pharm, 2021, 36(1): 217-220. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202101054.htm
[7]	李志明, 王芬, 周天, 等. 从五脏生克制化关系探讨肺结节的绿色防治模式[J]. 吉林中医药, 2020, 40(7): 875-879. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJL202007011.htm LI ZM, WANG F, ZHOU T, et al. Study on the green prevention and treatment model of pulmonary nodules from the relation of interpromotion and restraint of the five Zang-organs[J]. Jilin J Chin Med, 2020, 40(7): 875-879. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJL202007011.htm
[8]	王冰. 黄帝内经素问注[M]. 北京: 人民卫生出版社, 1963. WANG B. Annotations to the Yellow Emperor's Inner Classic: Basic Questions[M]. Beijing: People's medical publishing house, 1963.
[9]	黄帝内经灵枢[M]. 成都: 四川科学技术出版社, 2008: 436. The Yellow Emperor's Inner Classic: The Spiritual Pivot[M]. Chengdu: Sichuan science and technology publishing house, 2008: 436.
[10]	李中梓. 医宗必读[M]. 天津: 天津科学技术出版社, 1999: 256. LI ZZ. Required Readings from the Medical Ancestors[M]. Tianjin: Tianjin science and technology publishing house, 1999: 256.
[11]	吴澄. 不居集[M]. 北京: 中国中医药出版社, 2002: 299. WU C. Monograph on Deficient Diseases[M]. Beijing: China press of traditional Chinese medicine, 2002: 299.
[12]	李玉波, 梁媛, 郝改梅, 等. 气郁的产生、病机演变及临床表现[J]. 北京中医药, 2019, 38(5): 463-466. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO201905018.htm LI YB, LIANG Y, HAO GM, et al. Onset, pathogenesis and clinical manifestations of qi depression[J]. Beijing J Tradit Chin Med, 2019, 38(5): 463-466. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO201905018.htm
[13]	朱震亨. 局方发挥[M]. 北京: 人民卫生出版社, 1956: 31. ZHU ZH. Elaboration on Formulas from the Imperial Pharmacy[M]. Beijing: People's medical publishing house, 1956: 31.
[14]	温笑薇. 168例肺结节患者证候分布特点研究[D]. 北京: 北京中医药大学, 2020. WEN XW. Study on syndrome distribution characteristics of 68 patients with pulmonary nodules[D]. Beijing: Beijing University of Chinese Medicine, 2020.
[15]	赵婷婷. 271例肺部结节患者中医证型分布及与体质的相关性分析[D]. 北京: 北京中医药大学, 2021. ZHAO TT. Distribution of TCM syndrome types in 71 patients with pulmonary nodules and correlation analysis with constitution[D]. Beijing: Beijing University of Chinese Medicine, 2021.
[16]	李七一. 周仲瑛教授论五脏痰瘀[J]. 北京中医, 1996, 15(3): 6-7. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO603.001.htm LI QY. Professor Zhou Zhongying's theory of phlegm and blood stasis in five Zang-organs[J]. Beijing J Tradit Chin Med, 1996, 15(3): 6-7. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO603.001.htm
[17]	李七一. 周仲瑛从痰瘀论治疑难病证九法[J]. 江苏中医, 1997, 29(6): 5-6. https://www.cnki.com.cn/Article/CJFDTOTAL-JSZY706.001.htm LI QY. Zhou Zhongying's nine methods of treating difficult diseases and syndromes from phlegm and blood stasis[J]. Jiangsu J Tradit Med, 1997, 29(6): 5-6. https://www.cnki.com.cn/Article/CJFDTOTAL-JSZY706.001.htm
[18]	周仲瑛. 国医大师周仲瑛[M]. 北京: 中国医药科技出版社, 2011: 396. ZHOU ZY. Zhou Zhong-ying: Master of Chinese medicine[M]. Beijing: China medico-pharmaceutical sciences and technology publishing house, 2011: 396.
[19]	张伟, 卢绪香. 浅析"肺毒"[J]. 中医学报, 2012, 27(12): 1556-1559. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201212009.htm ZHANG W, LU XX. Analysis on Lung toxicity[J]. Acta Chin Med, 2012, 27(12): 1556-1559. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201212009.htm
[20]	尤在泾. 金匮要略心典[M]. 上海: 上海人民出版社, 1975: 29. YOU ZJ. Personal Standards for the Essentials from the Golden Cabinet[M]. Shanghai: Shanghai people's publishing house, 1975: 29.
[21]	殷书敏, 徐振晔, 邓海滨, 等. 中医药重塑肿瘤微环境的作用机制与优势[J]. 上海中医药大学学报, 2019, 33(5): 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZD201905001.htm YIN SM, XU ZY, DENG HB, et al. Mechanism and advantages of traditional Chinese medicine in remodeling tumor microenvironment[J]. Acad J Shanghai Univ Tradit Chin Med, 2019, 33(5): 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZD201905001.htm
[22]	郁文越, 王谦, 朱博钰, 等. 运用益气养阴、解毒散结法治疗原发性支气管肺癌[J]. 中医杂志, 2021, 62(22): 2011-2014. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202122015.htm YU WY, WANG Q, ZHU BY, et al. Treatment of primary bronchial lung cancer with the methods of boosting qi and nourishing Yin resolving toxins and dissipating masses[J]. J Tradit Chin Med, 2021, 62(22): 2011-2014. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202122015.htm
[23]	陆乾人, 周庆华, 顾翔华, 等. "促阴限阳"诱导肺癌细胞凋亡探析[J]. 上海中医药杂志, 2011, 45(6): 12-15. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ201106004.htm LU QR, ZHOU QH, GU XH, et al. Analysis of Yin-producing and Yang-reducing therapy in inducing lung cancer cell apoptosis[J]. Shanghai J Tradit Chin Med, 2011, 45(6): 12-15. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ201106004.htm
[24]	贾勇圣, 郑建全. 癌基因和抑癌基因中的阴阳[J]. 中国中西医结合杂志, 2009, 29(1): 72-75. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ200901028.htm JIA YS, ZHENG JQ. Yin-Yang relationship between oncogene and antioncogene[J]. Chin J Integr Tradit West Med, 2009, 29(1): 72-75. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ200901028.htm
[25]	杨漾, 钟园园, 苏畅, 等. 基于阴阳理论探讨中医药干预铁死亡的研究进展[J]. 中国实验方剂学杂志, 2022, 28(11): 227-237. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202211027.htm YANG Y, ZHONG YY, SU C, et al. Traditional Chinese medicine intervention of ferroptosis based on Yin-Yang theory: A review[J]. Chin J Exp Tradit Med Formulae, 2022, 28(11): 227-237. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202211027.htm
[26]	朱静, 尚广彬, 张洁, 等. 自噬在中医药治疗肿瘤中的作用研究进展[J]. 中国实验方剂学杂志, 2019, 25(21): 220-226. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201921033.htm ZHU J, SHANG GB, ZHANG J, et al. Effect of autophagy in treatment of tumors with traditional Chinese medicine[J]. Chin J Exp Tradit Med Formulae, 2019, 25(21): 220-226. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201921033.htm
[27]	庞莉, 袁刘, 葛信国. 肿瘤炎性微环境与中医阴阳平衡的关系[J]. 中医杂志, 2018, 59(21): 1832-1835. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201821009.htm PANG L, YUAN L, GE XG. Relationship between inflammatory tumor microenvironment and balance of Yin and Yang in traditional Chinese medicine[J]. J Tradit Chin Med, 2018, 59(21): 1832-1835. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201821009.htm
[28]	周仲瑛, 周学平. 中医病机辨证学[M]. 北京: 中国中医药出版社, 2015: 175. ZHOU ZY, ZHOU XP. Pathogenesis Differentiation in Chinese Medicine[M]. Beijing: China press of traditional Chinese medicine, 2015: 175.
[29]	周仲瑛, 周学平, 郭立中, 等. 中医病机辨证新体系的构建及临床应用[J]. 江苏中医药, 2019, 51(2): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-JSZY201902002.htm ZHOU ZY, ZHOU XP, GUO LZ, et al. The construction and clinical application of new system of TCM pathogenesis differentiation[J]. Jiangsu J Tradit Chin Med, 2019, 51(2): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-JSZY201902002.htm
[30]	叶放, 周学平, 吴勉华, 等. 周仲瑛教授"复合病机论"探析[J]. 南京中医药大学学报, 2010, 26(4): 241-244. https://www.cnki.com.cn/Article/CJFDTOTAL-NJZY201004002.htm YE F, ZHOU XP, WU MH, et al. Analysis of Professor Zhou Zhong-ying's "theory of compound pathogenesis"[J]. J Nanjing Univ Chin Med, 2010, 26(4): 241-244. https://www.cnki.com.cn/Article/CJFDTOTAL-NJZY201004002.htm
[31]	周仲瑛, 周学平. 中医病机辨证学[M]. 北京: 中国中医药出版社, 2015: 255. ZHOU ZY, ZHOU XP. Pathogenesis Differentiation in Chinese Medicine[M]. Beijing: China press of traditional Chinese medicine, 2015: 255.
[32]	过伟峰. 审证求机知常达变: 周仲瑛教授谈中医临床辨证的思路与方法[J]. 南京中医药大学学报(自然科学版), 2000, 16(3): 133-136. https://www.cnki.com.cn/Article/CJFDTOTAL-NJZY200003001.htm GUO WF. Flexible analysis of pathogenesis in syndrome differentiation-prof. Zhou Zhong-ying's talk about syndrome differentiation[J]. J Nanjing Univ Tradit Chin Med(Nat Sci Edit), 2000, 16(3): 133-136. https://www.cnki.com.cn/Article/CJFDTOTAL-NJZY200003001.htm