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从五脏论治类风湿合并间质性肺炎

2022-01-06 风湿闰月说 网络

类风湿关节外受损最多的为肺部,主要是间质性肺部,肺部结节,活动期有部分会有胸腔积液,尤以类风湿关节炎合并间质性肺炎最常见。

类风湿关节炎是以滑膜炎和血管炎为病理改变、破坏外周关节及其周围组织并可累及全身多系统的自身免疫性疾病。

 

类风湿关节外受损最多的为肺部要是间质性肺部,肺部结节,活动期有部分会有胸腔积液,尤以类风湿关节炎合并间质性肺炎最常见。

 

 

什么是类风湿关节炎合并间质性肺炎?

 

类风湿关节炎合并间质性肺炎,即为中医“旭痹”内合“肺痹”,即“旭痹合肺痹”病名。

《素问·咳论篇》云“五脏六腑皆令人咳非独肺也”。

 

根据中医脏腑辨证理论,五脏痹、六腑痹均可引起肺痹之咳喘。

 

《医学真传·咳嗽》中云“诸病易治,咳嗽难以,诸病易治,咳嗽难医,夫所以难治者,缘咳嗽根由虽甚多,不止于肺”。

 

表明肺痹咳喘病因病机及治疗复杂,因此要抓住其根本,辨证论治。

 

从肺论治

 

《中藏经》曰“痹者风寒暑湿之气中于人脏腑之为也”,徐灵胎曰“诸病之中,惟咳嗽之病因各殊而最难愈”,外邪内伤皆可致咳。

 

(图源:摄图网)

 

尤其类风湿关节炎由皮毛入筋骨之痹,进一步发展,内舍脏腑而成肺痹。病程迁延,日久不愈,经脉、筋骨、脏腑郁滞致,气机受阻失调,有形之瘀或痰痹阻而致病。

 

类风湿关节炎合并间质性肺炎治疗时应内外同治,以补肺为主,《永类钤方》中补肺汤具有补气益肺,止咳平喘之效,研究显示能增强机体免疫力,有抑制炎症因子、抑制肺组织纤维化的作用。

 

从肝论治

 

《素问·咳论篇》曰:“五脏六腑皆令人咳,非独肺也……肝咳之状,咳则两胁下痛,甚则不可以转,转则两下满”。

 

在五脏引起咳嗽中,临床上肝咳常见,因五行相侮,肝气郁结,木侮金,故肝气犯肺,引发咳嗽。

 

《王氏医案释注·卷八》:“清肃之令不行,升降之机亦案”、“治节不行,一身之气皆失其顺降之机”

 

导致肺失清肃,气滞不畅,可出现胸闷咳嗽、喘息气急等症。且肝主筋,行气主疏泄,若肝气郁滞,痹阻经脉,则筋骨痹痛。

 

故治疗类风湿关节炎合并间质性肺炎时除活血化瘀,还要注意调节肝肺。

 

本病的发生早期与肝的关系非常密切。临床证型包括:肝肺热盛,痰瘀痹阻;肝肺气滞,筋脉痹阻;肝肺阴虚,脉涩络阻。

 

治疗则以清肝泄肺,化痰通瘀;疏肝解郁,化瘀通络;养肝润肺,养阴化瘀等法。

 

心论治

 

《素问·咳论篇》曰:“心咳之状,咳则心痛,喉中介介如梗状,甚则咽肿喉痛……”

 

心为五脏六腑之大主,与肺同属人体上焦,生理病理密切相关。

 

临床上多有心系病变引发咳嗽者,其病本在心,病标在肺,心肺同病。

 

(图源:摄图网)

 

类风湿关节炎合并间质性肺炎患者出现心脉病变时要注意心肺同治,心肺之病变常相关联,可分以下诸证:心肺热盛,热伤肺络;心肺阳虚,气虚血瘀;心脉瘀阻,肺失宣降;心肺阴虚,津亏不足。

 

治疗则以清心肺泻火,益气温阳补肺,养血化瘀通脉,益气生津止咳等为法。

 

从脾论治

 

《灵枢·经脉》曰“肺手太阴之脉,起于中焦,下络大肠,还循胃口,上膈属肺。”

 

《素问·经脉别论篇》中日“饮入于胃,游溢精气,上输于脾,脾气散精,上归于肺,通调水道,下输膀胱,水精四布,五经并行。”

 

类风湿关节炎合并间质性肺炎患者病因多是脾胃后天失养,脾胃强弱决定了痹病的发展趋势。故治疗肺痹,必须重视调理脾胃,治疗常以苓桂术甘汤温阳化痰,同时合以血府逐瘀汤等化瘀通络止痛。

 

从肾论治

 

《素问·咳论篇》中日“肾咳之状,咳则腰背相引而痛,甚则咳涎。“

 

肺为气之主,肾为气之根;肺主呼吸,肾主纳气。

 

有学者认为肺肾气阴两虚证是类风湿关节炎合并间质性肺炎最主要证型,占48.8%,其炎症活动程度最高。

 

《济生方》日“肾为生痰之本,肺为贮痰之器,脾为生痰之源,肺不伤不咳,脾不伤不久咳,肾不伤不咳不喘。”

 

病痹者多有先天肾气不足筋骨失养筋脉痹阻。

 

类风湿关节炎合并间质性肺炎患者,多为久病,久病伤肾,肾气不足,重在补肾化瘀、化痰止咳,以扶正为本,以整体辨证调节。

 

 

专家介绍
黄闰月

中西医结合临床医学教授

博士生导师  

国医大师李济仁教授学术传承人,广东省中医院风湿免疫研究团队负责人,中华中医药学会免疫分会青年副主委,广东省中医药学会风湿病专委会副主委,国家公派荷兰访问学者,广东省杰出青年医学人才,广东省中医院拔尖人才,首届广州市科普名师。

 

擅长:中西医结合诊治痛风、类风湿关节炎、强直性脊柱炎、银屑病关节炎、系统性红斑狼疮、干燥综合征等风湿免疫病。

 

 

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    2022-01-14 ms4000000813024725

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    2022-01-06 ms7000000167247375

    学习#学习#

    0

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    2022-01-06 ms3000001777893761

    学习

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    2022-01-06 ms5000000254917531

    讲的经典

    0

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