基于五脏相关理论探讨慢性阻塞性肺疾病及其合并症的病机演变

基于邓铁涛教授的五脏相关理论,结合现代医学研究成果,分析慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）及其并发症的病机演变规律。COPD的主病之脏为肺,同时与脾、肾、心、肝等密切相关,互相影响可致他脏之病。COPD患者反复外感后,可导致肺气亏虚,痰湿内生。痰留肺间致本脏传变而出现支气管扩张、肺癌;气虚不能助心行血,心血瘀阻则致高血压、心功能不全等心血管疾病;肺气亏虚,子病犯母,脾胃运化失司,痰湿内生则致胃食管反流病;肺气郁滞,肝失疏泄则致焦虑、抑郁等情志病;肺虚及肾,肾精亏虚,骨软无力则致骨质疏松;肺脾肾虚,呼吸不利,气道肌肉失养则致阻塞性睡眠呼吸暂停低通气综合征;肺胀病久,肺脾肾阴津亏损,燥热内盛则为消渴。临床治疗COPD应首先注意筛查其合并症,基于五脏相关理论,综合调理全身脏腑以防治COPD合并症,提高临床疗效。

Discussion on the Pathogenesis Evolution of Chronic Obstructive Pulmonary Disease and Its Complications Based on the Theory ofFive-Viscera Correlation

Based on Professor DENG Tie-Tao’s five-viscera correlation theory and the achievements of modern medical research, the pathogenesis evolution of chronic obstructive pulmonary disease（COPD） and its complications was analyzed. It is believed that COPD mainly involves the lung,and is also closely related to the spleen,kidney,heart and liver,which can affect each other and cause the disease of other organs. After repeated exogenous attack of pathogens,COPD patients usually have lung qi deficiency and internal retention of phlegm-damp. Phlegm retention in the lungs induces the self-transmission and change of the viscera which causes the development of bronchiectasis and lung cancer;qi deficiency fails in helping the heart to promote the movement of blood, and then the heart blood stasis and obstruction occurs which can cause cardiovascular diseases such as hypertension and cardiac insufficiency. For the child-organ disease affects its mother-organ,lung qi deficiency can induce the transportation and transformation disorders of the spleen and stomach and internal retention of phlegm-damp,which causes gastroesophageal reflux disease. Lung qi stagnation and liver failing in maintaining free movement of qi dysfunction can lead to the emotional diseases such as anxiety and depression. Lung deficiency affects the kidney, and then the depletion of kidney essence and deficiency of bones occur which can cause osteoporosis. The deficiency of lung,spleen and kidney results in the impairment of breathing and the malnutrition of airway muscle which causes obstructive sleep apnea-hypopnea syndrome. The prolonged lung distension results in the insufficiency of the lung,spleen and kidney yin and fluid and the internal abundance of dry heat which causes diabetes. During the clinical treatment of COPD, its complications should be identified firstly, and comprehensive regulation of the zang-fu organs based on five-viscera correlation theory should be performed for the prevention of the COPD complications,thus to enhance the clinical efficacy.