中医治疗慢性阻塞性肺疾病研究的策略与实践

文章围绕中医临床研究中若干关键问题,基于近年中医药治疗慢性阻塞性肺疾病(COPD)的主要研究进展并结合笔者的研究实践展开讨论。内容主要包括病机研究"正虚积损"理论的提出,证候分类与诊断标准的制定,疗效评价研究的系统评价和疗效的实证及综合评价方法的探索,诊疗指南的研究,疗效评价指标体系的建立与测评工具的研制,动物模型的建立与机制探讨包括稳定期模型的优化、COPD急性加重期(AECOPD)模型建立及病证结合模型的建立与评价等。文章还就有关COPD研究提出应着重4点:①病机与证候学研究应着眼于基于COPD变化规律而完善证候辨证的规范/标准并达到共识;②疗效评价研究要注重突出中医治疗优势评价方法的研究与应用;③诊疗指南制定应结合不同实际因素(地域、气候等)而不断完善更新;④有关模型的建立与应用等基础研究应结合中医药疗效特点和临床应用的实际而注重有关方法学研究。

Strategies and practice research for the treatment of chronic obstructive pulmonary disease by traditional Chinese medicine

Based on the research progress of traditional Chinese medicine(TCM) for chronic obstructive pulmonary disease(COPD) and the author’s study practice,the paper made a summary and discussion on the work-related issues of COPD,which were the proposal of the "accumulation of health qi deficiency damage on the lung" pathogenesis hypothesis,the establishment of the syndrome classification and diagnostic criteria,the study of curative effect evaluation,the research of the diagnosis and treatment guidelines,the development of the curative effect evaluation index system and the assessment tools,the build and evaluation of the animal model.There are four key points that should be attention for the treatment of COPD by TCM.The studies of pathogenesis and syndrome should focus on changing regular pattern of the disease to improve the standard of the contents of syndrome;the study of curative effect evaluation and its’ methods should not only follow the internationally recognized method but also highlight advantages of TCM evaluation method and application;the study of the formulation and application of the diagnosis and treatment guidelines should combine different actual factors(regional,climate,etc.) for continuous improvement,or formulate appropriate clinical diagnosis path by using the guidelines;the build and application of the animal model should combine characters of TCM evaluation and practical and useful methodology,which provided the basis for exploring the action mechanism,developing new drugs,optimizing treatment methods or study protocol.