《黄帝内经》核心观念视角下从风、痰、虚探析支气管哮喘临证思路

Exploration of clinical thinking for bronchial asthma from the perspectives of wind, phlegm and deficiency based on the core concept of Huangdi Neijing

摘要

支气管哮喘简称哮喘，是临床常见的呼吸道异质性疾病，易反复且难以根治。本文基于《黄帝内经》（简称《内经》）核心观念探析哮喘的临证思路，提出运用象思维从病象入手认识哮喘，哮喘之象分为风、痰、虚三象。运用精气学说分析哮喘之象，正虚邪侵，痰浊窠臼；运用阴阳学说分析哮喘之象，阴阳乖戾，随期而变；运用五行学说分析哮喘之象，制化失序，脏腑传变。基于哮喘之象的解析拟定临证治疗策略，包括：审象用药，衷中参西；分期论治，精准把控，急性发作期祛邪为先、兼顾扶正，持续、控制期补精气为主、兼除伏邪；内外同调，针药并施。

Abstract

Bronchial asthma (referred to as asthma hereafter) is a commonly encountered heterogeneous respiratory disease in clinical practice, which is prone to recurrence and refractory to radical cure. Based on the core concept of Huangdi Neijing, this paper explores the clinical thinking for the diagnosis and treatment of asthma. It proposes to understand asthma starting from disease manifestations through xiang (image) thinking, and classifies the pathological xiang of asthma into three categories: wind xiang, phlegm xiang, and deficiency xiang. The pathological xiang of asthma is analyzed through the theory of essential qi, which manifests as healthy qi deficiency and pathogenic invasion, leading to the formation of entrenched phlegm turbidity as a persistent nidus. It is further interpreted via the theory of yin and yang, which presents as disharmony of yin and yang that fluctuates with different disease stages. Additionally, it is elucidated through the theory of five phases, which shows disorder of the generation and restriction cycles, accompanied by transmission and transformation among zang-fu organs. Based on the above analysis of the pathological xiang of asthma, clinical treatment strategies are formulated as follows: prescribing medication in accordance with xiang characteristics with integrated application of Traditional Chinese and Western Medicine; implementing stage-based treatment with precise management, in which priority is given to eliminating pathogenic factors with concurrent reinforcement of healthy qi during the acute exacerbation stage, and the core therapeutic principle is replenishing essential qi with concurrent elimination of latent pathogenic factors during the persistent and control stages; conducting simultaneous regulation of internal and external conditions with combined application of acupuncture and herbal medicine.

关键词

支气管哮喘 / 《黄帝内经》核心观念 / 象思维 / 风、痰、虚 / 临证思路

Key words

bronchial asthma / core concept of Huangdi Neijing / xiang thinking / wind, phlegm, deficiency / clinical approach

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基金资助

国家中医药管理局高水平中医药重点学科建设项目(zyyzdxk-2023252)