Treatment of bronchiectasis based on the theory of "pathogen hiding in lung collaterals"

ZHAI Ting; WANG Pan; WANG Yuan; HUANG Donghui; MENG Yufeng; WANG Huixian

doi:10.3969/j.issn.1006-2157.2023.06.017

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Treatment of bronchiectasis based on the theory of "pathogen hiding in lung collaterals"

Clinical Studies | 更新时间：2023-07-05

- Treatment of bronchiectasis based on the theory of "pathogen hiding in lung collaterals"
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 6, Pages: 853-858(2023)
- 作者机构：
  
  1.广州中医药大学　广州　510006
  2.苏州市中西医结合医院
  3.珠海市中西医结合医院
  4.北京大学人民医院
  5.广东省中医院珠海医院
- 作者简介：
  
  HUANG Donghui, Chief Physician, Doctoral Supervisor. Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, No.208, Yuehua Road, Xiangzhou District, Zhuhai 519000. E-mail: 13600001163@139.com
- 基金信息：
  
  National Natural Science Foundation of China(82074345);Research project of Guangdong Provincial Bureau of Traditional Chinese Medicine(20221362)
- DOI：10.3969/j.issn.1006-2157.2023.06.017
  CLC： R256.13
- Received：27 November 2022，
  
  Online First：12 April 2023，
  
  Published：30 June 2023
- 稿件说明：
移动端阅览
ZHAI Ting, WANG Pan, WANG Yuan, et al. Treatment of bronchiectasis based on the theory of "pathogen hiding in lung collaterals"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(6): 853-858.
DOI：

ZHAI Ting, WANG Pan, WANG Yuan, et al. Treatment of bronchiectasis based on the theory of "pathogen hiding in lung collaterals"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(6): 853-858. DOI： 10.3969/j.issn.1006-2157.2023.06.017.

摘要

支气管扩张症以反复气道感染、进行性炎症反应加重、肺功能持续下降为主要特点，气道重塑是其病理关键。运用中医学“伏邪”致病理论及“久病入络”理论阐释支气管扩张症发生气道重塑的动态演变过程具有重要意义。肺络细小而微，有运行气血、渗灌濡养之能，痰、瘀、热等伏邪有潜藏深远、自我积聚、蓄作有时、日久入络的致病特点。邪气伏藏，肺络功能结构因而改变，与支气管扩张症的细菌定植引起慢性炎症的过程密切相关。基于此，认为支气管扩张症急性期病机为外因触发，伏邪内动，痰火气急，邪壅络伤；稳定期病机为伏邪内潜，久病络损，肺虚络瘀，络息成积，“邪伏肺络”为支气管扩张症病机核心，伏痰贯穿整个病程始终。临证治疗应依据“络以通为用”辨证施治，急性期当辛以通络，剔络透邪；稳定期当补虚通络，扶正祛邪，以期为指导临床治疗提供新思路。

Abstract

Bronchiectasis is characterized by recurrent airway infections

a progressive inflammatory response

and persistent decline in lung function. Airway remodeling is the key to its pathology. It is of great significance to explain the dynamic evolution of airway remodeling in patients with bronchiectasis using the theory of "latent pathogen" and "chronic diseases affecting the collaterals"

which are essential pathogenesis theories of traditional Chinese medicine. Lung collaterals are small and microscopic

and they allow the flow of qi and blood to infiltrate and nourish the lungs. Phlegm

blood stasis

heat

and other latent pathogens can hide deep and distantly

causing self-accumulation and aggregation

time-delayed attacks

and long-term affecting the collaterals. The process by which the functional structure of the lung collaterals is changed due to the accumulation of evil qi is closely related to the process of chronic inflammation caused by bacterial colonization in bronchiectasis. Based on the above

our team believed that the pathogenesis of the acute stage of bronchiectasis is triggered by external factors

the internal hidden pathogens are activated

phlegm and fire mutually cause immediate qi activity

and the latent pathogens accumulate to damage the lung collaterals. The pathogenesis in the stable stage differs

in that the latent pathogens move inward

and the lung collaterals are damaged after prolonged disease

with lung deficiency and collateral stasis. Furthermore

pathogens from masses in collaterals due to long-term retention

and "pathogenic qi in the lung collaterals" is the core of the pathogenesis of bronchiectasis

and latent phlegm is present through the entire course of the disease. The clinical treatment of our team is based on the syndrome differentiation and treatment of "dredging collaterals to make it work"

which is mainly treated with a pungent drug. In the acute phase

pungent drugs should be used to dredge collaterals

clear collaterals

and remove pathogens

while the patient in the stable period should be treated by a tonifying deficiency

dredging collaterals

and supporting the healthy qi to dispel the pathogen. This approach provide new ideas for guiding clinical treatment.

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