基于“亢害承制”理论探讨脓毒症肺损伤的诊疗思路

Based on the theory “restraining excessiveness to acquire harmony” to explore the treatment of lung injury in sepsis

关键词:  亢害承制  脓毒症  肺损伤

Key words:  restraining excessiveness to acquire harmony  sepsis  lung injury

摘要:

目前现代医家对于脓毒症肺损伤的治疗多遵循脓毒症的辨证治法，治以清热解毒、化痰祛瘀、通腑泄热及补虚为主，易忽略肺脏的生理特性及肺脏与其余四脏之间的联系而笼统治之，效果往往欠佳。亢害承制理论不仅能阐明人体生理病理机制，更能运用其承制关系拟定相应治法，以达到扭转病势之目的。脓毒症肺损伤的病机为“正气虚弱，毒邪亢盛，肺失宣肃”，其发病过程与亢害承制规律相符，即邪势鸱张，亢而为害为发病之标，正气亏虚，承制不及为发病之本，五脏相关，相互累及为病进之因；宣肃失调，承制失常为发病之机。治疗上应立足于整体，“平其所亢，扶其不及”，驱毒邪平其所亢以治标，调五脏承而制之以固本，调气机承制宣肃以复肺；另附验案一则。

Abstract:

At present，modern clinicians mostly follow the traditional Chinese medicine（TCM） discriminate treatment of sepsis for pulmonary injury in sepsis，which is mainly based on clearing away heat and toxic materials，activating blood and dissolving stasis，resolving phlegm，venting heat from the intestines and replenishing deficiency. And it is easy to ignore the physiological characteristics of the lungs and the connection between the lungs and the other four organs，and adopt general treatment，but the clinical results are often suboptimal. The theory of “restraining excessiveness to acquire harmony” can not only clarify the physiological and pathological mechanism of the human body，but also use its relationship to formulate corresponding treatment methods to reverse the disease situation. The author believes that the pathogenesis of pulmonary injury in sepsis is “weakness of righteousness，hyperactivity of toxic evil，and the imbalance of the ascending and descending of pulmonary qi”，and it is consistent with the law of “restraining excessiveness to acquire harmony”. The excessiveness is the symptom of the disease，and the deficiency of positive qi is the root of the disease. As the five organs are related，mutual involvement is the cause of disease progression. And the imbalance of the ascending and descending of pulmonary qi is the mechanism of pathogenesis. The treatment should be based on the whole condition and take into account the physiological characteristics of the lung. Calm the hyperactivity and help the weak. Expel the toxic evil to calm its excessiveness and treat the symptom. Regulate the five organs to control the root of the disease. Regulate the ascending and descending to restore the pulmonary qi. The experimental case is attached.