【作者】 卢绪香；

【导师】 张伟；

【作者基本信息】 山东中医药大学 ， 中西医结合临床， 2012， 博士

【摘要】 目的：依据中医对“毒”的认识，结合临床资料研究，寻找肺系病的症状、证候、用药规律，总结其共性，在此基础上探讨肺毒的形成机理、病性特点、致病特点以及治疗原则，并且构建肺毒病的理论体系，制定相应的诊疗规范，为临床肺系病的诊疗提供宏观的理论依据，以期肺毒学说的研究将为脏腑毒理论体系的建立提供理论模板，可为肺系难治性疾病的诊疗提供新的思路和理论依据，或为肺系病新药开发或诊疗方法优化提供理论借鉴。方法：应用文献学研究法和医学统计法相结合的方法进行肺毒的探讨。首先，应用文献学研究方法梳理历代医家对“毒”的中医认识，整理各医家从“毒”论治肺系病的研究现况；继之以毒邪理论为研究依据，进一步对临床资料进行研究，统计分析肺系病的病、症、证、药的规律性，借鉴毒邪理论，构建肺毒学说；最后构建肺毒病的理论体系，制定相应的诊疗规范，以指导临床诊疗。结果：第一，梳理有关“毒”的中医认识及“毒邪理论”的研究动态及水平，结合从“毒”论治肺系病的研究现况，提示“肺毒”致病的广泛性和普遍性，亟待进行系统研究，凝练科学假说，指导临床实践。第二，临床研究显示，咳痰喘为肺系病的常见、普遍症状；痰证、瘀证、肺气虚证在肺系病证候中占主导地位；肺系病用药经统计显示，具有宣降肺气、化痰、活血、补气功效的药物占主导地位。第三，提出“肺毒学说”。第四，制定肺毒病诊疗规范。结论：笔者认为肺毒系指无论外感还是内伤之邪，毒害部位在肺，影响肺的生理功能，致使肺脏气血津液失调而产生的客观存在的有毒害物质。肺毒包括痰毒和瘀毒。肺毒病性多热，致病特点概括为：伏藏性、依附性、从化性、正损性、顽恶性。肺毒病治疗应以调气、解毒、扶正为基本原则，兼有表证者治以解表达邪，或疏风清热，或疏风散寒，或疏风清肺，另仍需按本虚标实的主次酌情兼顾。同时除直接治肺之外，还应从整体出发，注意治脾、治肝、治肾等。更多还原

【Abstract】 Purpose:This is a review based on the theory of "Toxicity" in traditional Chinese medicine (TCM), and clinical literature review, aims at seeking for the symptoms, syndromes, and TCM regularity, summarizing the universality, and discussing the mechanism, characteristics, pathologies and therapeutic principles of the pulmonary system diseases. It also aims at establishing a theoretical system and the relative criteria for Lung Toxicity diseases, providing a theoretical model for the theoretical system of internal organs toxicity, offering new directions and theoretical basis of refractory diseases in pulmonary system, and providing theory references for the new medicine development or optimizing treatment for the pulmonary system diseases.Methods:A combination method of literature review and medical statistics in discussing "Lung Toxicity" theory was used in this study. First of all, a thorough literature review of the "Toxicity" theory from all the pioneers in the past was performed; experiences and point of views regarding the treatment of pulmonary system diseases from the etiology of "Toxicity" were classified. Then, based on the "Toxicity" theory, the diseases, symptoms, syndromes, and treatment of pulmonary system diseases were statically analyzed from previous published clinical studies, referencing to the "Toxicity" theory, building up the "Lung Toxicity" theory. At the end, a theoretic system of "Lung Toxicity" was proposed, and relative treatment standards were suggested, helping guiding clinical diagnosis and treatment.Results:1. Reviewed the relative TCM theories and the current research tendencies and directions of "Toxicity" theory. Current research results indicated the high pervasiveness and universality of "Lung Toxicity" pathology, and a system research is in need. Hypothesis was compacted and discussed in the conduction of clinical practice.2. Clinical studies indicated that cough, sputum, and asthma are the most common symptoms in pulmonary system diseases; the phlegm syndrome, stasis syndrome, and the Qi deficit in lung are the three main syndromes in pulmonary system diseases; the statistics indicated herbal medicine functioning in regulating Qi in pulmonary system, reducing phlegm, invigorating the circulation of blood, and tonifying Qi are mainly used in pulmonary system diseases.3. Proposed "Lung Toxicity" hypothesis.4. Suggested "Lung Toxicity" diseases treatment standards.Conclusions:"Lung Toxicity" is the harmful substance resulted by the pathology in pulmonary system, which disturbances the normal pulmonary system functions, and leads to the disorders of the Qi, blood, and fluid. It includes both phlegm and stasis syndromes, and most likely heat in nature. Pathogenic characteristics can be concluded as:terma, anaclisis, caprice, harm, and malignancy. The therapeutic principles are regulating Qi, detoxify, and strengthening healthy energy. For those illness at exterior, relieve of the exterior is recommended, treatment principles include:treat the heat pathology, treat the cold pathology, or treat the lung channel pathology. The nature such as manifestation or root cause, excess or deficiency is also important to be identified. When dealing with the pulmonary system pathology, the whole body balance should be considered, spleen system, liver system or kidney system should be treated if necessary.更多还原