【作者】 沈承玲；

【导师】 孙广仁；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2003， 博士

【摘要】 本文对饮的概念与饮证形成机理、寒饮蕴肺证的概念、寒饮蕴肺证的基本病机、肺阳在肺主行水中的作用、寒饮蕴肺证的病机关键与发病机理、寒饮蕴肺证的诊断与治疗及其类证鉴别等进行了系统全面的论证，丰富了寒饮蕴肺证理论。依据对寒饮蕴肺证形成的病因病机的认识，在本课题以前研究的基础上，结合当前肺病证候动物模型研究的进展情况，在寒冷的环境中，烟熏刺激，配以生理盐水输液，气管插管以控制通气量的方法，建立寒饮蕴肺证家兔病理模型，并用温阳化饮方进行干预，观察检测了相关指标如动脉血气，血与肺组织内皮素ET、NO的含量，肺组织iNOS及iNOSmRNA的表达，肺组织TNFαmRNA的表达等，以探讨寒饮蕴肺证的内在机制和温阳化饮方的作用机制，从而深化对肺主行水理论的认识。实验结果显示：模型组家兔的一般体征与寒饮蕴肺证的临床表现相符，微观指标的变化也与该证相关的肺系疾病一致，如家兔血与肺组织内皮素ET、NO的含量升高，肺组织iNOS及iNOSmRNA、TNFαmRNA的表达明显增强，肺组织出现炎性损伤。而治疗组的上述各项指标都有不同程度的改善。以上结果表明：寒饮蕴肺证病理模型的研制是比较成功的。TNFα、NO与iNOS、ET分别参与了寒饮蕴肺证的形成，它们之间还相互影响，促进该证的形成。温阳化饮方对寒饮蕴肺证确有较好的治疗效果，其疗效机制可能在于调控肺组织TNFα和iNOS的基因表达，使肺组织TNFα、ET与NO水平保持相对稳定，不仅能降低肺血管通透性，抑制肺组织充血、水肿，炎性渗出，保护肺组织损伤，而且能调节气道舒缩，改善肺通气。说明温阳化饮方的温补肺阳，蠲化寒饮及改善肺通气的作用，与其调控肺组织中的ET、NO、iNOS、TNFα等有关，这也可能是肺气行水的部分微观机制。更多还原

【Abstract】 This thesis expounds systematically the theoretic problems about the syndrome of accumulation of cold fluid in the lung, such as the conception of fluid-retention and the forming mechanism of fluid-retention syndrome, the conception and fundamental pathogenesis of the syndrome of accumulation of cold fluid in the lung, the lung yang’s role in the function of the lung’s promoting water metabolism, the key pathogenesis and the mechanism of the incidence of diseases related to the syndrome, the diagnosis and treatment of the syndrome as well as the differentiations of similar syndromes, so as to enrich the theory of the syndrome. Based on the understanding of the pathogenesis of the syndrome, the former study and the current progress about animal model study of syndrome in pulmonary diseases, pathologic rabbit models with the syndrome of accumulation of cold fluid in the lung were set up with the methods of smoke stimulation, infusion of physiologic saline and controlling the ventilating volume in the cold environment. The models were prevented and treated by "Yang-Warming and Fluid-Dispersing Formula". To approach the internal mechanisms of the syndrome of accumulation of cold fluid in the lung and the functional mechanisms of "Yang-Warming and Fluid-Dispersing Formula" so as to understand further the theory of the lung’s promoting water metabolism in TCM, the relevant indexes including arterial blood gas, the levels of ET and NO in blood and lung tissues, the expressions of iNOS, iNOSmRNAand TNF a mRNA in lung tissues, etc. were detected. The results of the experiment showed that not only general syndromes of the rabbits in the model group were in accord with clinical symptoms of patients with the syndrome of accumulation of cold fluid in the lung but also the changes of microcosmic indexes coincided with those of pulmonary diseases related to the syndrome. For examples, the levels of ET and NO in blood and lung tissues in the model group were higher than those in the control group, the expressions of iNOS, iNOSmRNA and TNF a mRNA in lung tissues were significantly reinforced and lung tissues were inflammatorily damaged, while the above indexes in the treatment group were improved in varying degrees. These results suggest that the development of pathologic rabbit models with the syndrome of accumulation of cold fluid in the lung is comparatively successful and reliable. TNF α , NO, iNOS and ET participate the forming mechanisms of the syndrome of accumulation of cold fluid in the lung respectively, furthermore, these indexes promote the forming of the syndrome by interaction. "Yang-Warming and Fluid-Dispersing Formula" has marked curative effect on the syndrome. The mechanisms of the effect are probably that it can maintain the levels of TNF a , ET and NO in lung tissues stable so as to reduce permeability of pulmonary vessels and inhibit hyperemia, edema and inflammatory effusing in lung tissues to protect lung tissues and regulate diastolization and contraction of airway to improve ventilation of the lung by controlling the gene expressions of iNOS and TNF a in lung tissues. That is, the functions of warming yang and dispersing cold fluid and improving ventilation of the lung of "Yang-Warming and Fluid-Dispersing Formula" have close relationship with its controlling ET, NO, iNOS, TNF a etc., and this is probably part microcosmic mechanism of the lung’s promoting water metabolism.更多还原