摘要
放射性肺损伤(radiation-induced lung injury,RILI)病机为热毒犯肺,早期以邪实为主,晚期以正虚为主,热毒贯穿疾病始终。由于火热毒邪有轻重、虚实之不同,清法可分为清伏透热法、清金降火法、清肺通络法、清补气阴法等。对于放射面积小、放射剂量少、临床发现早、症状表现轻微的患者,火毒之势不著,火微宜凉,用药宜轻,以麻杏甘石汤为基础方。短时间大剂量放疗导致疾病骤发或反复放疗致疾病复发、加重者,病势较急,热势偏重,当治以清金降火,以银翘散为基础方。随着RILI病程进展,所形成的肺纤维化与瘀血密切相关,当在清肺基础上,治以活血通络,以当归活血汤加减为基础方。病至后期,当时刻顾护气阴,以益气养阴为主,辅以清热润燥,方用沙参麦冬汤加减。
The pathogenesis of radiation-induced lung injury(RILI) is heat toxin invading the lung.In the early stage,it is mainly manifested as pathogenic excess,and in the late stage it is mainly manifested as deficiency of healthy qi.Heat toxin runs through the whole disease.Due to the different degrees of fire,heat and toxin,deficiency and excess,clearing methods can be divided into the following:method of clearing latent pathogens and eliminating heat in nutrient aspect;method of clearing lung fire;method of clearing lung and dredging collaterals;method of nourishing qi and yin.For the patients with small radiation area,low radiation dose,early clinical discovery and mild symptoms,if the fire toxin is not serious,the fire is mild,and the medication should be light.Ephedra and Apricot Kernel and Gypsum and Licorice Decoction can be chosen as the basic formula.If the short-term high-dose radiotherapy leads to sudden onset of disease or relapse and aggravation of disease caused by repeated radiotherapy,the disease is more acute,and the heat potential is more severe.Method of clearing lung fire should be used.Lonicera and Forsythia Powder can be chosen as the basic formula.With the progress of RILI course,pulmonary fibrosis is closely related to blood stasis according to TCM.On the basis of clearing lung fire,the treatment should be based on activating blood circulation and dredging collaterals,and the basic formula is Modified Chinese Angelica Blood-Activating Decoction.In the later stage of the disease,the treatment should focus on protecting and nourishing qi and yin at that time,supplemented by clearing away heat and moistening dryness.Modified Radix Adenophorae seu Glehniae and Radix Ophiopogonis can be adopted.
作者
郑延龙
朱振刚
李文治
ZHENG Yan-long;ZHU Zhen-gang;LI Wen-zhi(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin,China,300193;Traditional Chinese Medicinal Hospital of Qingdao West Coast New Area,Qingdao,Shandong,China,266500)
出处
《河南中医》
2020年第10期1471-1474,共4页
Henan Traditional Chinese Medicine
基金
国家自然科学基金项目(81673900)。
关键词
放射性肺损伤
清伏透热法
清金降火法
清肺通络法
清补气阴法
radiation-induced lung injury(RILI)
method of clearing latent pathogens and eliminating heat in nutrient aspect
method of clearing lung fire
method of clearing lung and dredging collaterals
method of nourishing qi and yin
