文章摘要
张艳,徐丽萍,关天容,等.从“风、毒”探讨宋欣伟分期诊治结缔组织病相关间质性肺病[J].浙江中医药大学学报,2021,45(8):829-834.
从“风、毒”探讨宋欣伟分期诊治结缔组织病相关间质性肺病
Discussion of the Stage Diagnosis and Treatment of SONG Xinwei on Connective Tissue Disease Related Interstitial Lung Disease from Wind and Toxin
DOI:10.16466/j.issn1005-5509.2021.08.004
中文关键词: 结缔组织病  间质性肺病      名医经验  分期诊治  宋欣伟  验案
英文关键词: connective tissue disease  interstitial lung disease  wind  toxin  clinical experience of famous TCM experts  staged diagnosis and treatment  SONG Xinwei  medical cases
基金项目:宋欣伟全国名老中医药专家传承工作室项目(国中医药人教函[2018]134号);浙江省教育厅一般科研项目(Y201738611)
作者单位E-mail
张艳 浙江中医药大学附属第一医院浙江省中医院杭州 310006  
徐丽萍 浙江中医药大学附属第一医院浙江省中医院杭州 310006  
关天容 浙江中医药大学附属第一医院浙江省中医院杭州 310006  
宋欣伟 浙江中医药大学附属第一医院浙江省中医院杭州 310006 sxw1055@163.com 
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中文摘要:
      [目的]探析宋欣伟教授治疗结缔组织病相关间质性肺病(connective tissue disease related interstitial lung disease,CTD-ILD)的临床经验,总结中西医结合诊治CTD-ILD的要点。[方法]通过临床跟师学习,收集病案,从中医病因病机、脏腑传变、中西药联合施治等方面对宋欣伟教授诊治CTD-ILD的中医理论及处方用药思路进行分析总结,并列举验案一则加以佐证。[结果]宋欣伟教授提出以“风、毒”分期论治CTD-ILD,急性期以治“风”为首,辨表里内外、兼夹传变,强调早期识别病情变化,谨防“炎症风暴”;慢性期以祛“毒”为要,并明确所合之邪,权衡病势及邪正盛衰,可重用虫毒之物以毒攻毒,并兼顾调补脾肾。所举验案为干燥综合征并发ILD,病程已属晚期,治以益气养阴、搜风攻毒、祛瘀通络,经投以生脉散加减,联合西药抗炎及抗肺纤维化治疗,终获良效。[结论]宋欣伟教授针对临床中CTD-ILD复杂性、异质性、难治性的特点,提出分期诊治理论,对于疾病的早期识别、个体化治疗以及中西医结合治疗时机的把握均具有重要的临床借鉴意义,值得学习和推广。
英文摘要:
      [Objective] To explore Professor SONG Xinwei's clinical experience in treating connective tissue disease related interstitial lung disease(CTD-ILD) and summarize the key points of combining traditional Chinese and western medicine in the diagnosis and treatment of CTD-ILD. [Methods]Through learning from teacher in clinical works and collecting the cases, Professor SONG’s diagnosis and treatment of CTD-ILD theory and prescription of medicine were analyzed and summarized from the Chinese medicine etiology, viscera transmission, combined treatment of traditional Chinese medicine(TCM) and western medicine. One clinical case was cited for verification. [Results] Professor SONG puts forward to stage treatment of CTD-ILD from“wind, toxic”. In acute phase, the treatment of “wind” is the most important, he distinguishes between exterior and interior, and mixed transmittal, emphasizing early identification of disease changes, be ware of “inflammatory storm”; in chronic phase, it is necessary to eliminate “toxic”, identify the pathogenic factors, analyze the disease trend and the pathogenic factors, and use insect drugs to treat poison with poison, as well as regulate the spleen and kidney. The case was a Sjogren syndrome complicated with ILD, the course of the disease had been late, after the application of modified Shengmai powder to tonify Qi and nourish Yin, expel wind and attack poison, remove blood stasis and dredging collaterals, combined with western medicine anti-inflammatory and anti-pulmonary fibrosis, finally the patient achieved good effects. [Conclusion] According to the clinical characteristics of the complexity, heterogeneity and refractory in CTD-ILD, Professor SONG proposes the theory of diagnosis and treatment by stages, which has important clinical reference significance for the early identification of the disease, individual treatment and the timing of integrated traditional Chinese and western medicine treatment, and is worth learning and promoting.
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