| 陈洋溢,朱可奇.浙派名中医朱可奇肺结节诊疗思路经验撷要[J].浙江中医药大学学报,2023,47(6):647-650. |
| 浙派名中医朱可奇肺结节诊疗思路经验撷要 |
| Zhejiang Famous TCM Expert ZHU Keqi’s Thoughts and Experiences in Treating Pulmonary Nodules |
| DOI：10.16466/j.issn1005-5509.2023.06.013 |
| 中文关键词: 肺结节 中西医结合 中医整体观 辨证论治 辨体论治 名医经验 |
| 英文关键词: pulmonary nodules Chinese and western integrative medicine the holistic view of TCM syndrome differentiation and treatment constitutional differentiation and treatment experience of famous doctor |
| 基金项目:浙江省朱可奇名老中医专家传承工作室建设计划项目(GZS2020039)；宁波市医学重点扶植学科(2022-ZF03) |
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| 中文摘要: |
| [目的] 总结浙江省名中医朱可奇主任对于肺结节中医诊疗的思路经验，以期促进肺结节中医诊疗的发展并提高疗效。[方法] 通过收集分析朱师治疗肺结节的临证医案，结合其辨治体会与关于该病的论述，全面认识肺结节之病因病机，总结朱师论治肺结节的经验，并举医案加以论证。[结果] 朱师提出，肺结节基础病机为正气亏虚、痰瘀郁结，病位在肺，但与五脏合病，尤以肝脾肾三脏为甚，或因肝肺失调，气机不畅；或因肺脾亏虚，气化失常；或因肺肾不足，水液失司，终致痰瘀郁结。临证之时既要熟悉西医指南，辨识疾病风险，制定随访策略；又注重中医整体观指导下的病机认识与治疗，改善患者偏颇体质，谨守病机以补正气、化痰瘀、散毒结。所举医案中患者已过六八之数，其气已衰，外感内伤致气阴亏虚，痰湿郁结于肺，治以益气养阴、化痰散结，经治后肺结节消散。[结论] 中医防治肺结节应当坚持中西医结合，以风险辨识为前提，以辨证、辨体论治为核心要素，以综合评估和动态观察为重要手段，既需要在整体观指导下进行整体调治，又应重视局部病灶的动态变化。 |
| 英文摘要: |
| [Objective] To summarize the Zhejiang famous traditional Chinese medicine(TCM) expert Professor ZHU Keqi’s thoughts and experience in treating pulmonary nodules， in order to improve the curative effect of the TCM treatment of pulmonary nodules. [Methods] Based on the collection and analysis of Professor ZHU’s clinical cases of pulmonary nodules， combined with her experiences of treatment and the opinions of the disease， this paper discussed the etiology and pathogenesis of pulmonary nodules comprehensively， summarized Professor ZHU’s experience in treating pulmonary nodules， and a medical case was cited to demonstrate it. [Results] Professor ZHU puts forward that the basic pathogenesis of pulmonary nodules is deficiency of vital Qi and stagnation of phlegm and stasis， the disease is in lung， but it is combined with the five Zang organs， especially the liver， spleen and kidney， or because of the liver and lung disorder， the Qi movement is not smooth; or because of the lung and spleen deficiency， Qi transformation is abnormal; or because of the lung and kidney deficiency， liquid loses control， eventually leading to phlegm and stasis stagnation. At the time of clinical practice， doctors should not only be familiar with the guidelines of western medicine， identify the risks of disease， and formulate follow-up management strategies， but also pay attention to the pathogenesis and treatment under the guidance of the holistic view of TCM， improve patients’ biased constitutions， and abide by the pathogenesis to supplement healthy Qi， dissipate phlegm stasis and toxins. The patient in the mentioned medical case was 48 years old， and had Qi deficiency， exogenous and internal injuries result in deficiency of Qi and Yin， the phlegm appeared stagnant in the lung. He was treated to supplement Qi and nourish Yin， to resolve phlegm and dissipate the masses， and the pulmonary nodule was dispersed after treatment. [Conclusion] TCM prevention and treatment of pulmonary nodules should adhere to the integrated Chinese and western medicine. The therapeutic schedule takes risk identification as the premise， syndrome and constitutional differentiation and treatment as the core elements， and comprehensive assessment and dynamic observation as the important means， it not only should do the holistic treatment under the guidance of holistic view， but also should pay attention to the dynamic changes of local lesions. |
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