夏逸飞 孙子凯

〔摘要〕 介绍孙子凯主任医师辨治哮喘-慢阻肺重叠（ACO）的经验。哮喘-慢阻肺重叠较单纯哮喘或慢阻肺而言，治疗难度更大，预后更差。孙老师强调肺脾肾亏虚是发病之本，痰饮为标，感受外邪是诱发因素。辨治应紧密结合病机特点，发时治肺，辨痰为要，兼顾其本;平时治本，补中益气，温阳固肾。用药精当，组方灵活，才能收获满意疗效。

〔关键词〕 哮喘-慢阻肺重叠;慢性阻塞性肺疾病;中医药疗法;孙子凯

〔中图分类号〕R256.1       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.05.013

〔Abstract〕 The experience of chief physician SUN Zikai in treating of asthma-chronic obstructive pulmonary disease overlap （ACO） was introduced. ACO is more difficult to treat and has a worse prognosis than either asthma or chronic obstructive pulmonary disease. Teacher SUN emphasized that the deficiency of lung， spleen and kidney is the root cause of the disease， and phlegm is the manifestation， and contracting the external pathogen is the inducing factor. Combined with the characteristics of pathogenesis， treating the lung at the time of onset， differentiating phlegm is essential， taking into account its root cause. In alleviating period， treating the root cause， invigorating spleen-stomach and replenishing Qi， warming Yang and invigorating the kidney， with excellent medication， flexible prescription and with satisfactory results.

〔Keywords〕 asthma-chronic obstructive pulmonary disease overlap; chronic obstructive pulmonary disease; traditional Chinese medicine treatment; SUN Zikai

支气管哮喘和慢性阻塞性肺疾病（简称慢阻肺）是两大常见的阻塞性气道疾病，临床上部分患者可同时具备这两种疾病的特征[1]。哮喘与慢阻肺共存，称为“哮喘-慢阻肺重叠（Asthma-COPD overlap， ACO）”。对于患有慢阻肺或哮喘的病人而言，其发病率介于15%～20%[2]。有学者认为，嗜酸性粒细胞与中性粒细胞共同介导的慢性气道炎症可能是ACO出现症状重叠的主要发病机制[3]。临床发现，本病通过治疗虽症状可部分或显著减轻，但疾病依旧存在进展，且需要高强度治疗[4]。研究显示，ACO较单纯慢阻肺或哮喘而言，急性加重事件次数更多，肺功能进展更快，死亡率更高[5-6]。

由于循证医学证据的缺乏，ACO暂无明确的定义和统一的诊断标准，在治疗上也未达成共识[7]。本病症状主要为咳嗽、咳痰、呼吸困难、胸闷气急、活动后喘息明显等，归属于中医学“哮病”“痰饮”“喘证”“肺胀”等范畴。孙子凯主任医师师承吴门名医曹世宏教授，跟随国医大师周仲瑛抄方数载，从事呼吸科临床工作二十余年，对ACO的治疗有独到之处，现结合临床经验与体会，总结辨证思路与治法如下。……