夏慧敏 陈志祥 张华

[摘要]慢性阻塞性肺疾病（COPD）是呼吸科常見病之一，以不完全可逆、进行性发展的气流受限性为特征，中医学认为 COPD 主要症状为咳痰喘，称为“肺胀、喘证”等，其基本病机为本虚标实，本虚多为肺脾肾虚，标实多为痰瘀，病位在肺，虚和痰贯穿疾病始终。COPD 稳定期的患者多表现为咳嗽咳痰，呼吸无力，动则气喘，伴见纳差消瘦等，归属于肺脾气虚之证。脾主运化，在体合肉，为“气血生化之源”“后天之本”，脾运化功能直接影响 COPD 稳定期患者的运动耐力及生活质量。张华主任临证时提倡肺脾同治，善用参苓白术散加减治疗稳定期 COPD，体现了“培土生金法”，疗效显著。该文介绍张华主任运用参苓白术散加减治疗 COPD 稳定期经验。

[关键词]慢性阻塞性肺疾病稳定期;肺脾同治;培土生金;参苓白术散

[中图分类号] R259  [文献标识码] A   [文章编号]2095-0616（2021）23-0108-04

An introduction to Zhang Hua's experience of treating chronic obstructive pulmonary disease at stable stage with modifiedShenlingBaizhu Powder

XIA  Huimin    CHEN  Zhixiang    ZHANG  Hua

1. Department of Respiratory and Critical Care Medicine， Professional Postgraduate Training Base of Wuhu Hospital of Traditional Chinese Medicine Affiliated to Anhui University of Chinese Medicine， Anhui， Wuhu 241002， China;2. Department of Respiratory and Critical Care Medicine，Wuhu Hospital of Traditional Chinese Medicine of Anhui Province，Anhui， Wuhu 241002， China

[Abstract] Chronic obstructive pulmonary disease （ COPD ） is one of the common diseases in respiratory department，which is characterized by incompletely reversible and progressive development of airflow limitation. Traditional Chinese medicine believes that the main symptoms of COPD are expectoration and asthma，which are called "lung distention and dyspnea" etc. The basic pathogenesis is deficiency in root and excess in manifestation. The deficiency in root is mostly the deficiency of lung，spleen，and kidney. The excess in manifestation is mostly phlegm stasis. The disease location is in the lung，and deficiency and phlegm run through the disease all the time. The patients with COPD at stable stage usually have the symptoms of cough and expectoration，lassitude in respiration，dyspnea on exercise，accompanied by anorexia and emaciation，which belong to the syndrome of Qi deficiency of lung and spleen. The spleen dominates the movement and transforms， and combines the flesh in the body，which is "the source of qi and blood biochemistry" and "the foundation of nurture". The transformation and transmission function of spleen directly affects the exercise endurance and quality of life of the patients with COPD at stable stage. In clinical practice，Director Zhang Hua advocates combined treatment of lung and spleen in treating COPD at stable stage with modified ShenlingBaizhu Powder， which show "the method of supplementing spleen to nourish lung" and produce remarkable curative effect. In this paper，Director Zhang Hua's experience of treating COPD at stable stage with modified ShenlingBaizhu Powder was introduced.

[Key words] Chronic obstructive pulmonary disease at stable stage;Combined treatment of lung and spleen; Supplementing spleen to nourish lung;ShenlingBaizhu Powder

慢性阻塞性肺疾病（chronic obstructive pulmonary disease， COPD）是一种不完全可逆、进行性发展的气流受限性呼吸科疾病，近年来发病率不断增长，已成为严重影响患者生活质量的重要疾病之一[1-2]。据不完全统计我国有近1亿 COPD 患者[3]。全球各个地区及年龄段 COPD 的患病率稍有不同，统计全世界30岁以上的人群，1990—2010年 COPD 患病率从10.7%增长到11.7%[4-5]。据调查，在我国不同地区 COPD 患病率波动值为3.9%～13.7%，严重危害着人民健康[6]。COPD 患病率高且为慢性病程，患者频繁就诊、频繁因急性发作住院，并需要长期治疗（如辅助供氧、药物），使用了大量的医疗资源[5]。目前各种常规的非中西药联合治疗药物方案虽可短期取得良好的临床疗效，但长期使用发生不良反应的概率也较大，并且长期反复大量用药使机体产生耐药性时也会直接严重影响此类药物的治疗效果[7-8]。……