作者：崔力心，张新宇，周瑞玲，马秋晓，张雯，张琼

单位：

1.北京中医药大学2.中国中医科学院西苑医院呼吸科

Units：

1.Beijing University of Chinese Medicine, Beijing 100029, China 2.Department of Pneumology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China

关键词：

肺疾病,慢性阻塞性; 肺动脉高压; 血管重塑; 血不利则为水;

Keywords：

Pulmonary disease, chronic obstructive; Pulmonary hypertension; Vascular remodeling; Unsmooth blood circulation resulting in water retention

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.148

Funds：

国家自然科学基金面上项目（81673817）；中国中医科学院科技创新工程（CI2021A01106）

摘要：

慢性阻塞性肺疾病（COPD）是我国常见的呼吸系统疾病，近年来其发病率和死亡率逐年攀升。肺动脉高压（PH）可促使COPD发展为右心衰竭，增加患者的死亡风险，现受到研究者重视。医学研究表明，肺血管重塑是COPD继发PH的重要病理环节，但由于其病因复杂，尚无特效西医治疗手段，而中医辨证施治具有因人制宜等独特优势。“血不利则为水”理论出自《金匮要略》，笔者立足于该理论认为脏腑亏虚引起血水不利是COPD继发PH的始动环节，血水失衡所生瘀血及痰饮是肺血管重塑的重要机制，同时也是导致肺血管重塑进展的关键。因此，治疗COPD肺血管重塑应以“血水同治”贯穿始终，兼顾补益脏腑。本文基于“血不利则为水”理论浅析COPD肺血管重塑的病机及辨治COPD肺血管重塑的思路，以期为中医辨治COPD继发PH提供思路。

Abstract：

Chronic obstructive pulmonary disease (COPD) is a common respiratory system disease in China, and in recent years, its incidence and mortality rates have been increasing year by year. Pulmonary hypertension (PH) can promote the development of COPD into right heart failure and increase the risk of death in patients, and it is now receiving increasing attention from researchers. Medical research has shown that pulmonary vascular remodeling is an important pathological process in COPD with secondary PH. However, due to the complexity of its etiology, there is still no specific Western medicine treatment for it, while the traditional Chinese medicine treatment has unique advantages such as personalized treatment. The theory of "unsmooth blood circulation resulting in water retention" comes from the Essential Prescriptions of the Golden Coffer. Based on this theory, the author believes that the viscera and bowels deficiency causes blood and fluid to flow poorly, which is the starting point of COPD with secondary PH. The imbalance of blood and fluid gives rise to static blood and phlegm reltention, which are important mechanisms of pulmonary vascular remodeling and are also key factors leading to its progression. Therefore, the treatment of pulmonary vascular remodeling in COPD should be based on the principle of "treating blood and fluid together" while also nourishing the organs. This article provides an analysis of the pathological mechanism and the dialectical treatment ideas for COPD with pulmonary vascular remodeling based on the theory of "unsmooth blood circulation resulting in water retention" , with the aim of providing ideas for utilizing the traditional Chinese medicine to treat COPD with secondary PH.

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