基于“形气神”三位一体角度探讨慢性阻塞性肺病稳定期的病机及治疗策略

Pathogenesis and Therapeutic Strategy for Stable Chronic Obstructive Pulmonary Disease from the Perspective of the Physique-Qi-Spirit Trinitarianism

摘要: 慢性阻塞性肺病(Chronic Obstructive Pulmonary Disease, COPD)其生理功能的持续衰退不仅给患者带来极大的健康心理压力，还带来巨大的社会经济负担。稳定期是慢性阻塞性肺病疾病管理的“黄金窗口期”，通过“药物 + 非药物”的综合干预，可显著延缓肺功能的下降、减少急性加重、改善生活质量，最终降低死亡率。形气神一体观源于《淮南子》，属中医理论从物质形态、能量功能、精神思维三个层面认识人体生理和病理的生命观。本文将“形气神三位一体观”引入COPD稳定期病机分析，认识到COPD稳定期的病机是一个以肺脾肾“形质亏虚”为根基，以“气虚气滞”为功能枢纽，以“痰瘀内伏”为有形病理产物，并受到“神志失调”深刻影响的复杂动态失衡系统。并基于“形气神三位一体观”的中医整体观，构建一个融药物治疗、康复锻炼、情志调摄于一体的综合管理模式，体现“形气神同调，心身共治”的观念，发挥中西医结合优势。

Abstract: The persistent decline in physiological function associated with Chronic Obstructive Pulmonary Disease (COPD) not only imposes substantial physical and psychological distress on patients but also incurs a significant socioeconomic burden. The stable phase represents a “golden window” for COPD management. Comprehensive interventions combining pharmacologic and non-pharmacologic modalities can effectively delay the decline in pulmonary function, reduce acute exacerbations, improve quality of life, and ultimately lower mortality rates. The holistic concept of Physique-qi-spirit, originating from “Huainanzi”, is a fundamental life perspective in traditional Chinese medicine (TCM) that understands human physiology and pathology across three interrelated dimensions: material form (physique), energetic function (qi), and mental consciousness (spirit). This study introduces the Physique-qi-spirit trinitarian perspective into the pathogenesis analysis of stable COPD. It recognizes that the pathogenesis of stable COPD constitutes a complex, dynamic imbalance system rooted in “deficiency of physique” involving the lung, spleen, and kidney, pivoting on functional disturbances characterized by “qi deficiency and qi stagnation”, manifesting tangible pathological products such as “hidden phlegm and static blood”, and profoundly influenced by “spirit-mind disharmony”. Grounded in the holistic TCM principle of the Physique-qi-spirit trinity, this paper proposes an integrated management model incorporating pharmacotherapy, rehabilitation exercises, and emotional regulation. This model embodies the concept of “simultaneous regulation of physique, qi, and spirit, and concurrent treatment of mind and body”, thereby leveraging the synergistic advantages of integrated traditional Chinese and Western medicine.