运用泽漆汤合泽兰、益母草辨治肺结节及术后合并胸腔积液的临证经验

Clinical Experience in Syndrome Differentiation and Treatment of Pulmonary Nodules and Postoperative Complicated with Pleural Effusion Using Zeqi Decoction Combined with Eupatorium japonicum and Leonurus japonicus

摘要: 肺结节是近年来的常见疾病，发病率和检出率逐年增高。目前西医对于肺结节多采用定期复查随访和手术治疗为主，治疗手段存在较大的局限性，对于尚未达到手术标准的患者没有有效的治疗策略，对于手术后的患者也没有进一步的诊疗方案。中医药在治疗肺结节及术后有独特的经验，黄师根据多年临证经验将其肺结节的病因病机归纳为“气郁为始、痰瘀为标、正虚为基”的动态演变过程。探讨肺结节及术后产生的痰、瘀、水、毒等病理因素的过程，分析肺结节及术后合并胸腔积液病因病机，提出了“调气活血，化饮利水，顾护肺气”的思想。通过运用经方——泽漆汤配伍泽兰、益母草治疗肺结节及其术后合并胸腔积液典型医案展示该治疗方案的临床疗效，为肺结节及术后合并胸腔积液的中医治疗提供理论参考与实践经验。

Abstract: Pulmonary nodules have become a common disease in recent years, with their incidence and detection rates increasing year by year. Currently, Western medicine mainly adopts regular reexaminations, follow-ups, and surgical treatment for pulmonary nodules, but these treatment methods have significant limitations: there is no effective treatment strategy for patients who have not met the surgical criteria, and no further diagnosis and treatment plan for patients after surgery. Traditional Chinese Medicine (TCM) has unique experience in treating pulmonary nodules and managing post-surgical conditions. Based on years of clinical experience, Professor Huang summarizes the etiology and pathogenesis of pulmonary nodules as a dynamic evolutionary process characterized by “qi stagnation as the initial cause, phlegm and blood stasis as the manifestations, and healthy qi deficiency as the foundation”. This paper explores the process of generating pathological factors such as phlegm, stasis, fluid, and toxin in pulmonary nodules and post-surgical cases, analyzes the etiology and pathogenesis of post-surgical pleural effusion associated with pulmonary nodules, and proposes the therapeutic concept of “regulating qi and activating blood circulation, resolving fluid retention and promoting diuresis, and protecting lung qi”. The clinical efficacy of this treatment plan is demonstrated through a typical medical case where the empirical prescription—Zeqi Decoction combined with Eupatorium japonicum and Leonurus japonicus is used to treat pulmonary nodules and post-surgical pleural effusion. This study provides theoretical references and practical experience for the TCM treatment of pulmonary nodules and post-surgical pleural effusion.