基于“窠囊痰瘀”理论探析特发性肺纤维化的病机与辨治

The Pathogenesis and Treatment of Idiopathic Pulmonary Fibrosis Based on the Theory of “Ke Nang Tan Yu” (“Saccular Lesions with Phlegm-Stasis”)

摘要: 特发性肺纤维化(IPF)是一种病因未明、进行性发展的慢性肺间质疾病，现代医学治疗手段有限，预后不佳。中医理论体系中的“窠囊”学说常被用以阐释痰瘀互结、深伏成巢的顽固性病理状态。IPF临床所见的持续加重的呼吸困难、咳嗽及影像学上特征性的网格影、蜂窝影，恰与“窠囊”作为有形之邪，痼结肺络，阻碍气机与血行的致病特点高度契合。其病机核心可概括为肺、脾、肾三脏功能失调，气机郁滞为先导，津凝为痰，血滞为瘀，终致痰瘀胶结，形成“窠囊”这一结构性病理产物。基于“窠囊痰瘀”理论与IPF在病机与辨治上的内在联系，IPF治疗上应确立“标本兼治，攻补并施”的总体原则，并采用“涤痰”、“逐瘀”、“治气”的方法进行辨治。

Abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic yet progressive pulmonary interstitial disease with an unclear pathogenesis, limited treatment options, and poor prognosis. In traditional Chinese medicine, the term “Ke Nang”, which refers to saccular pathological pockets, is often used to describe the pathological state of certain refractory and complicated diseases, with the coagulation of phlegm and stasis being its main pathogenic factor. The symptoms of IPF—characterized by progressively worsening dyspnea, cough, and grid-like shadows on imaging—are highly consistent with the pathogenic characteristics of “Ke Nang”, where phlegm-stasis coalesces into tangible saccular lesions, blocks the circulation of qi and blood, induces the adverse upward flow of lung qi, and ultimately leads to pathological changes in lung tissue. The overall pathogenesis of IPF can be summarized as follows: qi dysfunction involving the lungs, spleen, and kidneys as the core organs, followed by the transformation of Jin into phlegm and blood stagnation into stasis, and finally the cementation of phlegm and stasis to form a structural pathological product known as “Ke Nang”. Based on the intrinsic correlation between phlegm-stasis and Ke Nang, the treatment of IPF should adhere to the principle of “treating both the symptoms and the root causes, and combining purgation with tonification”, and adopt specific therapeutic methods of “resolving phlegm”, “removing blood stasis” and “regulating qi”.