基于“金水相生”与“久病入络”理论探讨 特发性肺纤维化病机与论治

Discussion on the Pathogenesis and Treatment of Idiopathic Pulmonary Fibrosis Based on the Theories of “Mutual Generation between Metal and Water” and “Prolonged Disease Entering the Collaterals”

摘要: 特发性肺纤维化(idiopathic pulmonary fibrosis, IPF)是一种病因未明的慢性进行性纤维化性间质性肺疾病，临床迁延难愈，预后较差。中医学多将其归属于“肺痹”“肺痿”等范畴，认为其病机以本虚标实、虚实夹杂为基本特点。本文基于“金水相生”与“久病入络”理论，对IPF的中医病机及论治思路进行综述。认为“金水相生”从肺肾相关立论，“久病入络”从病程演变着眼，二者合参有助于从肺肾亏虚、痰瘀络阻把握IPF的整体病机，并为补肺益肾、化痰祛瘀、通络散结等治法提供理论依据。现有研究表明，中医药在改善临床症状、提高生活质量及延缓疾病进展方面具有一定应用价值，但仍存在证候标准不统一、临床研究质量不足及理论与现代机制衔接不够紧密等问题。今后应进一步规范辨证体系，加强高质量临床与基础研究，为IPF的中医药防治提供更可靠依据。

Abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrosing interstitial lung disease of unknown etiology, characterized by a protracted course and poor prognosis. In traditional Chinese medicine, IPF is generally classified into the categories of “Feibi” and “Feiwei”, and its pathogenesis is considered to be fundamentally characterized by root deficiency and branch excess, as well as the coexistence of deficiency and excess. Based on the theories of mutual generation between metal and water and prolonged disease entering the collaterals, this article reviews the traditional Chinese medicine understanding of the pathogenesis and therapeutic approach of IPF. It is proposed that the theory of mutual generation between metal and water is centered on the lung-kidney relationship, whereas the theory of prolonged disease entering the collaterals focuses on disease progression. Taken together, these two theories contribute to an overall understanding of the pathogenesis of IPF from the perspectives of lung-kidney deficiency and phlegm-blood stasis obstructing the collaterals, and also provide a theoretical basis for therapeutic methods such as supplementing the lung and kidney, resolving phlegm, removing blood stasis, and unblocking the collaterals. Current studies have shown that traditional Chinese medicine has certain clinical value in improving symptoms, enhancing quality of life, and delaying disease progression. However, there are still some limitations, including inconsistent syndrome differentiation standards, insufficient quality of clinical studies, and inadequate integration between traditional Chinese medicine theory and modern biomedical mechanisms. Further efforts are needed to standardize syndrome differentiation and strengthen high-quality clinical and basic research, so as to provide more reliable evidence for the prevention and treatment of IPF with traditional Chinese medicine.