基于“清浊升降”理论探讨慢性阻塞性肺疾病的气机失常与辨治思路

Discussion on the Disorder of Qi Movement and the Approach to Syndrome Differentiation and Treatment of Chronic Obstructive Pulmonary Disease Based on the Theory of “Ascending of Clear and Descending of Turbid”

摘要: 本文以《黄帝内经》“清气在下，则生飧泄；浊气在上，则生䐜胀”的气机升降理论为切入点，系统探讨慢性阻塞性肺疾病(COPD)的中医病机本质与辨治策略。首先阐述该理论的核心内涵及其与COPD“肺失宣降、痰瘀互结”病机的内在联系。进而，从“肺脾相关”与“肠–肺轴”紊乱、“浊气在上”与气道慢性炎症及黏液高分泌、“清气不升”与全身性消耗及认知障碍、气机逆乱与COPD急性加重，以及基于气机升降理论的辨证分型与治则等五个方面，深入剖析COPD发生发展中气机升降失常的多维表现与病理环节。最后，总结以调畅气机为核心的整合治疗思路，为COPD的临床管理提供理论依据和实践参考。

Abstract: Based on the theory of ascending and descending of qi movement from the Huangdi Neijing, which states that “when clear qi stays below, it causes undigested food in diarrhea; when turbid qi stays above, it causes abdominal distension and fullness”, this paper systematically explores the pathogenesis and treatment strategies of chronic obstructive pulmonary disease (COPD) in traditional Chinese medicine. First, it elaborates the core connotation of this theory and its intrinsic relationship with the pathogenesis of COPD characterized by “loss of lung’s dispersing and descending functions and intermingling of phlegm and blood stasis”. Then, from five aspects—“lung-spleen relationship” and “gut-lung axis” dysregulation, “turbid qi upward disturbance” and airway chronic inflammation and mucus hypersecretion, “clear qi failing to ascend” and systemic wasting and cognitive impairment, reversal and disorder of qi movement and acute exacerbation of COPD, as well as syndrome differentiation and treatment principles based on the theory of ascending and descending of qi movement—it deeply analyzes the multidimensional manifestations and pathological links of disordered qi ascending and descending during the development of COPD. Finally, it summarizes an integrated treatment approach centered on regulating and smoothing qi movement, providing a theoretical basis and practical reference for the clinical management of COPD.