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高原慢性阻塞性肺疾病（COPD）患病率与病死率显著高于平原，其病机演变与高原特殊环境密切相关。本文基于气虚血瘀理论，系统阐释高原COPD的病机演变规律，提出“双重缺氧”（日间高原低氧叠加夜间阻塞型睡眠呼吸暂停低通气综合征间歇性低氧）加速病机演变的观点，认为本病以气虚为本、血瘀为标，贯穿病程始终，呈现三期演变特征：早期气虚血瘀、肺失宣降，中期气虚痰瘀、痹阻肺络，晚期气虚及心、瘀水互结。据此确立分期论治策略：早期化痰祛浊，佐以益气活血；中期益气活血，兼以化痰通络；晚期益气温阳，活血利水；并将通腑泄浊、顾护脾胃之法贯穿全程。气虚血瘀理论为高原COPD的中医辨治提供了新思路，其分期病机模型与现代医学肺血管重构、右心衰竭等病理特征高度契合，临床需因人、因期、因地制宜，以期为提高疗效、延缓疾病进展提供理论依据。
Abstract：The prevalence and mortality of chronic obstructive pulmonary disease(COPD) in high-altitude regions are significantly higher than those in plain areas, and its pathogenesis evolution is closely related to the unique high-altitude environment. Based on the theory of qi deficiency and blood stasis, this paper systematically elucidates the pathogenesis evolution pattern of high-altitude COPD and proposes the concept of "dual hypoxia"(daytime high-altitude hypoxia combined with nocturnal intermittent hypoxia due to obstructive sleep apnea-hypopnea syndrome) accelerating the pathogenesis evolution. It is proposed that the disease is fundamentally characterized by qi deficiency and superficially by blood stasis, a pathological state persisting throughout the entire course, presenting a three-stage evolution pattern: early stage with qi deficiency and blood stasis, lung failing in depuration and descending; middle stage with qi deficiency, phlegm and blood stasis, blockage of lung collaterals; advanced stage with qi deficiency involving the heart, intertwining of blood stasis and retained fluid. Accordingly, a stage-based treatment strategy is established: resolving phlegm and eliminating turbidity, supplemented by supplementing qi and activating blood in the early stage; supplementing qi and activating blood, combined with resolving phlegm and unblocking collaterals in the middle stage; supplementing qi and warming yang, activating blood and promoting diuresis in the advanced stage. Throughout the entire course, the methods of unblocking the bowels to discharge turbidity and protecting the spleen and stomach are consistently applied. The theory of qi deficiency and blood stasis provides a new approach for the TCM syndrome differentiation and treatment of high-altitude COPD. Its stage-based pathogenesis model highly coincides with the pathological features of pulmonary vascular remodeling and right heart failure in modern medicine. Clinical practice should adhere to the principles of individualized, stagebased and location-specific treatment, aiming to provide a theoretical basis for improving therapeutic efficacy and delaying disease progression.
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基本信息:
DOI：10.16289/j.cnki.1002-0837.2026.05001
中图分类号:R259
引用信息:
[1]苏宏芳,李伟,王仁嫒,等.基于气虚血瘀论探讨高原慢性阻塞性肺疾病的病机演变与治疗[J].航天医学与医学工程().DOI:10.16289/j.cnki.1002-0837.2026.05001.
基金信息:
2021年国家中藏医管理局项目(101601/415504); 青海省卫生健康委员会2023年中藏医药科研课题项目(J2023003); 大通县中医院科研项目(DZYLL-2024-002)
2026-05-26
2026-05-26
2026-05-26