从"肺与大肠相表里"探析脓毒症胃肠功能障碍的病机与治法OA

Sepsis is a life-threatening acute organ dysfunction caused by infection,with gastrointestinal dysfunction among its earliest complications.Presently,Western medicine lacks specific interventions targeting its pathogenesis,highlighting the urgent need to explore more targeted therapeutic strategies within the theoretical framework of traditional Chinese medicine(TCM).The concept that"the lung and large intestine are interior-exterior related"represents an important component of the TCM theory of visceral manifestation(zang-xiang).The lung and large intestine are mutually connected through the Taiyin Lung Channel of Hand and the Yangming Large Intestine Channel of Hand.Physiologically,the lung governs dispersion and descent and regulates water passages,whereas the large intestine governs waste transmission and transformation and fluid reabsorption,with the two organs functioning in a mutually complementary manner.Pathologically,the qi of the bowels becomes obstructed when the lung fails to disperse and descend;the intestinal tract becomes blocked when heat toxins shift to the intestines,thus the two organs influence one another.Based on the above theoretical foundation and in conjunction with the clinical and pathological characteristics of sepsis-associated gastrointestinal dysfunction,this paper proposes that the core pathogenesis of this condition lies in disharmony between the lung and intestine,obstruction of bowel qi,and disordered movement of qi and fluids.Three stages are identified according to disease progression.In the early stage,heat toxins invade the body,the lung fails to disperse and descend,and bowel qi becomes obstructed.In the middle stage,excessive lung heat shifts to the bowels,with phlegm,blood stasis and toxins accumulating to obstruct the intestinal tract.In the late stage,prolonged illness leads to vital qi deficiency,with both the qi and yin of the lung and intestine being impaired,failing the conduction function.Treatment should be guided by the overarching principle of"unblocking."In the early stage,therapy should disperse the lung to expel pathogens and unblock the bowels to drain heat,achieving"unblocking"by opening the lung to activate the intestine.In the middle stage,treatment should aim to clear lung heat,resolve phlegm,invigorate the blood and unblock the bowels,achieving"unblocking"by purging and cleansing the intestinal tract.In the late stage,therapy should tonify the lung and benefit the intestine,supplementing qi and nourishing yin,achieving"unblocking"by tonifying deficiency to support functional activity.Simultaneously,safeguarding vital qi and regulating the spirit to maintain emotional well-being should be emphasized throughout the entire treatment course.This approach aims to provide a theoretical framework and a clinical pathway for the TCM-based differentiation and treatment of sepsis-associated gastrointestinal dysfunction.