【摘要】 慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）是慢性阻塞性肺疾病患者病情恶化的重要阶段，临床表现为咳嗽、咳痰、喘息等症状加重。炎性反应是AECOPD进展的关键机制。“伏火”是中医理论中的重要概念之一，通常用来解释内在的火热病理状态与多种慢性炎性疾病之间的关系。中医学认为，AECOPD的进展与伏火内蕴、外邪引动密切相关，伏火的发病过程与AECOPD的病理过程十分相似。现代研究表明，AECOPD作为慢性阻塞性肺疾病患者死亡主因，其“慢性炎症潜伏–急性爆发”的病理特征与伏火“久郁化热”的机制高度契合。文章基于“伏火理论”，结合现代医学对AECOPD病理机制的认识，系统探讨了“中医伏火理论”在AECOPD中的运用与临床价值，阐释了伏火致病的核心病机为“本虚标实、伏火内蕴、遇诱激发”，具有隐匿性强、易受激发、病程缠绵等致病特点。在辨证体系上，创新性提出四维辨证论治框架：(1)辨虚实、审内外、察转化、析脏腑，实火用泻白散，虚火取麦门冬汤。(2)外感伏火予银翘散，内伤伏火选百合固金汤。(3)针对不同转化归因，可在治疗上佐以祛风、化湿、润燥、散寒等药类。(4)肺脾伏火用藿朴夏苓汤，肺肾伏火以补肺汤加金匮肾气丸引火归原，心肺伏火取清营汤合清心莲子饮。整体分析，以期为中西医结合治疗AECOPD提供理论依据和临床参考。更多还原

【Abstract】 Acute exacerbation of chronic obstructive pulmonary disease(AECOPD) represents a critical phase of clinical deterioration in patients with COPD,characterized by the worsening of symptoms such as cough,increased sputum production,and wheezing.Inflammatory response is a key mechanism driving the progression of AECOPD."latent fire"(伏火) is a significant concept in traditional Chinese medicine(TCM) theory,which often is employed to explain the relationship between internal heat-related pathological states and various chronic inflammatory diseases.TCM posits that the progression of AECOPD is closely associated with the internal accumulation of latent fire and its provocation by external pathogens.The pathogenesis of latent fire closely aligned with the pathological process of AECOPD.Modern research indicates that AECOPD,as a leading cause of mortality in COPD patients,exhibits a pathological pattern of "chronic inflammatory latency followed by acute exacerbation",which aligns remarkably with the TCM mechanism of "prolonged stagnation transforming into heat" inherent to latent fire.Based on the "latent fire" theory and integrating modern medical understanding of AECOPD ’ s pathological mechanisms,this paper systematically explores the application and clinical value of the TCM "latent fire" theory in the management of AECOPD.It elucidates the core pathogenesis of latent fire as "root deficiency and branch excess,internal accumulation of latent fire,and triggering by precipitating factors", which is characterized by strong concealment,susceptibility to provocation,and a prolonged disease course.Within the diagnostic framework,this study innovatively proposes a four-dimensional syndrome identification and treatment system:(1)Identifying deficiency and excess-employing Xiebai San(泻白散)for excess fire and Maimendong Tang(麦门冬汤)for deficient fire.(2)Differentiating external and internal causes-using Yinqiao San(银翘散)for externally-co ntracted latent fire and Baihe Gujin Tang(百合固金汤)for internally-damaged latent fire.(3)Observing pathogenic transformations-incorporating additional medicinals to address concomitant pathogens,such as wind-dispelling,dampness-resolving,dryness-moistening,or cold-dispersing herbs as appropriate.(4)Analyzing Zang-Fu organ Involvement-applying Huopu Xialing Tang(藿朴夏苓汤)for lung-spleen latent fire,Bufei Tang(补肺汤)combined with Jingui Shenqi Wan(金匮肾气丸)to redirect fire back to its origin for lung-kidney latent fire,and Qingying Tang(清营汤)combined with Qingxin Lianzi Yin(清心莲子饮)for heart-lung latent fire.Through a comprehensive analysis,this study aims to provide a theoretical basis and clinical references for the integrated treatment of AECOPD using both TCM and Western medicine.更多还原