| 112 | 0 | 83 |
| 下载次数 | 被引频次 | 阅读次数 |
气道黏液高分泌具有昼夜节律性，其发生发展在时间上与夜间痰饮内聚、清晨症状易发或加重有关，这与现代时间生物学中神经内分泌低谷及核心生物钟节律异常具有一致性。基于此，在常规辨证基础上采用择时干预，于申时至亥时提前应用化痰平喘中药，以减少夜间痰液积聚，并结合“时-证-药”同治方案，晨间发作多从宣肺化痰着手，夜间加重者重在清热化痰，子后发作者兼顾补肾纳气。在药物干预基础上，还可结合顺应年节律的冬病夏治及顺应日节律的子午流注针法，以促进昼夜节律协调，维持机体生物钟稳态。
Abstract：Airway mucus hypersecretion exhibits distinct circadian rhythmic characteristics,and its occurrence and progression are temporally associated with the accumulation of phlegm-rheum during the night and the tendency for symptoms to emerge or worsen in the early morning.These characteristics are consistent with the decline of neuroendocrine activity and abnormalities in core circadian clock rhythms described in modern chronobiology.Based on this understanding,time-based intervention is applied in addition to conventional syndrome differentiation.During the period from shen（申） hour to hai（亥） hour(approximately 15:00-23:00),phlegm-resolving and panting-relieving Chinese herbal medicinals can be administered in advance to reduce excessive phlegm accumulation during the night.Furthermore,a combined "time-pattern-medicine" therapeutic strategy is proposed.For attacks occurring mainly in the morning,treatment focuses on diffusing lung and resolving phlegm.For symptoms aggravated at night,emphasis is placed on clearing heat and resolving phlegm,and for episodes occurring after midnight,treatment should additionally consider both tonifying the kidney and promoting qi reception.In addition to pharmacological intervention,therapies that follow annual and daily rhythms,including winter disease treated in summer,and midnight-midday acupuncture,may also be incorporated to promote circadian rhythm coordination and maintain homeostasis of the body's biological clock.
[1]Hill D B, Button B, Rubinstein M,et al. Physiology and pathophysiology of human airway mucus[J]. Physiol Rev,2022,102(4):1757-1836.
[2]Nosal C, Ehlers A, Haspel J A. Why lungs keep time:circadian rhythms and lung immunity[J]. Annu Rev Physiol,2020,82(1):391-412.
[3]曹宪姣，张伟.从“旦慧、昼安、夕加、夜甚”角度论支气管哮喘昼夜发病节律[J].辽宁中医药大学学报，2016,18(9):153-155.
[4]马厚芳，许筱颖，孟令昊，等.藏象时空结构理论探赜[J].中医杂志，2025,66(16):1629-1634.
[5]Sutherland E R. Nocturnal asthma[J]. J Allergy Clin Immunol,2005,116(6):1179-1186.
[6]Burioka N, Fukuoka Y, Koyanagi S, et al. Asthma:chronopharmacotherapy and the molecular clock[J]. Adv Drug Delivery Rev,2010,62(9/10):946-955.
[7]郭霞珍刘晓燕马淑然.“以时测脏”理论的分析和探讨[J].中医杂志，2006,47(2):85-87.
[8]Ehlers A, Xie W, Agapov E, et al. BMAL1 links the circadian clock to viral airway pathology and asthma phenotypes[J]. Mucosal Immunol, 2018,11(1):97-111.
[9]Hewitt R J, Lloyd C M. Regulation of immune responses by the airway epithelial cell landscape[J]. Nat Rev Immunol,2021,21(6):347-362.
[10]高福泉，王晓芝，焦文健，等.夜间哮喘发作患者血GM-CSF和皮质醇含量动态变化及意义[J].山东医药，2001,41(3):4-5.
[11]Sundar I K, Yao H, Sellix M T,et al. Circadian molecular clock in lung pathophysiology[J/OL]. Am J Physiol Lung Cell Mol Physiol,2015,309(10):L1056-L1075.https：//pubmed. ncbi. nlm. nih. gov/26361874/.
[12]Smolensky M H, Peppas N A. Chronobiology, drug delivery, and chronotherapeutics[J]. Adv Drug Deliv Rev,2007,59(9/10):828-851.
[13]Bateman J R M, Pavia D, Clarke S W. The retention of lung secretions during the night in normal subjects[J].Clin Sci,1978,55(6):523-527.
[14]Li M, Li Q, Yang G, et al. Cold temperature induces mucin hypersecretion from normal human bronchial epithelial cells in vitro through a transient receptor potential melastatin 8(TRPM8)-mediated mechanism[J]. J Allergy Clin Immun,2011,128(3):626-634.
[15]Ordovas-Montanes J, Dwyer D F, Nyquist S K, et al.Allergic inflammatory memory in human respiratory epithelial progenitor cells[J]. Nature,2018,560(7720):649-654.
[16]Feng Y, Chang S, Jing Z, et al. Transdermal delivery of sinapine thiocyanate by gelatin microspheres and hyaluronic acid microneedles for allergic asthma in guinea pigs[J/OL]. Int J Pharm, 2022,623:121899. https：//pubmed. ncbi. nlm. nih. gov/35710072/.
[17]Zhao J, He P, Jiang M, et al. Transdermally delivered tolerogenic nanoparticles induced effective immune tolerance for asthma treatment[J/OL]. J Control Release,2024,366:637-649. https：//pubmed. ncbi. nlm. nih. gov/38215983/.
[18]Lee S H, Chang G T, Zhang X,et al. Acupoint herbal patching for asthma:a systematic review and metaanalysis of randomized controlled trials[J/OL]. Medicine(Baltimore),2016,95(2):e2439. https：//pubmed. ncbi.nlm. nih. gov/26765427/.
[19]Liu S, Wang Z, Su Y, et al. A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis[J].Nature,2021,598(7882):641-645.
[20]Houtmeyers E, Gosselink R, Gayan-Ramirez G, et al.Regulation of mucociliary clearance in health and disease[J]. Eur Respir J, 1999,13(5):1177-1188.
基本信息:
DOI：10.13288/j.11-2166/r.2026.17.007
中图分类号:R259
引用信息:
[1]朴香,杭颖琪,李利清,等.气道黏液高分泌的昼夜节律特征与中医药因时制宜干预策略[J].中医杂志,2026,67(17):1840-1844.DOI:10.13288/j.11-2166/r.2026.17.007.
基金信息:
国家自然科学基金（82575136,82104925）; 上海市自然科学基金（25ZR1401327）
2026-09-01
2026-09-01