摘要
[目的]探讨基于“理-法-方-药-术”体系分期论治带状疱疹(herpes zoster,HZ)的经验。[方法]通过文献学习、理论分析及临床经验总结,根据西医分期理论,探讨HZ在疹前期、疱疹期、疹后期、后遗症期的病因病机、治则治法、组方遣药和外治措施,并举验案佐证。[结果]疹前期:此期以“风毒”为主,治以疏风泻热解毒,选用菊花茶调散、银翘散、升降散等加减,治疗以浅刺为主。疱疹期:此期以肝经湿热为主,治以清肝解毒、通络止痛,方用龙胆泻肝汤加减,治疗以火针配合拔罐加围刺、电针夹脊穴为主。疹后期:此期血瘀正亦虚,治以祛瘀止痛为主,辅以益气活血,可选用补阳还五汤或补中益气汤合金铃子散和(或)瓜蒌甘草红花汤等加减,治疗以刺络拔罐放血结合围刺、电针夹脊穴为主。后遗症期:此期阴虚血涩,治以养阴柔肝通络止痛,可选一贯煎加减,治疗以针刺加艾灸为主。所举医案为临床HZ典型病例,初诊时辨证为疱疹期-肝经湿热证,处方以龙胆泻肝汤加减,并予以火针联合拔罐,浅刺围刺加电针夹脊穴;二诊时辨证为疹后期-气虚血瘀证,处方以补阳还五汤化裁,并采用梅花针、拔罐,围刺、电针夹脊穴,疗效显著。回归临床,以案示理,表明临床运用“理-法-方-药-术”体系分期诊治HZ便捷效佳。[结论]基于“理-法-方-药-术”体系分期辨治HZ,采取相应的内外兼治方案,疗效显著,值得推广。
[Objective]To explore the staged treatment experience of herpes zoster(HZ)based on the system of“theory-method-formula-medicine-technique”.[Methods]Through literature study,theoretical analysis,summarization of clinical experience and according to the periodization theory of western medicine,the pathogenesis,therapeutic principles and methods,prescription medication,external treatment of HZ in pre-rash phase,herpes phase,rash anaphase and sequelae phase were discussed,and one case was attached to prove it.[Results]Pre-rash phase:It is dominated by“wind toxin”in this phase,the treatment is to expel wind,purge heat and detoxify,prescriptions with modified Juhua Chatiao Powder,Yinqiao Powder or Shengjiang Powder,and shallow puncture are mainly adopted.Herpes phase:It is dominated by the liver meridian damp heat in this phase,the treatment is to clear the liver and detoxify,dredge collateral and relieve pain,prescription with modified Longdan Xiegan Decoction,fire needle with cupping and surrounding needling,electroacupuncture at Jiaji acupoints are mainly adopted in this phase.Rash anaphase:Blood stasis and righteousness are asthenic in this phase.Consequently,the treatment gives priority to eliminating stasis and analgesia.Besides,it is assisted by Qi-invigorating and blood-activating method,modified Buyang Huanwu Decoction or Buzhong Yiqi Decoction and Jinlingzi Powder or Gualou Gancao Honghua Decoction should be selected.In this phase,pricking-cupping,exsanguinating and surrounding needling,electroacupuncture at Jiaji acupoints are mainly adopted.Sequelae phase:It is dominated by Yin asthenia blood astringent in this phase,the treatment is to nourish Yin,smooth the liver,and activate meridians to stop pain,modified Yiguan Decoction should be selected,acupuncture and moxibustion therapy are mainly adopted in this phase.The medical case was a typical case of HZ,the syndrome differentiation was herpes phase-liver meridian damp heat syndrome at the initial visit,Longdan Xiegan Decoction,fire needle with cupping and surround needling,electroacupuncture at Jiaji acupoints were selected to reduce the symptoms.The syndrome differentiation was rash anaphase-Qi deficiency and blood stasis syndrome at the second visit,Buyang Huanwu Decoction,plum-blossom needle with cupping and surround needling,electroacupuncture at Jiaji acupoints were selected to reduce the symptoms,with remarkable effectiveness.In the final sequence,returning to clinical,the case would be used to illustrate the principle,it is convenient and efficient to adopt the system of“theory-method-formula-medicine-technique”to the staged treatment of HP.[Conclusion]Stage differentiation and treatment of HZ based on the system of“theory-method-formula-medicine-technique”,taking the corresponding internal and external treatment,this scheme is effective and worthy of promotion.
作者
李梅
陶方泽
叶静静
陈宁刚
陈雷
LI Mei;TAO Fangze;YE Jingjing(Ningbo Hospital of Traditional Chinese Medicine,Ningbo(315000),China;Nanjing Hospital of Traditional Chinese Medicine)
出处
《浙江中医药大学学报》
CAS
2023年第8期863-868,共6页
Journal of Zhejiang Chinese Medical University
基金
浙江省中医药科技计划项目(2022ZB309)
浙江省陈雷名老中医专家传承工作室建设项目(GZS2020038)
第四轮宁波市中医医学重点学科建设计划(2022-Z04)
南京市中医药青年人才培养计划(宁卫中医﹝2020﹞4号)。
关键词
“理-法-方-药-术”体系
带状疱疹
分期论治
内外合治
经验
验案
“theory-method-formula-medicine-technique”system
herpes zoster
staged treatment
combined internal and external treatment
experience
test case
