狼疮头痛与中医内伤头痛的相关性

Relationship between lupus headache and headache due to internal injury in traditional Chinese medicine

1999年,美国风湿病学会(American College of Rheumatology,ACR)发表了神经精神狼疮的命名和病例定义,逐渐统一和规范了对系统性红斑狼疮神经精神损害的认识。其中,狼疮头痛是临床颇为棘手的难题,尤其是合并出现严重的多系统损害时;本病多数属于血管性头痛的范畴,极少数存在神经性头痛的特点;其病理生理学机制尚不清楚,ACR和国际头痛学会(International Head Society,I HS)的临床分类标准均存在局限性,特别是对精神症状相关头痛未给予明确分类;本病以经验治疗为主,包括对症处理、免疫抑制、抗血小板聚集或抗凝治疗。狼疮头痛应从中西医结合的角度,从内伤头痛立论,以本虚标实辨证,活血通络立法。

In 1999, the nomenclature and case definitions for neuropsychiatric lupus syndromes were published by American College of Rheumatology （ACR）, and the cognition of neuropsychiatric damage of systemic lupus erythematosus （SLE） was gradually unified and standardized. Lupus headache is an intractable problem in SLE, especially in SLE patients complicated with multiple organ injury. In general, vascular headache is common in most SLE patients, and a small number of SLE patients complicated with nervous headache are found in clinic. Moreover, its pathophysiological mechanism is far from being understood. Although early diagnosis is essential for good outcomes, the diagnosis method is rather confused in the world. There still exist some limitations in the proposal of clinical classification of headache from ACR and International Headache Society （IHS）, and the proposal does not mention the classification of headache related to psychiatric damage. Current therapeutic regimens are almost exclusively based on empirical evidence. Treatment approaches include symptomatic treatment, immunosuppressive, anticoagulant and anti-aggregant therapies. It provides enormous and hopeful space in research of combined therapy strategy, especially in the field of traditional Chinese medicine. The authors discussed the relationship between lupus headache and headache due to internal injury in the view of integrated traditional Chinese and Western medicine, and suggested that the treatment strategy for lupus headache should be made in argument with the headache due to internal injury. Syndrome differentiation treatment according to deficiency in the root and excess in the branch and the therapy for activating blood to dredge collaterals maybe have great advantages in treatment of the headache in SLE.