探析红斑狼疮使用GCS不同阶段的辨证施治

Explore Syndrome Differentiation and Treatment of Systemic Lupus Erythematosus in Different Periods of Using Glucocorticoid

系统性红斑狼疮(systemic lupus erythematosus,SLE)是自身免疫机制介导的,以血清中出现多种自身抗体和多器官、多系统累及为主要临床特征的弥漫性结缔组织病。目前现代医学治疗SLE以糖皮质激素(Glucocorticoid,GCS)为主。中医认为,GCS性属纯阳,长期大量使用多致伤阴耗气。在SLE使用GCS的首始阶段,患者多为热毒炽盛证,以清热解毒为主要方法,阴虚内热者以滋阴清热为法,瘀热闭阻证则用祛瘀解毒法;撤减阶段,患者多为气阴两虚,治以益气养阴为主;GCS维持量阶段,患者多为脾肾阳虚,当从温肾补脾论治,同时,视血瘀、热毒之轻重,分别予以兼顾。SLE使用GCS各个治疗阶段,要根据SLE病机发展变化的不同,辨证选用不同中药同病异治,以期取得增效解毒的临床效果。

Systemic lupus erythematosus is a diffuse connective tissue disease,which is mediated by autoimmune mechanisms.It results in multiple autoanti bodies in the serum and injury organs and systems.Modern medicine uses glucocorticoid as the main medicine in treating systemic lupus erythematosus.Glu cocorticoid is pure yang product,not only will it injure yin and qi for using long time,but also disturb syndrome type of traditional Chinese Medicine of SLE for using it in large number.In the starting phase of using glucocorticoid,if the patients present manifestation of toxic heat flourishing,we should clear heat and remove toxicity.If the patients present manifestation of yin deficiency and internal heat,we should nourish yin and clear heat.If the patients pre sent manifestation of stagnated heat stagnation,we should remove toxic heat and blood stasis.In reduction stage of using glucocorticoid,patients present manifestation of qi and yin deficiency.Then we should benefit qi and nourish yin.In maintenance stage of using glucocorticoid,patients present manifesta tion of yang deficiency of spleen and kidney.So we should warm the kidney and invigorate the spleen.During the whole course of treating,we should also care for blood stasis and toxin.The clinicians should also remove toxic heat and blood stasis depend on the changing of syndrome.Using GCS in treating SLE should depend on the syndrome differentiation and choose the right Traditional Chinese Medicine in order to reach the clinical effect.