辨证分型分期内外联合治疗带状疱疹40例临床观察

Clinical Observation on 40 Cases of Herpes Zoster Treated by Internal and External Treatment of TCM Syndrome Differentiation and Treatment

[目的]观察辨证分型分期内外联合治疗带状疱疹疗效。[方法]使用前瞻性设计方法,对40例门诊辨证分型分期内外联合治疗。汤剂内服,水煎300m L,150m L/次,早晚饭后30min温服;肝经郁热:龙胆泻肝汤,龙胆草、柴胡各10g,泽泻12g,车前子、生地黄各9g,当归尾10g,栀子、黄芩各9g,甘草6g;脾虚蕴湿:除湿胃苓汤,陈皮15g,苍术、厚朴各8g,茯苓10g,桂枝3g,泽泻、猪苓各5g,白术10g,甘草6g;气滞血瘀:逍遥散合金铃子散,柴胡15g,当归10g,白芍、白术各8g,茯苓10g,川楝子、延胡索各6g,甘草5g;心火亢盛,舌尖红赤,大便数日不行,加黄连。发病初期,高热,伴面赤,烦渴引饮,汗出恶热,脉洪大有力,配用白虎汤;火毒较重发于头面耳目,加金银花、野菊花、薄荷;肿胀明显,配普济消毒饮;疱疹起于胁肋部,疼痛明显,加郁金、延胡索、佛手、乳香、没药、五灵脂、川楝子;气血运行不畅,瘀阻不通而痛配血府逐瘀汤;体质较弱,气血不足,四物汤加减;疱疹初发于腰部,病程日久,疹退而见腰部酸软无力,喜揉按,加桑寄生,杜仲;下肢发病,配牛膝;湿邪偏重,配伍三妙散加减;后期气血亏虚配黄芪、白术、熟地、白芍等。针刺:沿被侵犯神经走行围刺,30min/次,1次/d,肝经郁火热盛,大敦、行间、阳陵泉;脾胃湿热,加血海、隐白、内庭;起于头面,以头痛为主的实证,加百会、头维、风池;虚证配百会、风池、足三里;眼痛配丝竹空、阳白、外关;耳鸣配翳风、听会、侠溪、中渚、太冲、丘墟;下颌部痛加承浆、颊车、翳风、内庭;疱疹发于腰、肋部,引起腰痛、肋痛配委中、膈俞;上肢发病配曲池、合谷;下肢发病针刺三阴交,引火下行。正气不足,气血亏虚,年老体弱,存在慢性基础病,多配伍气海、关元、足三里等。刺络放血闪罐:疱疹前期,头颈部以大椎穴为主,胸胁及腰部以华佗夹脊穴为主,梅花针叩刺出血,再用闪火法将玻璃罐吸附于叩刺处10min。出血量以5m L为宜,隔日1次。艾灸,疱疹后期,15~20min/次,以皮肤潮红、有热感传导为宜,1次/d。止痛酊涂擦,选红花、桃仁、丹参、延胡索等,用75%酒精浸泡后制成酊剂,每隔3h涂擦疼痛部位及疱疹处。疱疹未溃雄冰散(雄黄、冰片、白矾磨粉)茶水调成糊状敷患处,3~5次/d;已溃凡士林为基质调制成软膏,早晚涂擦于患处。连续治疗7d为1疗程。观测临床症状、疱疹、不良反应。连续治疗2疗程(14d),判定疗效。[结果]显效34例,有效5例,无效1例,总有效率97.50%。[结论]辨证分型分期内外联合治疗带状疱疹,疗效满意,无严重不良反应,值得推广。

[Objective] To observe the therapeutic effect of combined treatment of herpes zoster by internal and external differentiation of syndrome differentiation and treatment. [Methods] using prospective design method, 40 cases were treated by combination of internal and external. Decoction, Decoction 300mL, 100mL/ times, 30min day morning and evening meal; Liver Meridian： Longdan Xiegan decoction, Longdancao Chaihu 10g, Zexie 12g, Cheqianzi Shengdihuang 9g, Dangguiwei 10g, Zhizi Huangqin 9g, Gancao 6g; spleen xuYunsi： Chushi Weilingtang, Chenpi 15g, Cangzhu, houpo8g, Fulingl0g, Guizhi 3g, Zexie Zhuling 5g, Baizhu 10g, Gancao 6g; Qizhi Xueyn： Xiaoyansanhe Jinlingzisan, Chaihu 15g, Danggui 10g, Baishao Baizhu 8g, Fuling 10g, Jinlingzi Yanhusuo 6g, Gancao 5g; Xinhuo Kangcheng, red tongue, constipation days, add Huanglian. Early onset, high fever, with a red face, thirst, sweating, pulse small strong, with White Tiger Decoction; there is in the head and repeat, plus honeysuckle, wild chrysanthemum, mint; swelling significantly, with pujixiaodudeeoction; herpes from the rib, with obvious pain, radix curcumae, Rhizoma Corydalis, bergamot, frankincense, myrrh, honinrousette, Kawa Ko; the flow of Qi and blood stasis; not painful with Xuefuzhuyu Decoction; weak constitution, deficiency of Qi and blood, Siwu Decoction; herpes early in the waist, long duration, rash back and see waist numbness, like rubbing, Ghassan parasitism, Eucommia; incidence of lower limb, with emphasis on dampness, and Niuxi; three wonderful Decoction; late gas blood deficiency with Astragalus, Atractylodes, radix rehmanniae, Radix Paeoniae Alba etc. Acupuncture： along the nerve invasion of surrounding needling, 30 min/times, 1 times/d, hepatic hot Sheng, Greater London, Xingjian, Yanglingquan; spleen, and blood, hidden white and Neiting; from the head to the main empirical, headache, and Baihui, Touwei, Baihui, Fengchi Fengchi; syndrome distribution, Zusanli; eye pain with sizhukong, Yang Bai, Waiguan; tinnitus with Yifeng, Tinghui, creek, Zhongzhu, Taichong, Qiuxu; jaw pain and Chengjiang, Jiaehe, Yifeng, Neiting; herpes in waist and rib, rib pain, low back pain with Venezuela Geshu; upper limb onset with pool, Hegu Acupuncture Sanyinjiao; incidence of lower limb, fire down. The deficiency of vital qi, deficiency of Qi and blood, frail, there are many chronic diseases, Qihai, Guan Yuan, Zusanli compatibility. Bloodletting and cupping： herpes early, head and neck to Dazhui, chest and waist to Hua Tuo Jiaji, plum blossom needle bleeding, then flash method will be adsorbed on the glass tank tapping at 10min. The amount of bleeding should be 5mL, 1 times a day. Moxibustion, late herpes, 15-20min/, with skin flushing, thermal conduction is appropriate, 1 times/d. Dieentrine inunction, peach kernel, safflower, selection of Salvia, Rhizoma Corydalis, soaked with 75% alcohol tincture, every 3H pain and the herpes at inunction. No male ice powder （herpes ulcer realgar, borneol and alum powder） tea into a paste and apply to affected area, 3-5/d; already as matrix modulation into Vaseline ointment, and apply to affected area. Continuous treatment for 1 courses of 7d. Observation of clinical symptoms, herpes, adverse reactions. Continuous treatment for 2 course of treatment （14d）, to determine the efficacy. [Result] 34 cases were markedly effective, 5 cases were effective, 1 cases were ineffective, the total effective rate was 97.50%. [Conclusion] The treatment of herpes zoster by syndrome differentiation and staging combined with internal and external treatment is satisfactory and has no serious adverse reaction, it is worth popularizing.