祛风胜湿法治疗变应性鼻炎的理论与临床依据

Theoretical and Clinical Evidences of Dispelling Wind and Eliminating Dampness Therapy for Allergic Rhinitis

变应性鼻炎(AR)发病机制涉及变应原、免疫细胞、免疫球蛋白、炎性介质之间的层级急慢性反应,而且具有一定的异质性,对现有治疗方案的反应也不尽相同,部分患者临床效果不佳。中草药治疗AR不仅能改善临床症状,而且具有良好的安全性,已成为临床治疗AR的经常选项。由于古代医籍中关于鼻鼽的描述与AR的临床表现非常接近,其主要病因病机为外感风寒、肺中虚冷、邪郁化热生风。所以,现代中医认为鼻鼽包括变应性鼻炎、变应性鼻窦炎及血管舒缩性鼻炎。根据鼻鼽(包括AR)的病因病机及临床特点,应当属中医风病范畴。但现代中医辨证AR偏重于脏腑虚损,忽视风邪的辨证,与临床治疗必用风药的现实形成较大反差,甚至导致临床研究不重辨证的反常现象。文章从中医治疗AR必用风药的现象出发,结合传统中医论述和现代风病理论研究成果,提出AR属于中医外感风病范畴,风邪是主要病邪,临床辨证应突出风邪,祛风胜湿法是关键治法。并根据临床治疗AR所用经典名方大多源自《伤寒论》,且都是以风药为主、治疗外感病的处方,并且效果良好,推断风药具有的"祛风止痒"功效可减轻或阻断鼻黏膜的变态反应,达到止痒、止嚏的目的;"祛风胜湿"功效可减轻鼻黏膜水肿,起到止涕、通塞的作用。现代研究也发现,以风药为主的经典名方和临床用于AR治疗的风药大多具有良好的抗炎、抗过敏、调节机体免疫功能等作用,说明祛风胜湿法及其指导下的风药治疗AR不仅符合中医传统理论,而且具有现代科学依据。

The pathological mechanism of allergic rhinitis(AR)involves hierarchically acute and chronic reactions among antigens,immunocytes,immunoglobulins and inflammatory factors. AR,which is characterized by heterogeneity,reacts differently to the current treatment on diverse individuals. Some patients receive unsatisfying clinical outcomes after the treatment. Chinese herbal medicine has become a frequent option to treat AR because it can improve clinical symptoms with excellent safety. The description of Biqiu in ancient Chinese medical literatures is very similar to the clinical manifestation of AR. The major pathogeneses of Biqiu included infection of wind-cold pathogens,deficiency and cold in the lung,and evil depression into heat and wind. Therefore,in modern traditional Chinese medicine(TCM),Biqiu is considered as an integration of AR,allergic sinusitis and vasomotor rhinitis. According to the pathogenesis and clinical manifestations of Biqiu(including AR),this disease belongs to wind disease in TCM. But modern TCM focuses on deficiency of internal organs and ignores wind evil in syndrome differentiation,contrary to the fact that wind medicine is always used in treating AR. This even leads to an abnormal phenomenon that clinical studies attach little importance to syndrome differentiation. In this paper,we started from the phenomenon that wind medicine is always used in TCM for AR,considering TCM literatures and the study results of modern therapy for wind diseases,and put forward the ideas as follows:AR belongs to exogenous wind disease in TCM,and wind pathogen is the major pathogen,in clinical syndrome differentiation,we should attach more importance to wind evil,and dispelling wind and eliminating dampness is the key to treatment. Meanwhile,based on the fact that most of the classical prescriptions with good effectiveness for AR originated from Treatise on Febrile Disease,mainly including the wind medicines for treating exogenous diseases,it can be inferred that the wind-dispelling and itch-arresting effects of wind medicines are helpful to alleviate or block the allergic reaction of nasal mucus and achieve the goal of relieving itching and sneezing,and the wind-dispelling and dampness-eliminating effects are helpful to alleviate the edema of nasal mucus and achieve the goal of relieving running nose and nasal obstruction. In modern researches,it is also found that classical prescriptions which take wind medicine as a principle component and wind medicine used in AR treatment have good anti-inflammatory,anti-allergic and immune function adjusting effects. This indicates that dispelling wind and eliminating dampness and the wind medicine treatment under its instruction not only correspond to TCM theory,but also have modern science evidences.