活血化瘀联合温阳生肌法治疗青斑样血管炎临床分析

Analysis of the Effection of Livedoid Vasculitis Treatment with Removing Blood Stasis Combined with Wenyang and Shengji

目的分析青斑样血管炎的临床特征及中医证候特点,提高对本病的诊断及中医辨证水平。方法对12例确诊的青斑样血管炎患者的临床表现、组织病理、中医证候、中医治则、方药、预后进行回顾性分析。结果12例患者中男3例,女9例,年龄15~45岁,平均年龄20.17岁,中医药治疗时间为14~70 d,平均时间为54.60 d。12例患者均为对称皮疹,均伴有疼痛;皮损特点均为红斑、水疱、紫癜、坏死、水肿、溃疡,呈现线状或放射状分布;皮损痊愈后见色素沉着斑或线状象牙白色萎缩性瘢痕。所有患者经过组织病理确诊。12例患者均符合寒凝血瘀证。坏死期选用活血化瘀法,应用桃红四物汤加减;溃疡期选用温阳生肌法,应用自拟方温阳生肌汤加减。局部使用黄连膏换药。12例患者经中医药治疗后皮损均完全消退,溃疡愈合,遗留色素沉着斑及象牙白色萎缩性瘢痕。停药后随访6个月无1例复发。结论活血化瘀联合温阳生肌法为中医治疗青斑样血管炎提供了新的思路,并能明显降低复发率,值得进一步研究。

Objective To analyze the clinical characteristics and traditional Chinese medicine(TCM)syndrome characteristics of livedoid vasculitis.Methods The clinical manifestations,histopathology,TCM syndromes,TCM treatment principles,prescriptions and prognosis of 12 patients with livedoid vasculitis were analyzed retrospectively.Results There were 3 males and 9 females,aged from 15 to 45 years,with an average age of 20.17 years.The TCM treatment time was 14 to 70 days,with an average of 54.60 days.All patients had symmetrical rash with pain,the lesions were characterized by erythema,blister,purpura,necrosis,edema and ulcer,linear or radial distribution,there were pigmentation spots or linear ivory white atrophic scars after cured.The diagnosed were confirmed by histopathology.All patients in accordance with the syndrome of cold coagulation and blood stasis.In the necrotic stage,promoting blood circulation and removing blood stasis was used,and Taohong Siwu Decoction was used,in ulcer stage,Wenyang Shengji decoction was used.Topical drug with Huanglian ointment.After treatment with traditional Chinese medicine,all lesions subsided completely,ulcers healed with discoloration spots and ivory white atrophic scars.There was no recurrence after 6 months follow-up.Conclusion Activating blood circulation and removing blood stasis combined with Wenyang and Shengji provides a new idea for the treatment of livedoid vasculitis,and can reduce the recurrence rate significantly.