从三焦辨证论治干燥综合征

Discussion About Treating Sjogren′s Syndrome Based on Syndrome Differentiation of Triple Energizers

三焦通道不畅,气血、痰饮等阻滞,津液运行道路受阻,导致干燥综合征(sjogren′s syndrome,SS)发生;三焦气化功能减弱,导致气血津液布散代谢等功能失常,导致SS发生。从三焦辨证论治SS应分清主次,合而兼顾。燥邪易损上焦肺阴,在SS中常表现为口、鼻、咽、舌、皮肤皆干燥,伴有干咳。中焦不通,则精微不能上荣,全身失于营养,日久皮肤干燥,口眼干涩。因脾胃的生理特性,中焦发病除了干燥表现外,常伴有纳差、嗳气、乏力等。下焦肝肾不足,津血亏虚,则易出现口干眼涩、气短、乏力、出血等SS症状。上焦主"心肺之病",可选玄参、麦冬、知母、竹叶、芦根以清肺热,滋生阴液,培养肺阴,以润肺燥。中焦主"脾胃之病",可选玄参、麦冬、生地黄以滋阴增液,黄芪、山药等补气之品,助益脾胃健运。下焦主"肝肾之病",以滋养肝肾为主,可选封髓丹补益肝肾。

Sjogren′s syndrome(SS)is caused by the obstruction of triple energizers′channel,blood stasis and phlegm retention,and the obstruction of body fluid.The weakening of triple energizers′qi transportation leads to dysfunction of distribution and metabolism of qi,blood and body fluid,which leads to SS.We should distinguish the primary and secondary causes in the treatment of SS from the differentiation of symptoms and signs of triple energizers.Dryness pathogen is vulnerable to lung yin of upper energizer.In SS,it is often manifested as dry mouth,nose,pharynx,tongue and skin,accompanied by dry cough.If the middle energizer fails to work,the whole body will lose nutrition due to lack of refined essence,and the skin the mouth and eyes will be dry.Due to the characteristics of the spleen and stomach,besides the manifestation of dryness,anorexia,belching and fatigue are often seen in the middle energizer.If the liver and kidney are insufficient and the body fluid and blood are deficient in the lower energizer,the symptoms of SS such as dry mouth,astringent eyes,shortness of breath,fatigue and bleeding are easy to appear.Because the upper energizer is in charge of"cardiopulmonary diseases",Xuanshen(Radix Scrophulariae),Maidong(Radix Ophiopogonis),Zhimu(Rhizoma Anemarrhenae),Zhuye(Folium Phyllostachydis Henonis),and Lugen(Rhizoma Phragmitis)can be used to clear lung heat,generate yin fluid,cultivate lung yin and moisten lung dryness.Because the middle energizer is in charge of"diseases of the spleen and stomach",Xuanshen(Radix Scrophulariae),Maidong(Radix Ophiopogonis)and Shengdihuang(Radix Rehmanniae)can be selected to nourish yin and increase body fluid,Huangqi(Radix Astragali)and Shanyao(Rhizoma Dioscoreae),etc.to help strengthen the spleen and stomach.Because the lower energizer is in charge of"diseases of the liver and kidney",the treatment should focus on nourishing the liver and kidney,Fengsui Elixir(封髓丹,FSE)is often used.