基于《内经》探析系统性硬化病的诊治

Diagnosis and Treatment of Systemic Sclerosis Based on “Inner Canon of Yellow Emperor ”

[目的]探析《黄帝内经》思想对于诊治系统性硬化病(systemic sclerosis,SSc)的理论指导意义及临床应用价值。[方法]通过梳理《黄帝内经》中关于"痹病"的论述,从病名与症候、病因病机及辨治要点三个方面来探讨SSc的中医传变规律、发病机制及处方诊治要点,并列举验案一则。[结果]《黄帝内经》中关于"痹病"的论述及脏腑表里传变理论,与SSc的临床特点及并发内脏损害有相通之处,据此认为SSc的发病及转归与素体元阳亏虚、外邪侵袭及脏腑表里之传变密不可分,治法上当立足温补,气血阴阳兼顾,处方常以阳和汤加减。所举验案为SSc典型病例,存在弥漫性皮肤硬化及内脏受累,经以阳和汤为基础方调治,并根据不同时期病情变化特点,辨证不离辨病,灵活处方,获得良效。[结论]《黄帝内经》中关于"痹病"及疾病传变规律的论述对加深理解SSc病情变化规律具有重要临床价值,为SSc的中医辨治提供了中医理论基础及处方用药依据。

[Objective] To explore the theoretical guiding significance and clinical application value of the "Inner Canon of Yellow Emperor"for the diagnosis and treatment of systemic sclerosis(SSc).[Methods] By combing the discussion of "arthralgia syndrome"in "Inner Canon of Yellow Emperor",this paper discussed the traditional Chinese medicine(TCM) transmission regularity,pathogenesis and prescription diagnosis and treatment points of SSc from the three aspects of disease name and syndrome,etiology and pathogenesis,and the key points of syndrome differentiation and treatment,and a clinical medical case was cited as proof.[Results]The discussion on"arthralgia syndrome"and the theory of internal and external transmission of viscera in"Inner Canon of Yellow Emperor"are similar to the clinical characteristics and concurrent visceral damage of SSc. Therefore,it is believed that the pathogenesis and outcome of SSc are closely related to the deficiency of Yuanyang in the body,the invasion of exogenous pathogenic factors,and the transfer to viscera. The treatment method is mainly warming and nourishing Qi,Blood,Yin and Yang,prescriptions are often based on Yanghe Decoction. The attached medical case was a typical SSc case with diffused skin sclerosis and visceral involvement. The treatment was based on Yanghe Decoction,and according to the characteristics of the disease changes in different periods,the disease was treated according to syndrome differentiation combined with disease differentiation,the prescriptions were flexible,and good effect was obtained.[Conclusion]The discussion on "arthralgia syndrome"and the regularity of disease transmission in "Inner Canon of Yellow Emperor"has important clinical value for deepening the understanding of the regularity of change of SSc condition,and provides the theoretical basis of TCM and prescription for TCM differentiation and treatment of SSc.