镇万雄治疗幼年特发性关节炎全身发热、白细胞增多的经验

Chief Physician ZHEN Wanxiong’s experience in treating juvenile idiopathic arthritis with systemic fever and leukocytosis

镇万雄主任医师是鄂南知名中医,擅长运用中医药治疗幼年特发性关节炎。镇老认为,幼年特发性关节炎患儿多属先天不足,后天失养,正虚邪扰。小儿为纯阳之体,在不同季节、不同地域感受不同邪气,或为外受风寒,从阳化热,或为感受风热邪气,初期多伴有卫表证,时间短暂,很快出现气分发热,入营至血。入营至血的标志是发热时出现皮肤红斑、白细胞增多、血小板增多,予抗感染治疗白细胞难以下降。内有血分伏热外透不得,外有卫表证未消,营卫不调,故许多患儿出现皮疹瘙痒。部分患儿伴有肺脾不足,卫强营弱,表虚自汗,则发热皮疹往往较轻,纳差食少便溏,病情缠绵难愈,与现代医学所认为的肠道菌群紊乱、肠黏膜屏障破坏相吻合。治疗时需要清热解毒、透热转气、凉血化瘀、祛风止痒、顾护脾胃气血,热盛时以祛邪为主,热退后需扶正兼以祛邪,防止复发。

Chief Physician ZHEN Wanxiong is a well-known TCM physician in southern Hubei.He is good at using TCM to treat juvenile idiopathic arthritis.He believes that most children with juvenile idiopathic arthritis are caused by congenital insufficiency,acquired dystrophy,healthy Qi(气)deficiency and pathogen excessiveness.Children have infantile body of pure Yang(阳),they feel different pathogenic Qi in different seasons and different regions.Causes of disease include wind-cold,wind-heat,pathogenic Qi.It initially manifested as the Weibiao syndrome(卫表证),but for a short time,followed by syndrome of Qifen(气分)fever,Yingfen(营分)and Xuefen(血分)invaded by toxin.The clinical manifestations are skin erythema,leukocytosis,and thrombocytosis during fever,and it is difficult to decrease leukocytes by anti-infective treatment.Because of the heat lodging in Xuefen in the body,the external manifestations of the Weibiao syndrome,disharmony between nutrient Qi and defensive Qi,many children have rashes and itching.Some children are accompanied by deficiency of both lungs and spleen,strong Wei(卫)and weak Ying(营),superficies deficiency and spontaneous sweating,mild fever and rash,poor appetite and loose stool,with long course of disease and recurrent attacks.It is consistent with the testinal flora disturbance and testinal mucosal barrier failure in modern medicine.Treatment methods include clearing heat and removing toxicity,clearing heat of Yingfen to Qifen,cooling blood for removing blood stasis,dispelling pathogenic wind and relieving itching,protecting spleen and stomach Qi and blood.During the heat period,the treatment method is mainly to eliminate the pathogen.After the fever subsides,it is necessary to strengthen the body and remove the pathogens in order to prevent recurrence.