从脾胃论治儿童腹型过敏性紫癜探析

Treatment of Abdominal Allergic Purpura in Children by Stages Based on Spleen and Stomach Theory

腹型过敏性紫癜是儿童常见的血管炎性疾病,以皮疹、腹痛为主要临床表现,可伴有呕吐、消化道出血等症状,发病率日益增加。小儿脾常不足,基于李东垣脾胃学说中的“内伤脾胃,百病由生”理论,本病病位在中焦,核心病机为正气亏虚、湿热瘀阻,可将其分为急性期和恢复期进行辨治。急性期湿热瘀阻,治以清热利湿、活血通络,方选除湿胃苓汤合犀角地黄汤化裁;恢复期脾气虚弱,治以健脾护中、益气摄血,方选归脾汤化裁。健运脾胃与活血通络之法贯穿始末,因时制宜,同病异治,以期为本病的治疗提供新的思路,附验案1则兹以佐证。

Abdominal Henoch-Sohonlein purpura is a common vasculitis disease in children,with rash and abdominal pain as the main clinical manifestations,accompanied by vomiting,gastrointestinal bleeding and other symptoms,and the incidence is increasing. Children′s spleen is often insufficient,based on the spleen and stomach theory of Li Dongyuan′s "the damage of spleen and stomach would cause many diseases" theory,the location of the disease is Zhongjiao,and the core pathogenesis is deficiency of vital qi,hot and damp stasis resistance. The disease can be divided into acute stage and recovery stage for syndrome differentiation. In the acute stage,it can clear away heat and dampness,promote blood circulation and remove blood stasis;for medication,modified Chushi Weiling Decoction combined with Xijiao Dihuang Decoction could be applied;in recovery stage,the spleen qi is weak,and treatment should be focused on strengthening the spleen,qi and blood;for medication,modified Guipi Decoction should be selected. The method of nourishing spleen and stomach and activating blood and dredging collaterals runs through the beginning and end. In order to provide new ideas for the treatment of this disease,a case is attached to prove the method.