从虚瘀毒辨治青斑样血管病

Treatment of Livedoid Vasculopathy from Deficiency,Blood Stasis and Toxicity

青斑样血管病是一种罕见难治性的非炎症性血栓闭塞性脉管疾病,该病皮损多样且迁延难愈,反复发作,严重影响患者的生活质量。曹建春在中西医汇通的诊疗背景下,对血管相关疾病的中医论治有独具特色的诊疗方法与学术观点,该文从“脉痹”着手,阐明青斑样血管病的病因病机为“虚”“瘀”“毒”,虚为“正气不足,营卫失调”,是疾病基本的病理基础,瘀为“血脉瘀滞的状态”,是疾病关键的病理基础,毒为“风寒暑湿燥火等六淫及痰饮瘀血等病理产物”,是疾病重要的致病因素,该病病位主要在血脉肌肤,局部症状明显,湿热毒瘀证最为常见,故诊治上重视治标与治本兼施,整体与局部兼顾,辨病与辨证相结合的诊疗思想,确立了扶正祛邪,祛邪为主的治则,清热解毒利湿,凉血活血散瘀,调和营卫气血的治法,采取了中药内服以“四藤一仙汤、紫鹤五草汤、黄芪桂枝五物汤”为基础方加减从根本上扶正祛邪,减少复发,同时配合以“过敏性皮炎洗剂”为基础方的中药熏洗方式以求急祛其邪,减轻局部症状。中药内服加外洗,标本兼顾的诊治特点在该病的治疗上取得了良好临床疗效。

Livedoid vasculopathy(LV)is a rare and intractable non-inflammatory thrombo-occlusive vascular disease with diverse and recurrent lesions that seriously affect the quality of life of patients.Chief Physician CAO Jianchun has unique diagnosis and treatment methods and academic views on vascular-related diseases under the background of integrated traditional Chinese and Western medicine.Starting from“Maibi”,this paper clarified that the etiology and pathogenesis of LV are deficiency,blood stasis and toxin.Deficiency is deficiency of vital Qi and imbalance of Ying and Wei,which is the basic pathological basis of the disease.Blood stasis is the state of blood stasis in vessels,which is the key pathological basis of the disease.Toxicity is the pathological product of six evils such as wind,cold,heat,dampness,dryness and fire and phlegm,blood stasis and other pathological products.It is an important pathogenic factor of the disease.The disease is mainly located in the skin of blood vessels.Local symptoms are obvious.Damp-heat and toxin and blood stasis syndrome is the most common.Therefore,the diagnosis and treatment emphasizes the treatment of both the symptoms and the root of the disease,taking into account both the overall and local aspects,and combining the diagnosis of the disease with the symptoms,and establishes the treatment principle of helping the righteous and eliminating the evil,with the main focus on eliminating the evil,clearing heat,detoxifying dampness,cooling the blood,activating blood circulation,dispersing blood stasis,and harmonizing Qi and blood of Ying and Wei.The traditional Chinese medicine was taken orally.The basic prescriptions include Siteng Yixian Decoction(四藤一仙汤),Zihe Wucao Decoction(紫鹤五草汤),Huangqi Guizhi Wuwu Decoction(黄芪桂枝五物汤)to fundamentally strengthen healthy Qi and eliminate pathogenic factors and reduce recurrence.At the same time,the traditional Chinese medicine fumigation and washing method based on allergic dermatitis lotion was used to remove the pathogenic factors and alleviate local symptoms.Traditional Chinese medicine combined with external washing has achieved good clinical efficacy in the treatment of the disease.