刘爱民辨治过敏性紫癜经验

Liu Aimin's Experience of Treating Allergic Purpura

刘爱民教授对过敏性紫癜采用逆向辨证模式,即先辨皮损,而后逆向查找皮损的原因,从局部到整体,反向推导出核心病机及各个证候。起病急,皮损为鲜红色瘀点、瘀斑,常发生在双膝关节以下者,为外感风湿热邪,入血化热,热邪迫血妄行,治应清热凉血,祛瘀消斑,药用牛膝、仙鹤草、茜草、栀子、牡丹皮、白茅根、生地黄、薏苡仁、甘草等。瘀斑多见于下肢,色红而大,或可兼见瘀斑上有血疱或水疱者,为素体湿热,或感受外在湿热,或嗜食肥甘辛辣,湿热下趋,日久络脉灼伤,血溢脉外,治应清热除湿,凉血消斑,方用四妙丸加减。病程迁延日久,常反复发作,皮损色淡暗或略发黄者,为脾虚不固,统血无权,血溢脉外而发斑,治应益气健脾,养血止血,方用归脾汤加减。皮损色紫红,伴见午后潮热,颧红盗汗,五心烦热,舌质红苔少,脉细数者,为虚火上炎,灼伤脉络而发斑,治应滋阴清热,采用二至丸合六味地黄丸加减。瘀斑色淡红,久治不愈或反复发作,劳累则瘀斑增多者,为脾肾阳虚,失于温固,血溢于脉外,治应温补脾肾,方选黄土汤加减。

For allergic purpura,Professor Liu Aimin adopts a reverse syndrome differentiation model,which first identifies the skin lesions,then reversely searches for the causes of the lesions,and deduces the core pathogenesis and various syndromes from the local to the overall.For patients with acute onset and skin lesions with bright red ecchymosis or spots,occurring below the knee joint,the disease is caused by externally contracted wind,dampness and heat pathogens,which enter the blood and transform heat,leading to the heat forcing the blood to move recklessly.Treatment should focus on clearing heat and cooling blood,removing blood stasis and spots,so Niuxi(Radix Achyranthis Bidentatae),Xianhecao(Herba Agrimoniae),Qiancao(Radix et Rhizoma Rubiae),Zhizi(Fructus Gardeniae),Danpi(Cortex Moutan),Baimaogen(Rhizoma Imperatae),Shengdi(Radix Rehmanniae),Yiyiren(Semen Coicis),Gancao(Radix Glycyrrhizae),etc.can be used.For those with ecchymosis mostly in the lower extremities,red and large,or accompanying blood blisters or blisters on the ecchymosis,the disease causes include constant dampness-heat constitution,or externally contracted dampness-heat,or eating fat sweet spicy food,leading to dampness-heat moving downward,burning collaterals,blood spilling outside the vessels.Treatment should focus on clearing heat and removing dampness,cooling blood and eliminating spots,so Modified Wonderfully Effective Four Pill can be used.For those with the prolonged course of allergic purpura,repeated attacks,light dark or slightly yellow skin color,the disease is due to spleen deficiency failing to control blood leading to blood spilling outside the vessels,the treatment should focus on replenishing qi and activating the spleen,nourishing blood to stop bleeding,so Modified Spleen-Restoring Decoction can be used.For those with purplish red skin color accompanied by afternoon tidal fever,flushed malar eminence,night sweat,vexing heat in chest,palms and soles,less tongue red fur,thin and quick pulse,the disease is because of deficiency fire flaming upward leading to burning collaterals,the treatment focuses on nourishing yin and clearing heat,so Modified Double Supreme Pill combined with Six-Ingredient Rehmannia Pill can be used.For those with light red color of ecchymosis,long-term treatment or repeated attacks,and increased ecchymosis due to fatigue,it is due to spleen-kidney yang deficiency,failing to warm and consolidate blood leading to spilled blood outside the vessels.The treatment should focus on warming and tonifying the spleen and kidney,so Modified Yellow Earth Decoction can be used.