基于叶桂“上燥治气,下燥治血”理论探讨干燥综合征的发病与辨治

Discussion on the Pathogenesis and Treatment of Sj?gren's Syndrome Based on YE Gui's Theory of“Upper Dryness Treats Qi and Lower Dryness Treats Blood”

提出干燥综合征外感燥邪、内伤精血、禀赋阴虚、情志异常的发病观,认为本病有干涩不通、虚实夹杂的病机特点;并根据叶桂《临证指南医案》“上燥治气,下燥治血”理论,将干燥综合征分为上燥与下燥辨治。临证治疗时顺应五脏刚柔特性,用药柔静凉润,忌刚动温燥,重视血肉有情之品。上燥以桑杏汤清气润燥,翘荷汤辛凉清上,沙参麦冬汤养阴生津;下燥以复脉汤充养五液,六味地黄丸滋肾填精,五仁丸润燥养血,为干燥综合征辨治提供新思路。

The pathogenesis of Sj?gren's syndrome(SS)was considered to involve external dryness,internal injured essence and blood,yin-deficiency endowment,and abnormal emotion and spirit,and it was believed that SS has the characteristics of dryness and impassability,and the pathogenesis of deficiency-excess in complexity.According to the theory“upper dryness treats qi,and lower dryness treats blood”in YE Gui's monograph“Medical Records for Clinical Guidance”,the dryness was divided into upper dryness and lower dryness syndromes to be differentiated and treated.When treating dryness syndrome,the patient should follow the characteristics of the five zang organs,using soft and cool medicines,avoiding warm and dry medicines,and valuing the animal products.The upper dryness could be treated with Sangxiang Decoction(桑杏汤)to clear the qi and moisten the dryness,Qiaohe Decoction(翘荷汤)to clear the upper with pungent-cool,and Shashen Maidong Decoction(沙参麦冬汤)to nourish yin and promote the production of body fluid.The lower dryness could be treated with Fumai Decoction(复脉汤)to enrich and nourish the five kinds of fluid.Liuwei Dihuang Pill(六味地黄丸)to nourish the kidneys and supplement essence,and Wuren Pill(五仁丸)to moisten the dryness and nourish the blood,which provided a new way of thinking for differentiation of the dryness syndrome.