国医大师丁樱儿童过敏性紫癜病因病机“六字诀”

Grandmaster of Chinese Medicine Ding Ying′s "Six Character Knack" onEtiology and Pathogenesis of Pediatric Allergic Purpura

过敏性紫癜病因病机不离风、热、湿、毒、虚、瘀六大要素,且六者之间既有区别又有联系。风邪袭表,风者善行、主动,风邪扰络则络阻血动,溢出脉外,发为紫癜,为关键病因病机。风邪虽可单独致病,也多夹热致病,风与热皆为阳邪,风热入络,风者善行、热者迫血,“两阳相劫”,合则更甚,血溢络外发为紫癜,为常见病因病机。血溢成瘀,瘀血阻络,血行受阻,“瘀”与“溢”互为因果,瘀贯穿疾病始终,为本病一贯病机。湿邪亦为本病常见病因,如外感暑湿以及风湿、湿热、湿毒之邪夹杂,尤以湿热为著。毒邪病机除同湿、热或瘀类似外,还具有致病急骤重笃,凶猛善变,病变复杂,侵及部位多,胶着难愈,变证从生等毒邪致病的病机特点。正气虚弱,祛邪无力,可致外邪留伏,而成伏邪,遇新感而发紫癫。临证紧抓病机六要素,辨证辨病遣方用药,方能药到病除。

The etiology and pathogenesis of allergic purpura are closely related to the six factors of Wind,Heat,Dampness,Toxicity,deficiency and stasis,and there are both differences and connections among the six ones.Wind evil is active and attacks the surface.If Wind evil disturbs the meridians and block blood flow,which overflows outside the meridians and purpura develops.This is the key cause and pathogenesis of purpura.Although Wind evil can cause diseases alone,it is also often accompanied by Heat.Wind and Heat are both Yang evil factor.Wind Heat enters the meridians,and it is good at their actions.Wind with Heat would induce blood running abnormally.If the two Yang act to each other,the negative effect becomes more severe and blood would flow out of the meridians,which leads to purpura.This is the commonly existing pathogenesis of purpura.Blood overflow becomes stasis and obstructs collaterals,and the blood flow is eventually obstructed.Stasis"and"overflow"are mutually causal and effect,so stasis runs through the entire process of the disease,which is the consistent pathogenesis of purpura.Dampness is also a common cause of this disease,such as external summer Heat and Dampness,as well as a combination of Wind Dampness,Dampness Heat and Dampness Toxin,in which the last one is the most serious factor.In addition to being like Dampness,Heat,or blood stasis,the pathogenesis of Toxin pathogens also has the characteristics of rapid and severe pathogenic changes,fierce and changeable nature,complex lesions,multiple invading parts,difficult to heal,and the varied of changes.Weakness of Zheng Qi and its inability to dispel the evil factors can lead to the retention of external pathogens,resulting in the formation of latent pathogens and the development of purpura when encountering the evil factors another time.Clinically,the six elements of disease pathogenesis should be considered,with differentiation of symptoms and diseases,proper medication applied can effectively cure the disease.