中医药治疗视神经脊髓炎谱系疾病的研究进展

A review on treating neuromyelitis optica spectrum disorder in TCM

视神经脊髓炎谱系疾病(Neuromyelitis Optica Spectrum Disorder,NMOSD)是中枢神经系统自身免疫病,临床表现与自身免疫受累部位密切相关,可表现为急性视力减退、肢体无力、感觉异常、呕吐等。西医虽有较好疗效,但大剂量激素冲击治疗、血浆置换、免疫抑制剂等手段具有价格昂贵、不良反应多等局限性。中医因重视同病异治观念,个体化治疗程度较高,在减轻症状、延缓复发等方面具有优势。在病因病机方面,NMOSD多因先天、后天不足导致邪伏体内,蕴结不解而成毒,遇诱因发作,邪气侵犯髓系和目系。其症状可分属“暴盲”“痿证”“呃逆”等范畴。因受患者先天禀赋或后天职业、地域、生活习惯不同等影响,本病多虚实夹杂。急性期多痰、瘀、湿、毒等邪实表现明显,治疗当以祛邪为主,邪去正安;缓解期多表现为肝脾肾不足,当以补虚为主,使邪伏不现。临床应注重分期论治、辨证论治,治疗当因人制宜,标本兼顾。中医治疗手段多元化,可采用中药化裁、针刺、灸法、耳穴压豆、八段锦等多种疗法缓解症状,尤其在改善神经功能缺损等方面取得较好疗效。文章从NMOSD中医病名、病因病机、证型分布规律、中医治疗等方面进行总结,为本病治疗提供临床参考。

Neuromyelitis optica spectrum disorder is an autoimmune disease of the central nervous system.Its clinical manifestations are closely related to the affected parts of the autoimmune system which can be manifested as acute visual impairment,limb weakness,paresthesia,vomiting,etc.Although western medicine has good curative effects,but high-dose hormone shock therapy,plasma exchange,immunosuppressive agents and other means have limitations such as high price and many adverse reactions.Traditional Chinese medicine attaches great importance to the concept of different treatment for the same disease and has a higher degree of individualized treatment.It has advantages in alleviating symptoms and delaying recurrence.In terms of etiology and pathogenesis,neuromyelitis optica spectrum disorders are mostly caused by congenital and acquired deficiency,which lead to accumulation of evil in the body.If the evil is not eliminated,it will become a toxic evil,which will lead to diseases when encountering incentives.And the evil Qi(气)invades the medullary system and eye system.Its symptoms can be divided into“sudden blindness”,“flaccidity syndrome”,“hiccups”and other categories.Due to the influence of patients’innate endowments or acquired occupation,region,living habits,the disease is mostly mixed with deficiency and excess.In the acute phase,there are obvious manifestations of phlegm,blood stasis,dampness,toxin,and other evils,during which the treatment gives priority to dispelling pathogenic factors,the body will become healthy if the evil is removed;in the remission stage,it is mostly manifested as liver,spleen,and kidney deficiency,during which the treatment gives priority to tonifying.In clinical practice,attention should be paid to the treatment by stages and syndrome differentiation.The treatment should be individualized and target both the root causes and symptoms.The treatment methods of TCM are also diversified.Various therapies such as modified TCM prescription,acupuncture,moxibustion,auricular point pressing beans,Baduanjin and other therapies can be used to relieve symptoms,especially in ameliorating neurological deficits.This article summarizes the disease name,etiology and pathogenesis,syndrome distribution,and treatment of neuromyelitis optica spectrum disorder in TCM in order to provide clinical reference for the treatment of this disease.