基于“五脏应时”理论探讨儿童过敏性紫癜病因病机

Discussion on etiology and pathogenesis of henoch-schönlein purpura in children based on the theory of‘five-Zang organs corresponding to the seasons’

内外合邪为儿童过敏性紫癜主要病因,四时之气不同,应时之脏不同,时令之邪不同,其病因病机也不同。春季,其病机或为伏邪遇外邪诱发,或为外邪与肝之相火相合,或为风邪犯络,治疗应顺应气之升发之性,引伏邪外出,不用寒凉之品遏制肝气,同时兼顾祛风散邪;夏季,其病机或为阳气过亢损伤络脉,或为热入血分,或为气不摄血,治疗应清热降气,凉血养阴,兼顾活血化瘀;秋季,其病机或为湿热之邪被肃降之气所遏,或为外邪犯卫,或为燥邪伤津,瘀血伤络,治宜清宣伏邪,益气养阴,兼顾润燥;冬季,其病机或为腠理郁闭,热无以散,或为外邪犯肾,或为寒邪客络,治疗应顺应冬之封藏之性,避免他邪干肾,恢复肾中阴阳平衡,兼顾发散风寒之邪;脾应长夏,主运化,主四时,四季均应顾护脾胃。基于“五脏应时”理论对儿童过敏性紫癜进行辨治,既考虑了人的因素,又考虑了天的因素,体现了《素问·气交变大论》“上知天文,下知地理,中知人事”思想。

Combination of internal and external pathogens serves as the main cause of henoch-schönlein purpura in children.Different qi in the four seasons corresponds with different Zang-organs;different pathogens in seasons can also lead to different etiologies and pathogenesis.In spring,its pathogenesis may be latent pathogens induced by external pathogens,or the combination of external pathogens and liver fire,or the invasion of collaterals by wind pathogen.On treatment,the ascending property should be followed to usher latent pathogens.Meanwhile,drugs in cold or cool property should be avoided in case suppressing the liver qi.Besides,methods of expelling wind and dispelling pathogens should be considered.In summer,its pathogenesis may be exuberance of qi damaging the collaterals,or heat pathogen entering the blood aspect,or qi failing to securing blood.The treatment strategy concludes clearing heat and descending qi,and cooling the blood and nourishing yin,with the consideration of promoting the blood circulation and removing blood stasis.In autumn,its pathogenesis may be that the pathogens of dampness and heat are suppressed by the descending qi,or the external pathogens invading the defense,or the dry pathogen damaging the body fluid with stagnated blood damaging the collaterals.The main treatment principles include clearing and diffusing latent pathogens,boosting qi and nourishing yin,together with moisturizing dryness.In winter,the pathogenesis may be closing of muscular interstices and no dispersion of heat,or external pathogens attacking the kidneys,or cold pathogen residing in the collaterals.On treatment,the property of sealing should be followed to avoid other pathogens affecting the kidneys,so that,the balance of yin and yang in the kidneys can be restored.Meanwhile,the dispersion of the wind and cold pathogens should be considered.In addition,the spleen corresponds to later summer,governs its transport and transformation as well as the four seasons.Protection of the spleen and stomach should bear in mind in all seasons.Diagnosis and treatment of henoch-schönlein purpura in children based on the theory of five-Zang organs corresponding to the seasons takes into account not only human factors,but also the factors of the heaven,reflecting the thought of‘knowing astronomy in heaven,geography on earth,and human affairs’in the chapter of Discussion on the Changes of Qi-Convergence in Plain Questions.