祛邪扶正法辅助治疗原发性中枢神经系统血管炎1例  

A case report of primary angiitis of the central nervous system treated adjuvantly with the dispelling pathogen and reinforcing healthy qi method

作　　者：张新宁 陈志刚 蔡英丽 李楠楠 任珊 陈路 康盛华 ZHANG Xinning;CHEN Zhigang;CAI Yingli;LI Nannan;REN Shan;CHEN Lu;KANG Shenghua(Beijing University of Chinese Medicine,Beijing 100029;Dongfang Hospital,Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院

出　　处：《现代中医临床》2023年第4期112-116,共5页Modern Chinese Clinical Medicine

基　　金：国家中医药管理局“十一五”重点专科专病基金(No.040104001003)。

摘　　要：原发性中枢神经系统血管炎(PACNS)是一种主要累及脑实质、脊髓和软脑膜的中小血管的重度免疫炎性疾病,因该病的罕见性和异质性,目前尚缺乏有效治疗策略。本例PACNS患者在使用激素冲击治疗及免疫抑制治疗后,病情仍持续进展,笔者临证以祛邪扶正为总法,审标本、分主次,以痰、热为主要病邪要素,结合邪实向本虚演变的核心病机变化,先予清热豁痰开窍以祛邪,待患者病势渐缓,又予培元补虚之品加强扶正固本之力。使用中医药祛邪扶正治疗后,患者病情稳定,症状逐渐好转,取得良效,为中医药治疗PACNS提供思路。Primary angiitis of the central nervous system(PACNS)is a severe immunoinflammatory disease mainly affecting small and medium blood vessels in the brain parenchyma,spinal cord and pia mater.Due to its rarity and heterogeneity,effective treatment strategies are currently lacking.In this study,the disease progression was not halted in the patient with PACNS after pulse glucocorticoid therapy and immunosuppressive therapy.In the adjuvant treatment with TCM,the overall principle was to dispel pathogen and reinforce healthy qi,prioritizing the differentiation between the manifestations and root causes and identification of the primary problems.It was consequently found that phlegm and heat were the main pathogenic factors,and the core pathogenesis change was pathogenic excess evolving into deficiency of healthy qi.The first step adopted was to dispel pathogen by clearing heat,eliminating phlegm,and opening the orifices.Qi-nourishing and deficiency-supplementing herbs were used later when the patient’s progression started to slow down.After TCM treatment,the patient’s conditions gradually improved,and remarkable efficacy was achieved,which provided a new perspective for TCM treatment of PACNS.

关 键 词：原发性中枢神经系统血管炎 中医 祛邪扶正 

分 类 号：R259[医药卫生—中西医结合]