从“火毒伏络”论老年性带状疱疹之病机演变及治法  

Discussion on TCM Pathogenesis Evolution and Treatment of Senile Herpes Zoster from"Fire Toxin Lurking in Collaterals"

作　　者：王婧琳 李鸿涛[1] 陈广坤[1] 张明锐[2] 叶瑜 马越 Wang Jinglin;Li Hongtao;Chen Guangkun;Zhang Mingrui;Ye Yu;Ma Yue(Institute of Information on Traditional Chinese Medical,China Academy of Chinese Medical Sciences,Bejing 100700,China)

机构地区：[1]中国中医科学院中医药信息研究所,北京100700 [2]内蒙古医科大学,内蒙古呼和浩特010110 [3]贵州中医药大学,贵州贵阳550025

出　　处：《中国中医急症》2024年第2期240-243,251,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家重点研发计划(2023YFC3502901);第五批全国中医临床优秀人才研修项目(国中医药人教2022-239);中国中医科学院科技创新工程重大攻关项目(CI2021A00505;CI2021A05302);《中华医藏》编纂出版项目(KJS-ZHYC-2020-016)。

摘　　要：带状疱疹属于中医“络病”范畴,老年人正气不足、阴精亏乏,是本病的高发人群,使用中医药诊治该病疗效显著。火毒伏络、外内合邪是老年性带状疱疹发病的病机关键,络脉阴枯血瘀是疼痛经久不愈的重要原因,其病机演变分为3个阶段:潜伏期,火毒深伏少阴阴络,待正虚、外邪引动,逐渐遍及脏腑络脉;疱疹期,肝胆郁火攻窜,突破浅表阳络而发疹;后期火毒焦灼络脉,阴枯血瘀,发为顽痛。综合近年专家和同行研究实践,结合笔者团队自身的探索与体会,提出祛除络脉火毒的6种治法:清热泄火法、祛风散火法、除湿导火法、化瘀排火法、顺气降火法、益水潜火法,其中尤须重视填补五脏络脉真阴,以恢复络脉功能。此外,运用中医学“取类比象”思维方法,使用药物络部、皮部,可使药力直达病所,以期为老年性带状疱疹的诊治提供思路和启发。Herpes zoster belongs to the category of collateral disease in traditional Chinese medicine(TCM).The elderly are the high-risk population of this disease due to the lack of positive qi and yin essence.TCM has a significant effect on diagnosis and treatment for this disease.Fire toxin lurking in collaterals and external and internal evils together attacking are the keys to the pathogenesis of senile herpes zoster.The pathogenesis evolution is divided into three stages,i.e.,the latent period,eruption period and postherpetic neuralgia period.The fire toxin firstly lurks in the Shaoyin yin collateral.When the positive qi losing and the external evil invading,the fire toxin gradually spreads throughout the viscera collaterals.Then,stagnated fire toxin in liver and gallbladder attacks up-ward and breaks through yang collaterals,so herpes zoster is formed in the skin.Finally,the fire toxin burns the collaterals,resulting in yin drying up and blood stasis,and causing stubborn pain.At the same time,combined with the relevant research practice and our team's own exploration,six treatment methods for removing fire toxin in collaterals are summarized,i.e.,clearing internal heat and fire,expelling wind and dispersing fire,dissipating dampness and expelling fire,regulating qi and reducing fire,removing blood stasis and dispersing fire,nourishing water for suppressing hyperactive fire.In particular,attention must be paid to fll the true yin of five viscera,in order to restore the function of collaterals.In addition,according to obtaining image from analogy,using the skin and vein of herbs,can make the effects directly to the disease location.This study will provide ideas for the diagnosis and treatment of senile herpes zoster.

关 键 词：带状疱疹 火毒 络脉 神经痛 阴精 老年人 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]