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基于"毒瘀虚"分期论治皮肌炎的临证经验

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皮肌炎是一种累及皮肤、骨骼肌的自身免疫性疾病.临床表现以皮疹、肌无力、肌痛为主.本病初期外邪入里,化热为毒,邪毒蕴阻肌肤,发为皮疹;而后热毒与湿、瘀相互胶结,可见皮疹加剧,关节肌肉灼痛;久病气血阴阳亏虚,出现肌肉酸痛、肢体痿弱无力.汤小虎教授根据多年临床经验总结,急性期以热毒为主者,治以清热解毒,活血止痛;如热毒内陷心营,治以清营解毒,透热养阴.缓解期以瘀热偏重者,治以活血化瘀,理气健脾;以湿热偏重者,治以清热利湿,宣通经络.慢性期以气血两虚为主者,治以益气温经,养血和络;以阴虚为主者,治以滋补肝肾,益气养阴;以阳虚为主者,治以温阳通络,健脾益肾.临证之时汤小虎教授辨清病理因素,精准用药,本文以急性期热毒炽盛,内陷心营为例,选方清营汤合青蒿鳖甲汤加减进行阐述.
Based on the Clinical Experience of"Poison Stasis Deficiency"Staging in the Treatment of Dermatomyositis
Dermatomyositis is an autoimmune disease that affects the skin and skeletal muscles.The clinical manifestations are mainly rash,muscle weakness,and myalgia.In the early stages of this disease,external pathogens enter the interior,transforming heat into toxins.The toxins accumulate in the skin,leading to rash;Subsequently,heat toxicity,dampness,and blood stasis are intertwined,leading to an exacerbation of the rash and burning pain in the joint muscles;Long term illness with deficiency of Qi,blood,Yin and Yang,resulting in muscle soreness,limb weakness and Professor Tang Xiaohu summarized based on years of clinical experience that in the acute phase,heat toxicity is the main pathagen,and the treatment should focus on clearing heat and detoxifying,promoting blood circulation and relieving pain.If the heat toxin is trapped in the heart camp,the treatment is to clear the camp,detoxify,and nourish Yin through heat.For those with a heavy emphasis on blood stasis and heat,the treatment should be to promote blood circulation and remove blood stasis,regulate Qi and strengthen the spleen.For those who are more prone to dampness and heat during the remission period,the treatment should be to clear heat,promote dampness,and promote the circulation of meridians.In the chronic stage,patients with deficiency of both Qi and blood are mainly treated with nourishing Qi,warming meridians,nourishing blood,and collaterals.For those who mainly suffer from Yin deficiency,the treatment is to nourish the liver and kidneys,nourish Qi and nourish Yin.For those with Yang deficiency as the main treatment,it is recommended to warm the Yang and unblock the meridians,strengthen the spleen and benefit the kidneys.At the time of clinical diagnosis,professor Tang Xiaohu identified pathological factors and used precise medication.This article takes the example of acute heat toxicity and invagination of the heart as an example,and elaborates on the combination of Qingying Tang and Qinghao biejia Tang with modifications.

dermatomyositistoxic stasis deficiencyclearing camp and detoxifyingpromoting dampness and removing blood stasisbenefiting Qi and nourishing bloodwarm Yang and nourish Yinclinical experience

杜时雨、王海洋、彭昭蓉、汤小虎

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云南中医药大学,云南昆明 650500

云南中医药大学第一临床医学院,云南昆明 650500

云南省中医医院,云南昆明 650021

皮肌炎 毒瘀虚 清营解毒 利湿祛瘀 益气养血 温阳滋阴 临证经验

云南省"万人计划"名医专项国家中医药管理局国家中医临床研究基地建设项目

20191号国中医药科技函[2018]131号

2024

云南中医学院学报
云南中医学院

云南中医学院学报

影响因子:0.933
ISSN:1000-2723
年,卷(期):2024.47(3)
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