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1、支气管哮喘过敏鼻炎荨麻疹湿疹介绍n支气管哮喘 n过敏性鼻炎 n荨麻疹 n湿疹Bronchial Asthma支气管哮喘Overview(概述)nAsthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role.nCells: eosinophil, mast cell, T cell , neutrophil and epithelial cells,etc. 支气管哮喘是由多种细胞(如噬酸性粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、气道上
2、皮细胞等)和细胞组分参与的气道慢性炎症性疾病。Overview(概述)nChronic inflammation leads to broncho-hy-perreactivity and recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning . 这种慢性炎症导致气道高反应性的增加,并引起反复发作性的喘息、气急、胸闷或咳嗽等症状,常在夜间或清晨发作、加剧.诊断n气道高反应性为特征n典型的哮喘发作时:胸
3、闷、呼吸困难、 伴咳嗽、咯痰等症状。 多在夜间发作; 肺部听及吹口哨声音,满布哮鸣音。n哮喘发作前几分钟往往有过敏症状:如 鼻痒、眼睛痒、打喷嚏、流涕、流泪和 干咳等。诊断n不典型的哮喘:主要表现为长期反复干咳,咽痒,胸闷不适,常发生在,影响睡眠,一般消炎止咳治疗无效。Understanding of Modern Medicine(Etiology)现代医学的认识(病因)nGenetic Factor( Polygenic Inheritance) 遗传因素(多基因遗传)nShooting Factor(Allergic Constitution and External Factors)
4、激发因素(个体过敏体质及外界环境的影响是发病的危险因素)Pathogenesis(发病机制)nImmune-inflammation mechanism 免疫炎症机制nNeural mechanism 神经机制nAirway hyperreactivity mechanism 气道高反应性机制Understanding of TCM(中医的认识)nBronchial asthma belongs to asthma syndrome or dyspnea syndrome of TCM. 支气管哮喘属于中医学的“哮证”、“喘证”范畴。nThe name of asthma wao first
5、created by Zhudanxi.He made a special articles in the Dan Xi Xin Fa. 朱丹溪首创哮喘之名,在丹溪心法一书中作为专篇论述。 Related Viscera and Meridians相关的脏腑、经络nThe disease location is in the lung,mainly impact the spleen and kidney. 病位在肺,主要关系到脾肾。 nRelated meridians(相关的经络): lung meridian 肺经 large intestine meridian 大肠经 heart m
6、eridian 心经 kidney meridian 肾经 Liver meridian 肝经Therapeutic Principle(治疗原则)nTreating the branch in attacking stage,treatment the root in remission stage-the basic therapeutic principle of this disease 发时治标、平时治本是治疗哮喘的最基本原则。Acupuncture and Moxibustion Therapy(针灸治疗)nAcupuncture treatment of asthma is in
7、 a very wide range of clinical applications.the effective rate of the therapy is about 80% in clinical reports.针灸诊疗哮喘在我国临床应用非常广泛,在临床报道中,有效率在80%左右。Needling Methods with Filiform Needle(毫针刺法)nAcute attack:Feishu,Dingchuan, Tiantu,Lieque,Fenglong. 急性发作期:肺俞、定喘、天突、列缺、丰隆。 In the case of invasion of wind-c
8、old in the lung:add Dazhui,Fengmen. 风寒犯肺者,加大椎、风门。 In the case of stagnation of phlegm-heat in the lung:add Chize,Yuji,(reducing manipulations ) 痰热壅肺者,加尺泽、鱼际,针用泻法。Needling Methods with Filiform Needle(毫针刺法)nRemission stage:Gaohuangshu,Feishu, Dingchuan,Guanyuan,Taiyuan. 缓解期:膏肓俞、肺俞、定喘、关元、太渊。nLung and
9、spleen qi deficiency:add Pishu,Zusanli. 肺脾气虚者,加脾俞、足三里。nYang deficiency of spleen and kidney:add Shenshu,Taixi(reinforcing manipulation). 脾肾阳虚者,加肾俞、太溪,针用补法。Three Points-Five Needles-One CupTherapy“三穴五针一罐”疗法nPrinciple Points: Feishu(couple), Fengmen(couple),Dazhui. 主穴:肺俞(双)、风门(双)、大椎穴nSupplementary poi
10、nts based on different symptoms 随症配穴nNeutral reinforcing-reducing manipulation 平补平泻手法nGet cupping after filiform needling 针后加拔火罐 支气管哮喘急性发作n平喘方法:双侧鱼际穴,直刺入1寸,强刺激,得气后留针30min,间隔行针10min,捻转1次,每天治疗1次。 (一般30min内可见效)双侧翳风穴,针刺时斜刺或直刺1寸,进针后以提插手法为主,平补平泻,行针3-5min,起针时强刺激,不留针,针刺1min后有效。平喘方法双侧听会穴,双侧均进针后,双手提插捻转,以提插为主,
11、平补平泻,行针1min。 大部分病人可见哮喘平息,口唇紫绀转红润,听诊哮鸣音明显减少。组方主配穴n主穴:肺俞、定喘。 配穴:脾俞、肾俞、少商。 此五穴均有较明显:抗过敏和平喘效果。n操作:用三棱针刺入穴位,深达肌层,上下划拨5-10次,以得起为度,每周2-3次。6-8次为一疗程,连续治疗2-3个疗程。注:此法实为针挑疗法的沿用; 少商穴少用,疼痛明显。赖氏经验取穴平喘(4+1)n治则:发时治肺,兼调任脉。n主穴:尺泽双、孔最双、列缺双、鱼际双。 配穴:天突、膻中、鸠尾。n操作:主穴(4个)+配穴(1个,任选)。先针主穴,顺序从尺泽鱼际,逆行而治,行捻转提插补泻法,得气后留针30min。中间行针
12、1次,每日1次,6次为1疗程。n此法对于急性、慢性、虚实寒热均可用。本人已适用几十年,疗效显著。赖氏刺血拔罐法+针刺五穴n主穴:大椎、定喘,以三棱针刺血拔罐. 配穴:膻中、曲池、三阴交、太溪、 复溜。 均双侧取穴,以针刺方法得气后平补平泻,留针30min,每天1次,隔5天1次。n治疗支气管哮喘急性发作。挑刺法n主穴:天突、肺俞双、定喘双。 配穴:(定喘)鸠尾。n操作:以自制挑刺专用钩针,针尖入穴位时,捻转(80度),进入真皮后以牵拉或抖动的方法挑断白色纤维。每周2次,6次为1疗程。n可收显著的平喘疗效。n注:为已故著名针灸学家司徒铃教授创用。Warming Moxibustion on Thr
13、ee Back-Shu Points温和灸三俞nPrinciple points:Feishu,Pishu.Shenshu 主穴:肺俞、脾俞、肾俞。nSupplementary points:Dazhui,Guanyuan, Zusanli. 配穴:大椎、关元、足三里。nPerformance :warming moxibustion (with moxa stick)操作方法:艾条温和灸。nCombining with filiform needling. 结合针刺治疗 灸少商穴法n艾炷灸双侧少商穴,每次3-5壮,每日1次,10次为一疗程。n10次后可见明显疗效。赖氏传统三伏天灸法n主穴:肺
14、俞、隔俞(四花穴)+定喘。 配穴:大椎(初伏) 百劳(中伏) 膏肓俞(末伏) 足三里(第四次加强) 注:四花穴为肺俞、隔俞,为本人导师已故司 徒铃教授几十年经验总结,可交通阴阳,调 理气血;加之定喘为经外奇穴中治疗哮喘的 特效穴,有别于治疗鼻炎等处方。赖氏传统三伏天灸法配穴的方法为赖氏经验天灸方: 白芥子、半夏、细辛、元胡、甘遂、斑蝥等适量研末,可用鲜姜汁调成糊状,制成药饼。儿童三伏贴n用“冬病夏治”流传验方: 白芥子 21g、细辛 21g、甘遂 12g、 延胡索 12g(也有用仙茅)n共研细末,用生姜汁调成糊状,制成药饼;也有另加麝香末,每次0.5g,撒在药饼中。分成三份,在炎热三伏天(初伏
15、、中伏、末伏各贴一次)儿童三伏贴天突、定喘、丰隆;肺俞、中喘;膻中、肾俞、足三里。n或选取背部的百劳、肺俞、膏肓俞三穴(双侧)n每次灸贴时间:婴儿1-2h; 学龄儿3-4h; 成人4-6h;3次为1疗程,需连续治疗3个疗程。儿童三伏贴n注:敷药后局部有针刺样烧灼感或蚁爬行感。将药取下局部潮红,不久后起小水泡,而后融合成大水泡。3-4天后水泡逐渐吸收、结痂,7-10天结痂脱落,不留瘢痕。 一般认为局部起泡者疗效较佳;局部无反应者多无疗效;局部反应快者由于反应慢者;水泡积液多者疗效优于积液少者。n作用机制:tigao迷走神经的兴奋性,还有扶阳固本。Auricular Acupuncture(耳针疗
16、法)nPrinciple points:Qiguan(CO16)trachea, Fei(CO14)lung,Shen(CO10)kidney, Shenshangxian(TG2p)adrenal gland,Shenmen(TF4). 取穴:支气管、肺、肾、神门、肾上腺。(图)nPerformance: Wangbuliuxingzi (Semen Vaccariae) fixed onto the ear acupoints. Advise the patient to press the acupoints many times a day; each time select one
17、ear and change the other side every two days.n操作:用王不留行籽贴压穴位。嘱患者每日按压耳穴数次,2d更换一次,两耳交替。Acupoint Injection(穴位注射)nPrinciple Points:Dingchuan,Feishu, Tiantu,Danzhong,Zhongfu,Kongzui,Fenglong,Shenzhu.n常用穴位:定喘、肺俞、天突、膻中、中府、孔最、丰隆、身柱等穴nCommon Injecta:CCO、Huangqi Injecta. 常用注射液:维D2果糖酸钙注射液或黄芪注射液等。 Chinese Medici
18、ne Therapy(中药治疗)Heat Syndrome(热喘)nTherapeutic Principle :cleaning away heat,resolving phlegm,asthma-relieving. 治则:清热化痰定喘nPrescription:Modified Dingchuan Decoction 方药:定喘汤加味nModification: On the base of Dingchuan Decoction:add Chuanbei,Jinqiaomai,Danshen. Add Gualou ,Madouling if cough seriously 以原方加川
19、贝、金荞麦、丹参、咯甚加瓜蒌、马兜铃。Cold Syndrome寒喘nTherapeutic Principle:warming the lung,dispelling cold,asthma-relieving. 治则:温肺散寒定喘nPrescription:Modified Suzijiangqi Decoction. 方药:苏子降气汤加味 nOn the base of Suzijiangqi Decoction:add Baijiezi,Zhimahuang,Danshen,Chuanbei.add Chuanjiao and Ganjiang if the symptom of co
20、ld syndrome is serious. 以原方加白芥子、炙麻黄、丹参、川贝, 寒甚加川椒、干姜。Deficiency Syndrome(虚哮)nTherapeutic Principle: reinforcing deficiency,asthma-relieving 治则:补虚定喘 nPrescription:self-made Guzhenjiangqi Decoction.n方药:固真降气汤加味(自拟) nIngredient:Renshen,Shudi,Danggui,Shanyurou,Hutaoren,Maidong,Wuweizi,Huainiuxi,Baijiezi,S
21、hengjiang, Placental powder(infused with water). 基本药物:人参、熟地、当归、山萸肉、胡桃肉、 麦冬、五味子、怀牛膝、白芥子、生姜、胎盘粉(吞服)。Wind Syndrome风哮nTherapeutic Principle:nourishing liver, dispelling wind,asthma-relieving 治则:柔肝祛风定喘nPrescription: modified Guominjian. 方药:过敏煎加味 nIngredient:Chaihu,Fangfeng,Wumei,Wuweizi,Huangqin,Sugeng,G
22、ancao,Xingren, Zhimahuang,Dilong. 药物:柴胡、防风、乌梅、五味子、黄芩、 苏梗、甘草、杏仁、炙麻黄、地龙干。Stasis Syndrome(瘀哮)nTherapeutic principle:activating blood and dissolving stasis 治则:活血化瘀nPrescription:Modified Xuefuzhuyu Decoction 主方:血府逐瘀汤加减Ingredient:Danshen,Honghua,Chuanxiong,Danggui, Chishao,Huainiuxi. On attack stage:add D
23、ilong,Tinglizi. Symptom of stasis syndrome is serious: add hirudo powder. 基本药物:丹参、红花、川芎、当归、赤芍、 怀牛膝,发作期加地龙干、葶苈子,瘀甚加用水蛭粉。儿童支气管哮喘n发作期 处方:射干、桂枝、五味子、法半夏 各9g,生石膏 30g,生麻黄、细辛(各3g)。 水煎内服,日1剂,分3次口服。中西医结合杂志1986(11)儿童支气管哮喘n缓解期 哮喘症状缓解后停用西药,改服中药。 处方:党参、黄芪、白术、黄精、沙参、丹参、熟地、五味子、仙灵脾(各15g)。 浓煎至200ml,用量:乳儿20ml,幼儿30ml,学龄
24、前(7岁前)40ml,8-16岁50ml。 一日两次,口服。4-8周为1疗程。n治疗后1年内不复发20%,总有效率90.6%.Steroid-dependent Asthma激素依赖型哮喘nBelong to deficiency syndrome,commonly appear after high-dose corticosteroids,also can be seen in the process of hormone withdrawal.The therapeutic principle is in favor of reinforcing deficiency,and take
25、into account of eliminating pathogenic factors. 激素依赖性哮喘属于虚喘,在大剂量应用激素后常见,在激素撤减过程中也可见到。治则重在补益,兼以祛邪。Steroid-dependent Asthma激素依赖型哮喘nThree sub-syndromes 此型患者有三个亚型:nKidney-yin-deficiency syndrome 肾阴虚nKidney-yang-deficiency syndrome 肾阳虚nKidney-yin-yang-deficiency syndrome 肾阴阳两虚Steroid-dependent Asthma激素依赖
26、型哮喘nKidney-yin-deficiency syndrome 肾阴虚 Shengdi,Shanyurou,Ejiao,Gouqi. 以生地、山萸肉、阿胶、枸杞为主nKidney-yang-deficiency syndrome 肾阳虚Fuzi,Rougui,Tusizi,Hajie. 以附子、肉桂、菟丝子、蛤蚧为主nKidney-yin-yang-deficiency syndrome 肾阴阳两虚 Combining nourishing yin and warming yang. 滋阴、温阳参合用之。Steroid-dependent Asthma激素依赖型哮喘n六味地黄丸对顽固性激
27、素依赖患儿在撤除皮质激素时应用。Cough Variant Asthma(CVA)咳嗽(变异)型哮喘nMostly belong to pulmonary qi and lung-yin deficiency syndrome. 中医诊断多属“肺气阴虚”型;nTherapeutic Principle: nourishing liver,nourishing yin,clearing lung. 治疗:以柔肝养阴清肺为治则Cough Variant Asthma(CVA)咳嗽(变异)型哮喘nexperienced prescription(self-made): Zhebei,Baizhi,B
28、ohe,Qianhu,Baibu, Shashen,Wuweizi,Suzi,Xingren, Sangbaipi,Digupi,Gancao. 经验方(自拟):浙贝、白芷、薄荷、前胡、百部、沙参、五味子、苏子 杏仁、桑白皮、地骨皮、生甘草。Drug Toxicity (药物的毒性反应)nHuangqin,Chaihu,Baiguo and Cangzhu may cause liver damage.It is related to the protoplasmic poison of these herbal medicine. 治疗哮喘的药物如黄芩、柴胡、白果、苍术均可引起肝损害。其机理
29、与上述药物的原浆毒有关。nWe should use the Zhimahuang,and strictly control the indications and dosage. 应用麻黄时选择炙麻黄,并应严格掌握适应症及用量。Other Prescriptions for Chinese Medicine其他中药方剂nHuagai Decoction: Mahuang,Zisuzi,Xingren,Sangbaipi,Chifuling, Juhong,Gancao. 华盖汤:麻黄、紫苏子、杏仁、生桑皮、赤茯苓、桔红、甘草。nSheganmahuang Decoction: Shegan,
30、Mahuang,Shengjiang,Xixin,Ziwan, Kuandonghua,Wuweizi,Chinese date,Banxia. 射干麻黄汤:射干、麻黄、生姜、细辛、紫菀、款冬花、五味子、大枣、半夏。Hongguangxiang(洪广祥)nJuanxiao Decoction(removing phlegm and blood stasis): Tinglizi,Qingpi,Chenpi,Binglang,Mujingzi,Weimao,Shengjiang,Dahuang. 蠲哮汤(涤痰祛瘀):葶苈子、青皮、陈皮、槟榔、牡荆子、卫矛、生姜、 大黄。Hongguangxian
31、g(洪广祥)nQifu Decoction and Huwei Decoction: Huangqi,Fuzi,Guizhi,Baishao,Shengjiang,Chinese date,Zhigancaoo,Lulutong, Fangfeng. 芪附汤(黄芪、附子)合护卫汤(桂枝、白芍、生姜、大枣、炙甘草、路路通、防风)Jiangchunhua(姜春华)nJiechuan Decoction: Bitaogan,Laoguancao,Jinqiaomai, Fangfeng,Hehuanpi,Foercao, Quangualou,Xuanfuhua. 截喘方 组成:碧桃干、老鹳草、金荞
32、麦、防风 合欢皮、佛耳草、全瓜蒌、旋覆花。 Huqiaowu(胡翘武)nRemission Stage(缓解期) Cold Phlegm Combined with Blood Stasis(寒痰夹瘀): Prescription:Liujunzi Decoction and Sanziyangqin Decoction,add Danggui,Chuanxiong, Honghua,Zelan,Sanqi 六君子汤合三子养亲汤,加当归、川芎、红花、泽兰、三七。 Huqiaowu(胡翘武)nHeat Phlegm Combined with Blood Stasis(热痰夹瘀): Prescr
33、iption:Qianjinweijin Decoction and Xuegeng Decoction,add Tinglizi,Chishao,Shuizhi,Dilong,Danshen.千金苇茎汤合雪羹汤,加葶苈子、赤芍、水蛭、地龙、丹参。Zhouzhongying(周仲瑛)nRemission StagenTreatment for gluey phlegm ,usually use Sanziyangqin Decoction and add Houpu,Xingren,Tinglizi,Zhuyazao. 治疗“胶固之痰”,常用三子养亲汤加 厚朴、杏仁、葶苈子、猪牙皂等Zhouz
34、hongying(周仲瑛)nLung(spleen)-kidney qi deficiency,cold phlegm lurk in interior.肺(脾)肾气虚,寒痰内伏。nPrescription:Yupingfeng Powder,Liujunzi Decoction,Pingchuanguben Decoction. 玉屏风散、六君子汤、平喘固本汤加减。nIngredient:Huangqi,Dangshen,Baizhu,Shanyao, Ziheche,Shanzhuyu,Yinyanghuo,Wuweizi,Buguzhi, Banxia,Kuandonghua,Lufen
35、gfang,Jiangcan,Zisuye. 药用黄芪、党参、白术、山药、紫河车、山茱萸、 淫羊藿、五味子、补骨脂、(姜)半夏、款冬花、 露蜂房、僵蚕、紫苏叶等。Zhouzhongying(周仲瑛)nlung-kidney yin deficiency,phlegm-heat lurk in interior.(肺肾阴虚,痰热内伏证)nPrescription:Maiweidihuang Decoction,Jinshuiliujunjian,Hechedazaowan.麦味地黄汤、金水六君煎、河车大造丸等加减。nIngredient:Beishashen,Maidong,Ziheche, S
36、hendihuang,Shanzhuyu,Zhimu,Zhuli,Banxia, Jiangcan,Dilong,Lufengfang. 药用北沙参、麦冬、紫河车、生地黄、熟地黄、山茱萸、知母、竹沥、半夏、僵蚕、地龙、 露蜂房等。Zhouzhaoshan(周兆山)nQingfeishenshi Decoction(Heat syndrome): Mahuang,Xingren,Shigao, Zhigancao,Dongguaren,Yiyiren,Fuling, Cheqiancao,Yuxingcao,Zhebeimu,Lugen,Chantui,Shegan,Shiwei. 清肺渗湿汤(
37、热哮):麻黄,杏仁, 石膏,炙甘草,冬瓜仁,薏苡仁, 茯苓,车前草,鱼腥草,浙贝母, 芦根,蝉蜕,射干,石韦。Wanglie(王烈)nChildhood Bronchial Asthma(小儿支气管哮喘)nAttack Stage(发作期) Prescription:Zhixiao Decoction(self-made): Zisuzi,Qianhu,Dilong,Baijuecai,Shegan,Kushen,Baixianpi,Jiangcan,Chuanbeimu,Xingren. 止哮汤加减(自拟)。药用紫苏子、前胡、地龙、白屈菜、射干、苦参、白鲜皮、僵蚕、川贝母、杏仁。Wangli
38、e(王烈)nRemission Stage(缓解期)nPrescription: Huanxiao Decoction(self-made): Baijuecai,Fuling,Shashen,Dannanxing,Banxia,Xingren,Taoren,Zisuzi,Qianhu,Baiqian,Laifuzi,Kuandonghua. 方拟缓哮汤加减(自拟)。药用白屈菜、茯苓、沙参、胆南星、清半夏、杏仁、桃仁、紫苏子、前胡、白前、莱菔子、款冬花。Wanglie(王烈)nStable Stage(稳定期)nPrescription: Fangxiao Decoction(self-mad
39、e): Huangqi,Yuzhu,Nvzhenzi,Buguzhi,Taizishen,Wuweizi,Moli,Chinese date,Foshou,Shanyao. 自拟防哮汤加减。药用黄芪、玉竹、女贞子、补骨脂、太子参、五味子、牡蛎、大枣、佛手、山药。 Modified Guxiao Decoction: Huangqi,Chenpi,Gancao,Foshou,Shanyao,Shudi, Heshouwu,Haipiaoxiao,Chinese date,Huangjing. 固哮汤加味。黄芪、陈皮、生甘草、佛手、山药、 熟地、何首乌、海螵蛸、大枣、黄精;Anxiaoxian(安
40、效先)nChildhood Bronchial Asthma(小儿支气管哮喘)nRemission Stage(缓解期)nYifeijianpi Decoction: Zhimahuang,Baizhu,Fangfeng,Yiyiren, Huangjing,Taizishen,Maidong,Wuweizi, Xingren,Chuanbeimu,Xianhecao,Baibu. 益肺健脾汤:炙黄芪、炒白术、防风、 炒薏苡仁、制黄精、太子参、麦冬、五味子、杏仁、川贝母、仙鹤草、百部等。Wangxiafang(王霞芳)nChildhood Bronchial Asthma(小儿支气管哮喘)nA
41、ttack Stage(发作期)nXuanfeitongluopingchuan Decoction: Zhimahuang,Xingren,Gancao,Suzi,Banxia, Huangqin,Kuandonghua,Ziwan,Jiangcan, Dilong, Xinyi,Chanyi,Zhibaibu. 宣肺通络平喘汤:炙麻黄、杏仁、甘草、苏子、半夏、黄芩、款冬花、紫菀、僵蚕、地龙、 辛夷、蝉衣、炙百部。Thank you ! Allergic Rhinitis过敏性鼻炎Overview 概述nAllergic rhinitis is a collection of symptom
42、s, mostly in the nose, which occur when you breathe in something you are allergic to.It is a suddenly and recurrent disease. 过敏性鼻炎是一种吸收变应原而导致的以鼻部症状为主的突然和反复发作的疾病。nMain symptoms that occur shortly include: sneezing、stuffy nose、itchy nose and runny nose. 临床以突发性或阵发性喷嚏、鼻塞、鼻痒、分泌大量清水样鼻涕为主要症状。Overview 概述nSy
43、mptoms that may develop later include: Clogged ears、decreased sense of smell、headache、 some symptoms that occur in the other allergic disease(bronchial asthma、urticaria,etc.) 伴随症状:可伴有暂时性耳鸣、听力减退、头痛,或其他变态反应性疾病的症状(如哮喘、荨麻疹等)。nCommon complications:allergic sinusitis、laryngopharyngitis、bronchial asthma、ur
44、ticaria、secretory otitis media. 常见并发症:变态反应性鼻窦炎、咽喉炎、支气管哮喘、荨麻疹、分泌性中耳炎等。概述-流行病学n极为常见的疾病,累计全世界的10%-25%的人口。人群患病率为10%-40%。在欧洲患病率约为25%,其中成年人中可以确定为变应性鼻炎的患病率从17%-28.5%不等。中国11个中心城市的AR自报患病率都在8%-21.4%之间,明显低于欧洲和加拿大的自报患病率。中国西部部分抽样调查AR患病率,结果均在30%以上,以中、重度持续性SAR和PAR为主。造成我国东西部地区变应性鼻炎患病率差异明显的原因,可能与西部地区复杂的地形和不同季风环流交替影响
45、形成的多样性气候以及海拔高、年降水量少、气候干燥,空气中漂浮颗粒物相对较多有关。概述-分类n常年性变应性鼻炎(allergic perennial rhinitis,APR)和季节性变应性鼻炎(又称花粉症)n2001年,世界卫生组织(WHO)从症状的持续时间和严重程度两个方面对AR进行分型: 间歇性(intermittent AR)和持续性(persistent AR); 轻度AR和中重度AR。概述-发病原因n遗传学 有明显的家族集聚性且符合常染色体显性遗传特点。 变应性鼻炎本身呈过敏体质,其发病的因素与遗传和环境有关,是遗传和环境双重作用的结果。概述-发病原因n吸入性变应原 尘螨:螨变应原与
46、酶活性有关,非特异性直接作用于呼吸道上皮,可增强Th2细胞应答。 据美国制商协会APPMA统计,近2/3的美国家庭拥有至少一只宠物,这些动物的皮屑及分泌物携带或含有引起变应性反应的强烈致敏原,通过空气传播,在空气中停留时间很长。概述-发病原因n吸入性变应原 花粉症又称季节性鼻炎或枯草热:是敏感个体对花粉的一种超敏反应。 花粉颗粒极其微小,可在鼻孔里或眼睛里沉积。其诱导的变应原是最典型IgE介导的变应性疾病。花粉季节中鼻粘膜中的各种炎性细胞数量均有增加并且朗汉斯细胞的数量也在增加。概述-发病原因n食入性过敏原:鸡蛋、牛奶、鱼、海鲜、大豆、坚果、花生等。 食物变态反应性鼻炎,不单独发作,患者存在其
47、他器官受累是常常发生,通常发生在儿童,3岁以下儿童食物过敏原以鸡蛋、牛奶为主。这由于婴幼儿和儿童的免疫系统为发育完全、屏障功能不全造成。概述-发病原因n环境与空气污染 尾气排放物的颗粒成分可以使免疫反应转向产生(IgE),并加重变应原炎症。n生活习惯 吸烟或被动吸烟 吸烟增加了鼻粘膜炎的患病率,并在鼻粘膜引起噬酸粒细胞性和“类变态反应”性炎症。概述-发病原因n气候改变 气候改变可以影响气传变应原,特别是花粉和霉菌。在气候改变下植物产生出大量的花粉,气温升高时污染地区树木花粉的变应原性更强。n精神因素 精神紧张、情绪不良、心理压力增大也可引起过敏发作;可引起T细胞功能缺陷,肥大细胞介质释放,Ig
48、E水平升高,细胞膜受体反应异常等。压力能影响特应性鼻炎的严重程度,常见的压力如失去亲人、重大考试等。过敏性鼻炎发病机制n过敏性鼻炎的病因学已统一了认识。抗原物质(各种化学物质、微生物、粉尘、室内尘螨、花粉等),经鼻吸入,穿入上皮屏障进入人体,被吞噬细胞吞噬,激发机体免疫功能,产生新细胞性反应素IgE抗体,并与肥大细胞、嗜碱白细胞结合,使鼻黏膜处于致敏状态,每当再次与相同抗原相遇,导致细胞内组织胺等介质脱颗粒包括组织胺,五羟色胺,慢性反应物质(ARS-A)、缓激肽,以及嗜酸性细胞趋化因子(ECF-A),作用于效应器官,引起毛细血管扩张,通透性增高,腺体分泌增多,黏膜水肿,鼻痒、打喷嚏、流清水涕等
49、一系列过敏症状。过敏性鼻炎发病机制n目前已知组织胺与过敏性鼻炎有关,而慢性反应物质(SRS-A)与哮喘有关。组织胺直接作用于血管壁的H1-受体而影响血管通透性增加与扩张。通过副交感神经感觉末梢支间接作用与鼻粘膜上皮刺激受体(即H2受体)使腺体兴奋,从而鼻分泌物增多。n常年性鼻炎由鼻粘膜小动脉收缩,静脉与静脉窦扩张,鼻甲水肿、苍白或形成息肉,产生持续性鼻塞。n季节性鼻炎则因血管扩张水肿而鼻塞(非持续性,间歇左右交替)。西医治疗n避免接触变应原n药物治疗抗组胺药 鼻毛细血管的扩张是由多种组胺受体亚型(如H1,H2等)所主导,其中以H2受体为主。因此H1和H2受体拮抗剂的联合适用对缓解鼻充血和鼻塞症
50、状要比使用H1受体拮抗剂更有效。西医治疗-药物治疗鼻内糖皮质激素 是目前治疗变应性鼻炎最有效的方法之一,特别是持续性变应性鼻炎。 与H1抗组胺药物相比,其起效相对缓慢,大约12h后方可生效,并且需要数天或数周的时间才能达到最大疗效。使用要保持规律性和持续性。 未能达到至少50%的总治疗计量而导致疗效不佳。西医治疗-药物治疗抗白三烯药物 半光氨酸白三烯(LTC4,LTD4,LTE4)是变应性鼻炎反应的重要介质之一,抗白三烯药物具有和抗组胺药物相类似的临床效果。 与组胺类药物相比,鲁斯特在迟发相中发挥关键作用,并可同时作用与上下气道,可同时治疗或减少哮喘的发生。对与绝大多数就诊的中重度过敏性鼻炎患
51、者疗效比组胺效果明显。西医治疗-药物治疗色酮类药物 比鼻内糖皮质激素和抗组胺药效相对弱,而且用药的时间比较长。西医治疗-手术治疗n下鼻甲严重肥大和黏膜下腺体增生,使患者对常规药物治疗不敏感。手术切除部分鼻甲可以减轻鼻塞和流鼻涕。 下鼻甲黏膜下组织射频电热切除术,鼻塞症状改善的占76%。Understanding of Traditional Chinese Medicine(中医的认识)nAR belong to Biqiu or Qiuti of TCM. 过敏性鼻炎属于中医学“鼻鼽”、“鼽嚏”的范畴。nThe name of Biqiu first appeared in the Plai
52、n Questions. 鼻鼽的病名首见于素问。 Etiology of TCM(中医病因)nEndogenous Pathogens:dysfunction of the viscera,mainly by lung deficiency、spleen deficiency、kidney deficiency. Deficiency of healthy Qi,especially of Yang Qi. 内在因素:多为脏腑功能失调,主要是肺、脾、肾三脏虚损,正气不足,尤其是阳气不足。nExogenous Pathogens:wind-cold、abnormal changes in the
53、 air. 外在因素:多为风寒、异气之邪侵袭鼻窍而致病。Pathogenesis of TCM (中医病机)nDeficiency of lung-qi ,unconsolidated wei-biao 肺气虚弱,卫表不固nDeficiency of lung-qi ,un-rising of lucid yang 肺气虚弱,清阳不升nInsufficiency of kidney-yang,breach of duty in warm-reinforcing 肾阳不足,温煦失职nLatent heat of lung meridian,attacking in nasal cavity 肺经
54、伏热,上犯鼻窍Treatment(治疗)nThe pathological feature is deficiency in root and excess in superficies. 本病特点多为本虚标实。 The clinical manifestations of deficiency in root refer to the deficiency of lung、spleen and kidney. 本虚症见肺、脾、肾三脏虚损病症; Treatment(治疗)nThe clinical manifestations of excess in superficies:frequent
55、ly sneezing 、alternately stuffy nose、runny nose,etc. 标实症见喷嚏频频,交替性鼻塞,大量流涕不止等。nTo eliminate the pathogenic factors and remove nasal obstruction as a symptomatic treatment; To replenish qi and nourish the lung, invigorate the spleen and strengthen the kidney as a causative treatment. 治标以祛邪通窍止涕为主; 治本以益气
56、补肺、健脾温肾为主。Relationship between Nose and Meridians(鼻与经络的关系)nmeridians running through the nose: 循行至鼻部的经络主要有:nstomach meridian of foot Yangming 足阳明胃经 large intestine of hand Yangming 手阳明大肠经 small intestine of hand Taiyang手太阳小肠经 triple energizer meridian of hand Shaoyang 手少阳三焦经 Relationship between Nos
57、e and Meridians(鼻与经络的关系) Bladder Meridian of Foot Taiyang 足太阳膀胱经 Gallbladder Meridian of Foot Shaoyang 足少阳胆经 Governor Vessel 督脉 Conception Vessel 任脉 Penetrating Vessel 冲脉 Yin Heel Vessel 阴跷脉 Yang Heel Vessel 阳跷脉 Telationship between Nose and Meridians(鼻与经络的关系)nFrequently using points on the meridian
58、s of hand yangming and foot yangming,and governor vessel for the treatment of this disease. 临床上多选取手、足阳明经和督脉三条经上的穴位来治疗本病。Main Methods of Acupuncture Treatment(针灸治疗的主要方法)nNeedling Methods with Filiform Needle 毫针刺法:nJins Nasal Three-point Needling 鼻三针nPenetration Needling around Nose 鼻部周围透刺针法nAcupunctu
59、ring Sphenopalatine Ganglion 针刺蝶腭神经节 Commonly Used Prescription for Acupuncture(常用处方一)nJins nasal three-point needling 鼻三针nPrinciple points:Yingxiang(LI20)、Bitong(EX-HN8)、Yintang(EX-HN3) 取穴:迎香、鼻通、印堂。nA filiform needle(size:30) 针具:30号短毫针。Jins Nasal Three-point Needling (鼻三针)nPerformance(操作) Yingxiang
60、:puncture obliquely or transversely towards the wing of nose 0.3 cun (acute illness);Puncture obliquely or transversely towards the nasal septum 0.5 cun (chronic illness). Yintang:puncture transversely towards the nasal septum 0.5 cun. Bitong:uncture obliquely towards the nasion 0.5-0.8 cun. Jins Na
61、sal Three-point Needling (鼻三针)n针刺方法 迎香穴:新病针尖向鼻翼水平进针约0.3寸;久病向鼻柱方向进针约0.5寸。 印堂穴:针尖向鼻柱方向平刺进针约0.5寸。 鼻通穴:针尖向鼻根部方向斜刺约0.5-0.8寸。Jins Nasal Three-point Needling (鼻三针)nAcupuncture manipulation:mainly use reinforcing manipulation of the filiform needle 针刺手法:以补法为主nThe order of acupuncture: BitongYingxiagnYintang
62、 先取鼻通穴,针尖向鼻根部方向斜刺;次取迎香,得气后局部胀痛;后取印堂,针感向鼻尖方向及鼻翼两侧放射。Jins Nasal Three-point Needling (鼻三针)nTotal effective rate:about 90% 总有效率:90%左右。nSupplementary points based on syndrome differentiation and different symptoms 在基本处方基础上,辨证配穴与随症配穴。 Supplementary Points Based on Different Symptoms(随症配穴)nLung Qi Deficie
63、ncy Syndrome:add Fenghi,Feishu,Taiyuan; 肺气虚:加风池、肺俞、太渊;nSpleen Qi Deficiency Syndrome:add Zusanli,Pishu,Zhongwan,Qihai,Guanyuan; 脾气虚:加足三里、脾俞、中脘、气海、关元;nKidney Qi Deficiency Syndrome:add Shenshu,Taixi,Fuliu; 肾气虚:加肾俞、太溪、复溜;nLatent Heat of Lung Meridian:add Chize,Kongzui,Yuji.(reducing manipulations) 肺经伏
64、热:加尺泽、孔最、鱼际。(毫针泻法)Supplementary Points Based on Different Symptoms(随症配穴)nRunny nose with watery discharge seriously:add Fenglong(ST40),moxibustion on Baihui(GV20) 鼻流清涕量多者配针丰隆,灸百会;nStuffy nose seriously:add Fengchi(GB20)、Hegu(LI4) 鼻塞甚者配针风池、合谷;Supplementary Points Based on Different Symptoms(随症配穴)nRun
65、ny nose with yellow or turbid discharge seriously :add Yanglingquan(GB34)、Taichong(LR3); 鼻流浊涕,配阳陵泉太冲;nItchy nose seriously:add Shangxing(GV23)、Lieque(LU7); 鼻痒甚者配上星、列缺;nHeadache:add Shangxing(GV23)、Taiyang(EX-HN5); 头痛配上星、太阳;Supplementary Points Based on Different Symptoms(随症配穴)nChronic illness:add Fe
66、ishu(BL13)、Dazhui(GV14),got moxibustion after filiform needling 久病配肺俞、大椎,针后加灸;nOften on the basis of Jins nasal three-point needling plus Hegu(LI4) and Shangxing(GV23)(another basic prescription). 常于基本处方(鼻三针)上配合谷、上星。(基本处方2)Penetration Needling around Nose 鼻部周围透刺针法nPerformance of principal points: Ba
67、ihui-through-Qianding, Shangxing-through-Shenting, Yintang-through-Shangen, puncture Yingxiang perpendicularly. 取穴及操作:百会透刺前顶,上星透刺神庭,印堂透刺山根,迎香穴直刺。Acupuncturing Sphenopalatine Ganglion针刺蝶腭神经节nLocation: about 33.5 cm in the front of antilobium, as about 11.5 cm in front of Xiaguan.n取穴:耳屏前约33.5 cm,即下关穴前
68、11.5 cm。Acupuncturing Sphenopalatine Ganglion针刺蝶腭神经节nInsert needle in the middle of depression before Xiaguan, obliquely toward anterosuperior side to a depth of 4560mm. After inserting, patient will feel numb, distent and heavy along the inner corner of eyes to the corner of mouth in the same side,
69、 accompanied with tightness in the nasal cavity and less nasal mucus. 操作方法:蝶腭神经节自下关穴前的弓形凹陷中央下进针,针尖斜向前上方,刺准后患者感同侧上自目内毗下至口角有麻木、胀、重感,同时伴有鼻腔紧缩感,且鼻涕立即减少;针刺深度范围为4560mm。Acupuncturing Sphenopalatine Ganglion针刺蝶腭神经节nSingle-point needling(单穴针刺法)nMulti-point needling(多穴针刺法)nPrincipal points:Sphenopalatine gang
70、lion、Yintang、Yingxiang、Bitong 主穴 :蝶腭神经节、印堂、迎香、鼻通。 nSupplementary points:Feishu.Pishu,Shenshu.配穴 :肺俞 、脾俞、肾俞。 Homemade Moxibustion with Thunder-fire Herbal (自制雷火神针药灸)nIngredients:Fangfeng,Kuhao,Cangerzi,Tianqi. 雷火灸药条:由防风、苦篙、苍耳子、田七等组成。nPrincipal points:Yingxiang,Hegu,Yintang, Shangxing,C1-7,Lieque. 取穴:
71、迎香、合谷、印堂、上星、颈l7、 列缺。nPerformance:Circling moxibustion 操作:回旋灸。 Other Moxibustion(其他灸法)nPrinciple points : Back-Shu points, Feishu,Dazhui. 取穴:以背俞穴为主。 主穴:肺俞、大椎。 Spleen deficiency syndrome:add Pishu; Kidney deficiency syndrome:add Shenshu. 脾虚加脾俞;肾虚加肾俞。 nGinger isolated moxibustion,moxibustion with moxa
72、wool,moxibustion with moxa stick. 隔姜灸、艾绒灸、艾条灸。Point Application(Dog-day Auto-moxibustion)穴位敷贴法(三伏天灸法)nPrincipal points:Feishu,Fengmen,Shenshu,Pishu. 取穴:肺俞、风门、肾俞、脾俞。nIngredients:Baijiezi,Yanhusuo,Xixin,Shengjiang, Shexiang. 组成:白芥子、延胡索、细辛各等份研成粉,加姜汁调成糊状,放入少许麝香。nTime for treatment:on the first, second a
73、nd third dog-day。The application is about 1-3 hours based on the situation of patient. 治疗时间:夏季农历三伏天的初伏、中伏、末伏这三天治疗,每次根据患者的耐受程度敷贴1-3小时。Point Application(穴位敷贴法)nMethod2(方法二)nPrinciple points: Yezhegong,Shangtiangong,Cangguogong, Xinluogong,Xuanweigong(The area has a diameter of 5cm at the center of umb
74、ilicus according to Jiugong and Bagua) 取穴:叶哲宫、上天宫、仓果宫、新洛宫、 玄委宫(以脐为中心周开5cm按九宫八卦选取)Method2(方法二)nIngredients: Deficiency-cold type: Baijiezi,Xixin,Yuanhu,Rougui; Heat syndrome accounted: Xuchangqing,Xinyi,Cangerzi,Chenxiang, Huangqin. 药物:虚寒型用白芥子、细辛、元胡、肉桂等;郁热型用徐长卿、辛夷、苍耳子、沉香、黄芩等。(图)Auricular Acupuncture(
75、耳针疗法)nPrinciple points: Fei(CO14)lung, Shen(CO10)kidney, Shenshangxian(TG2p)adrenal gland, Neibi(TG4)internal nose, Waibi(TG1,2)external nose. 取穴:肺、肾、肾上腺、内鼻、外鼻。Auricular Acupuncture(耳针疗法)nPerformance: Wangbuliuxingzi (Semen Vaccariae) fixed onto the ear acupoints. Advise the patient to press the acu
76、points at least three or four times a day, and 1-2 min each time; change the other side every 3-5 days.n操作:用王不留行压籽法,贴于以上穴,嘱患者每日自行按压3-4次,每次按压1-2分钟,隔3-5天更换对侧耳穴。(图)Acupoint Injection(穴位注射)nPrinciple points: Feishu,Yingxiang,Zusanli. 取穴:肺俞,迎香,足三里为主。nIngredients:Huangqi Injection,VB12,CCO,autologous bloo
77、d. 药物:黄芪注射液,VB12注射液,维D2果糖酸钙注射液或自血。nPerformance:select a couple of points every time,three groups of points are used in turn.操作:每次选1对穴,3穴轮流交替使用。Alternative Methods of Treatment(其他疗法)nAcupoint Catgut Embedment 埋线疗法nCalciferolis Calcii Colloid 蜂针疗法nNose-acupuncture Therapy 鼻针疗法nAcupoint Laser Irradiati
78、on 穴位激光 nBleeding Therapy 放血疗法nCupping 拔罐nHolography 全息 nAcupoint-Pressing Therapy 指针 Chinese Medicine Therapy(中药治疗)Lung Qi Deficiency Syndrome(肺气虚)nClinical manifestations:In addition to the nasal symptoms,and seeing worse when active,lassitude,low weak voice,spontaneous sweating,aversion to cold,p
79、ale complexion,pale tongue and deficient pulse. 症状和体征:除鼻部症状外,又见气短,倦怠,懒言,自汗,舌质淡,苔薄白,脉浮无力或沉弱。nPrescription: Yupingfeng Powder and Cangerzi Powder. 中药基本处方:玉屏风散合苍耳子散。Spleen Qi Deficiency Syndrome(脾气虚)nClinical manifestations:In addition to the nasal symptoms,and seeing abdominal distension,poor appetite
80、,worse after eating,loose stools,lassitude, shortness of breath,disinclination to talk,wasting away,sallow complexion,or obesity,or edema,pale tongue with white coating,or pale and enlarged tongue with tooth mark,slow and weak pulse. 症状和体征:除鼻部症状外,可伴有消瘦,纳呆,腹胀,肢困,便溏,舌淡苔白,脉濡。腹胀纳少,食后胀甚,大便溏薄,倦怠乏力,少气懒言,形体
81、消瘦,面色萎黄,或形体肥胖,或肢体浮肿,舌淡苔白,或舌淡胖有齿痕,脉缓弱。nPrescription:Buzhongyiqi Decoction. 中药基本处方:补中益气汤。Kidney Qi Deficiency Syndrome(肾气虚)nClinical manifestations:In addition to the nasal symptoms,and seeing attack obviously in the Morning and evening ,weakness in the lower back and knees,seminal emission,premature
82、ejaculation,cold limbs,frequent nocturia,pale tongue,weak pulse. 症状和体征:除鼻部症状外,早晚发作明显,腰酸膝软,遗精早泄,形寒怕冷,夜尿多,舌淡,脉弱。 nPrescription: Jinkuishenqi Pill and Yupingfeng Powder 中药基本处方:金匮肾气丸合玉屏风散。Latent Heat of Lung Meridian(肺经伏热)nIn addition to the nasal symptoms,and seeing cough,itchy throat,dry mouth,red ton
83、gue,white or yellow tongue coating,rapid pulse. 症状和体征:除鼻部症状外,或见咳嗽,咽痒,口干烦热,舌质红,苔白或黄,脉数。 Prescription:Xinyiqingfei Decoction 中药基本处方:辛夷清肺饮加减。Other Prescriptions for Chinese Medicine其他中药方剂nModified Guizhi Decoction: Baishao,Guizhi,Xinyi,Baizhi, Qianghuo, Shengjiang,Zhigancao,Xixin,Chinese date. 桂枝汤加减:白芍
84、、桂枝、辛夷、白芷、羌活、生姜、炙甘草、细辛、大枣。nModified Xiaochaihu Decoction:Sangye, Chaihu,Huangqin,Banxia,Dangshen,Manjingzi,Xinyi, Cangerzi,Shengjiang,Bohe,Chinese date. 小柴胡汤加减:桑叶、柴胡、黄芩、半夏、 党参、蔓荆子、辛夷、苍耳子、生姜、薄荷、大枣。Other Prescriptions for Chinese Medicine其他中药方剂nModified Xiaoqinglong Decoction Modification:Mahuang,Guiz
85、hi,Shaoyao,Xixin, Zhigancao,Ganjiang,Banxia,Wuweizi,Xinyi,Baizhi. 小青龙汤加减:麻黄,桂枝,芍药,细辛,炙甘草,干姜,半夏,五味子、辛夷、白芷。nZhititongqiaoyin:Huangqi,Baizhi,Xinyi,Cangerzi,Jingjie,Fangfeng,Chaihu,Bohe,Chuanxiong,Wuweizi,Gancao. 止嚏通窍饮:黄芪、白芷、辛夷、苍耳子、荆芥、 防风、柴胡、薄荷、川芎、五味子、甘草。 Ganwangzu(干望祖)nTuominDecoction:Qiancao,Zicao,Han
86、molian. 脱敏汤:茜草、紫草、墨旱莲。nJiemin Decoction: Qiancao,Zicao,Hanmolian,Xiqiancao,Fangfeng,Chaihu,Xuchangqing,Dilong,Wumei,Huangqi,Honey(infused with water). 截敏汤:茜草、紫草、旱莲草、稀签草、防风、柴胡、徐长卿、地龙、乌梅、黄芪、蜂蜜(冲服)。Ganwangzu(干望祖)nWenfeizhiliudan:Dangshen,Huangqi,Hezi,Xixin,Jinjie,Jiegeng,Shishouyunaogu(calcination), Ga
87、ncao. 温肺止流丹:党参、黄芪、诃子、细辛、荆芥、桔梗、石首鱼脑骨(煅)、甘草。nQingretuomin Decoction: Sangbaipi,Huangqin,Chanyi,Dilong,Lulutong, Zicao,Qiancao,Hanmolian. 清热脱敏汤:桑白皮、黄芩、蝉衣、地龙、 路路通、紫草、茜草、墨旱莲。Ganwangzu(干望祖)nJieminwumei Decoction: Wumei,Chaihu,Wuweizi,Baihe,Fangfeng,Gancao,Honey(infused with water). 截敏鸟梅汤:鸟梅、柴胡、五味子、百合、防风、甘
88、草、蜂蜜(冲服)。Chenxiaoning(陈小宁)nSeft-made Yiqituomin Decoction: Huangqi,Fangfeng,Baizhu,Baishao,Guizhi, Xixin,Xinyi,Baizhi,Gancao,Danggui,Wumei. 自拟益气脱敏汤:黄芪,防风,白术,白芍,桂枝,细辛,辛夷,白芷,甘草,当归,乌梅。nBuyanghuangwu Decoction Modification: Huangqi,Danggui,Taoren,Honghua,Chishao, Chuanxiong,Guizhi,Baizhi,Xixin. 补阳还五汤加减:
89、黄芪,当归,桃仁,红花,赤芍,川芎,桂枝,白芷,细辛。Zhushenyu(祝谌予)nGuominjian Decoction: Yinchaihu,Wumei,Fangfeng,Wuweizi. 过敏煎:银柴胡、乌梅、防风、五味子。nModification: Spleen deficiency syndrome:add Shanyao,Fuling,Chinese date. Kidney deficiency syndrome:add Yinyanghuo,Buguzhi,Tusizi. 加减:兼脾虚者,加山药,茯苓,大枣; 兼肾虚者,加淫羊蓬,补骨脂,菟丝子。Zhushenyu(祝谌予)
90、nYiqicongmingtang Decoction Modification: Huangqi,Dangshen,Gegen,Shengma, Manjingzi,Xinyi,Cangerzi,Baizhi,Baishao,Huangbo,Gancao,Congbai. 益气聪明汤加味:黄芪、党参、葛根、 升麻、蔓荆子、辛夷花、苍耳子、白芷、白芍、黄柏、甘草、葱白。Thank you ! Urticaria 荨麻疹Overview(概述)nIt is a kind of localized reflex edema disease with dilatation of minute ves
91、sels of the skin and increasing permeability of mucous membrane. 由多种原因所致的一种常见皮肤、黏膜小血管扩张及渗透性增加而出现的一种局限性水肿反应性疾病。概述n世界过敏组织(WAO)荨麻疹及血管性水肿诊疗指南(2009版): 荨麻疹是一种常见疾病。人一生中某个时间段发病的几率约为20%。慢性自发性荨麻疹和其他形式荨麻疹患者生存质量降级,工作效率减低20%-30%,可归类于严重的过敏性疾病(severe allergic diseases).概述n各种类型的荨麻疹主要临床表现为突发、风团疹,有如下3个特点:突然发作、形态多样的中心
92、水肿疹,常有反射性红晕。伴瘙痒,有时有烧灼感。时起时消,多于24h内消退不留痕迹。概述n血管性水肿临床特点:突然发作、真皮深层和皮下组织水肿。痒不明显,常表现为疼痛。常累及黏膜组织。多于72h内消退。n临床病例中,荨麻疹合并血管性水肿占50%,单纯荨麻疹占40%,单纯血管性水肿占10%。概述-病因n急性荨麻疹 常见病因:食物过敏、药物过敏、感染因素、物理因素(寒冷性、胆碱能性、压力性、振动性等)、昆虫叮咬、接触性过敏原(如胶乳过敏)、放射性造影剂等。n慢性荨麻疹 常见病因:物理因素、药物因素、肺IgE介导食物超敏反应、自身免疫性疾病如甲状腺炎、SLE等、感染因素,另有40%-50%病因不明。荨
93、麻疹(伴或不伴血管性水肿)分类概述-发病机制n荨麻疹和血管性水肿发病的中心环节是皮肤或黏膜组织肥大细胞脱颗粒,释放血管活性介质如组胺等,新合成的膜来源的介质如白三烯、前列腺素等随后释放,造成平滑肌收缩、毛细血管扩张、通透性增加等,引起荨麻疹及血管性水肿的临床表现。 近二十年,很多研究对各种类型荨麻疹的病因进行了探讨。急性或慢性感染如幽门螺杆菌(helicobacter pylori)感染、食物或药物类过敏反应(pseudoallergic)及由抗IgE受体的抗体介导的自体免疫等,都可能是引起荨麻疹的原因。概述-诊断通过病史询问了解荨麻疹诱发及缓解因素尤为重要.如(1)风团发生的诱因及缓解因素;
94、(2)风团性质(频率、大小、数目、24 h是否消退、消退后是否遗留色素沉着);(3)有无合并血管性水肿;(4)既往治疗及疗效;(5)合并疾病(胃肠道、甲状腺、外科植入物、造影剂、麻醉药、抗生素等药物、生存压力等);(6)家族史;(7)药敏史及食物过敏史。概述-其他鉴别诊断n如同一部位风团超过24 h,并伴有发热、关节痛等症状时,考虑荨麻疹性血管炎,如水肿超过96 h,应注意除外皮肌炎、上腔静脉阻塞症候群、日光性皮炎、克隆(Crohn)氏病的口腔和嘴唇病变、面部的蜂窝织炎等。概述-治疗n基本治疗原则:去除病因,治疗原发病,对症治疗。慢性荨麻疹症状控制用药选择Understanding of TC
95、M(中医的认识)nUrticaria belongs to Yinzhen(or Chizhen, Baizhen,Youfeng,Guifangeda)of TCM. 属中医学瘾疹(或赤疹、白疹、游风、鬼饭疙瘩)范畴。nYinzhen is the earliest records appear in the Plain Questions. “隐疹”作为病名出现的最早记载出现在素问中。 Related Viscera and Meridians相关的脏腑、经络 Twelve skin areas十二皮部 Lung meridian肺经 Spleen/stomach/large intest
96、ine meridian 脾、胃、大肠经 Liver(gallbladder) meridian 肝(胆)经 Acupuncture and Moxibustion Therapy(针灸治疗)Commonly used acupoints(常用经穴)nPrinciple points:mainly use points of large intestine meridian,stomach meridian,spleen meridian,liver meridian, gallbladder meridian: Hegu,Quchi,Zusanli,Yinlingquan,Sanyinjia
97、o, Taichong,Xuehai,Fengchi,Yanglingquan, Dazhui,Shenque. 多以手足阳明、足太阴、足厥阴、足少阳等经的穴位为主,如合谷、曲池、足三里、阴陵泉、三阴交,太冲、血海、风池、阳陵泉、大椎、神阙等.Commonly used acupoints(常用经穴)nSupplementary points: mainly used the Back-Shu points of related viscera and relate to blood:Feishu,Pishu,Geshu, Xuehai,Weizhong. 配合相应脏腑的背俞穴以及与血分病有关
98、的穴位,如肺俞、脾俞、膈俞、血海、委中等。nTreating blood before treating wind, and then wind will expel itself if blood circulation is unimpeded. 治风先治血,血行风自灭。Needling Methods with Filiform Needle毫针疗法nPrescription: Eliminate heat and anti allergy therapy(self-made) Principle points:Quchi,Waiguan,Hegu,Zusanli, Sanyinjiao
99、Taichong,Xuehai.n处方:清血抗敏方(自拟) 主穴:曲池、外关、合谷、足三里、三阴交、太冲、血海。 Modification(随症配穴)nLiver heat and onset at night: add Ququann 肝热较重,夜间发作明显者:曲泉nOnset before or after menstruation: add Tianshun 月经前后发 天枢nAccompanied with stomach heat, bad breath, constipation: add Neitingn 伴有胃热、口臭、便秘者:内庭nUrticaria located at l
100、imbs mainly: add Jianyu n 瘾疹发作以四肢为主者:肩髃n Modification(随症配穴)nPruritus of uneven location: Danzhong 瘙痒发作无定处者+膻中nSevere pruritus at night and hard to fall asleep:add Yintang,Baihui 夜间瘙痒严重、不得入眠者:印堂、百会nSevere itching accompanied with dysphoria: open four gates 瘙痒剧烈,烦躁不安:开四关nCold contact urticaria and chr
101、onic urticaria: moxibustion and/or with warmed needles 对寒性荨麻疹及慢性荨麻疹可用温针灸、灸法。针灸止痒n最强:膈俞穴刺络放血(可达完全不痒)n次效:血海、曲池放血(仅微痒)Other Acupuncture and MoxibustionTreatment其他针灸疗法Collateral-channel puncture and cupping therapy(刺络拔罐)nPrinciple points:Geshu,Dazhui, Xuehai,Feishu. 主穴:膈俞、大椎、血海、肺俞。nPerformance:cupping a
102、fter prick the acupoints or spot pricking, or cupping after prick along the meridian, or cupping on Shenque. 方法:穴位叩刺或点刺后拔罐,或循经点刺后拔罐,或神阙穴拔罐。 Auricular Therapy (耳穴疗法)nAuricular-plaster Therapy and Auricular-needle Therapy 耳穴贴压和耳穴针刺 nPrinciple points主穴: Shenmen(TF4),Xin(CO15)heart,Fei(CO14)lung,Pi(CO13
103、)spleen,Wei(CO4)stomach, Erjian(HX6,7 i),Anti-allergic area,Cortical gland. 神门、心、肺、脾、胃、耳尖、抗过敏区、 皮质腺。(图) Acupoint injection 穴位注射nPrinciple points:Quchi,Xuehai,Zusanli, Sanyinjiao,Dazhui,Fengchi. 主穴:曲池、血海、足三里、三阴交、大椎、风池。nInjecta:VitB12,CCO,Cimetidine, Dexamethasone 药物:维生素B12、维D2果糖酸钙注射液、西咪替丁、地塞米松等。 Othe
104、rs acupoint therapy 其它穴位疗法nAutohemotherapy自血疗法nPrinciple points:Zusanli,Sanyinjiao,Hegu, Quchi,Dazhui. 常用穴位:足三里、三阴交、合谷、曲池、 大椎等。nAcupoint Embedment穴位埋线 nPrinciple points:Zusanli,Xuehai,Quchi,Geshu. 常用穴位:足三里、血海、曲池、膈俞等. Chinese Medicine Therapy(中药治疗)Syndrome differentiation and treatment(辨证论治)nSyndrome
105、 of Exterior Attacked by Wind-heat 风热犯表证 nChief manifestations: red urticaria, aggravation after attack of heat and disappearance after attack of cold, locate above the waist, or accompanied with sore throat, reddish tongue with white or yellowish and thin coating, superficial, slippery and rapid pu
106、lse. 主症:主要表现为瘾疹色红,遇热加剧,得冷则隐,发于上半身,被覆部位为多,或兼咽喉肿痛,舌红、苔薄白或薄黄,脉浮滑数。Syndrome of Exterior Attacked by Wind-heat风热犯表证 nTherapeutic principle: to relieve exterior syndrome with pungent and cool herbs, and dissipate the wind and eliminate the heat. 治则:辛凉解表、疏风清热。nPrescription: Modified Yinqiao Powder 处方:银翘消风散
107、加减。 Ingredient:Jinyinhua,Kushen,Jingjie,Fangfeng, Huangqin,Lianqiao,Chantui,Danzhuye,Baixianpi. 方药:金银花、苦参、荆芥、防风、黄芩、连翘、 蝉蜕 、淡竹叶、白鲜皮。Syndrome of Exterior Attacked by Wind-heat风热犯表证 nModification(加减):nSevere sore throat: add Banlangen,Jiegeng; 若咽痛明显者加板蓝根,桔梗;nConstipation: add Shengdihuang,Dahuang; 便秘者加
108、生地黄,大黄;nRed and hot urticaria: add Mudanpi,Chishao; 风团鲜红灼热者加牡丹皮,赤芍;nThirst: add Shengdihuang,Tianhuafen; 口渴者加生地黄,天花粉;nSevere itching accompanied with dysphoria:add Baijili,Zhenzhumu. 瘙痒剧烈,情绪烦躁者加白蒺藜,珍珠母。Syndrome of Liver Stagnation and Blood Heat(肝郁血热证)nChief manifestations: red urticaria of small qu
109、antity and uneven location, accompanied with headache, dizzy, hypochondriac pain, or irregular menstruation, distension and pain of breasts, reddish tongue with few coating, string pulse. 主症:临床表现为瘾疹色鲜红,数量较少,发无定处,可伴头痛,目眩,胁下不适,或伴月经不调,乳房胀痛,舌红、少苔,脉弦。Syndrome of Liver Stagnation and Blood Heat(肝郁血热证)nThe
110、rapeutic Principle: soothe liver qi, alleviate mental depression, and cool blood to stop itchiness. 治则:疏肝解郁,凉血止痒。nPrescription: Suganliangxue Decoction(self-made) 处方:自拟疏肝凉血方。Syndrome of Liver Stagnation and Blood Heat(肝郁血热证)nIngredient:Kushen,Danggui,Chaihu, Baizhu,Bohe,Shengdihuang,Mudanpi, Fuling,
111、Chishao,Zicao,Difuzi,Shechuangzi,Baixianpi. 方药:苦参、当归、柴胡、白术、薄荷、生地黄、牡丹皮、茯苓、赤芍、紫草、地肤子、蛇床子、白鲜皮。Syndrome of Liver Stagnation and Blood Heat(肝郁血热证)nModification(加减): Stagnation of liver qi transforming into fire: add Zhizi; 伴有心情烦躁、舌红、苔黄腻等肝郁化火者加栀子;nReddish tongue with petechia and ecchymosis: add Taoren,Ho
112、nghua. 舌红有瘀点者加桃仁、红花。Syndrome of Blood Deficiency and Wind-dry (血虚风燥证)nChief manifestations: the old and the weak mainly belong to this syndrome. Reddish urticaria, 主症:临床表现为瘾疹色淡红,日轻夜重,舌淡、苔薄净,脉弦细。nTherapeutic Principle: replenish qi and nourish blood, calm liver wind and suppress hyperactivity liver y
113、ang. 治则:益气养血,熄风潜阳。nPrescription: Modified Dangguiyinzi 处方:当归饮子加减。Syndrome of Blood Deficiency and Wind-dry (血虚风燥证)nIngredient:Danggui,Huangqi,Shengdihuang, Baishao,Shouwu,Jingjie,Fangfeng,Baijili, Chuanxiong,Gancao. 方药:当归、黄芪、生地黄、白芍、何首乌、荆芥、防风、白蒺藜、川芎、生甘草。nModification(加减): Vexation, irritability and h
114、ypocondrium distension: add Shashen,Chuanlianzi; 心烦易怒,胸胁胀满者:沙参、川楝子;Syndrome of Blood Deficiency and Wind-dry (血虚风燥证)nInsomnia: add Yejiaoteng,Hehuanpi,Suanzaoren; 夜寐不安者:夜交藤 、合欢皮 、酸枣仁;nIrregular menstruation and dysmenorrhea, with purple petechia on the tongue: add Danshen,Yimucao; 月经不调、痛经,舌有紫气瘀点者加丹参
115、、益母草;nThirst with a desire to drink: add Tiandong, Maidong,Xuanshen. 口干欲饮者加天冬、麦冬、玄参。Syndrome of failing to regulate thoroughfare and conception vessels(冲任失调证)nChief manifestations: light urticaria of uneven location, increase in 2-3 days before menstruation and disappear after menstruation, mainly l
116、ocate on abdomen, lumbar and the interior of thigh, accompanied with irregular menstruation, abdominal pain during menstruation, light-colored tongue with thin coating, string and thin or string and slippery pulse.n主症:主要临床表现为风团色淡,发无定处,常于经前 23 天皮损增多,经后渐渐消失,以腹、腰骶、大腿内侧为多,至下次月经前又发作,伴月经不调,经来腹痛,舌淡、苔薄,脉弦细或
117、弦滑。Syndrome of failing to regulate thoroughfare and conception vessels(冲任失调证)nTherapeutic Principle:regulate thoroughfare and conception vessel. 治则:调摄冲任。nPrescription:Modified Erxiansiwu Decoction 处方:二仙四物汤加减。nIngredient:Xianmao,Yinyanghuo,Chaihu, Fangfeng,Jingjie,Danggui,Shengdihuang, Chishao,Danshe
118、n,Chantui,Chuanxiong,Gancao. 方药:仙茅、淫羊藿、柴胡、防风、荆芥、 当归、 生地黄、赤芍、丹参、蝉蜕、川芎 、 甘草 。Syndrome of failing to regulate thoroughfare and conception vessels(冲任失调证)nModification(加减):nWeek and dizzy:add Dangshen,Huangqi, Fuling,Baizhu; 伴体虚乏力、头昏者加党参、黄芪、茯苓、 白术;nAching and weekness of the loins and knees with scanty m
119、enorrhea:add Shudihuang,Roucongrong. 腰膝酸软,月经量少者加熟地黄、肉苁蓉、 杜仲。外治洗方(民间广东地区)n主治:过敏性皮肤病,急慢性荨麻疹,湿疹,皮肤瘙痒。n处方:大飞杨 60g、小飞杨 60g、 黄皮叶 60g、大桉树叶 60g、 七姐妹 60g、水翁叶 60g。 (鲜品均用半斤)n用大锅煮,最后加入薄荷50g,沸后立即倒出。用毛巾敷,温热适度,不宜感灼烫。一般1-2次即好。赖氏外洗方n处方:苦参 45g、百部 30g、花椒 10g、 白藓皮 60g、黄芩 30g。n若皮肤流疮水,加枯矾 15g。 一剂药熏洗2次。Other Prescriptions
120、 for Chinese Medicine其他中药方剂Zhurenkang(朱仁康)nWind-excess Type(风盛型):nModified Xiaofeng Powder: Qianghuo,Jingjiesui,Fangfeng,Baizhi, Jiangcan,Chanyi,Fuping,Beishashen, Yunling,Chenpi,Gancao,Yinhua. 消风散加减:羌活、荆芥穗、防风、白芷、僵蚕、蝉衣、浮萍、北沙参、云苓、 陈皮、甘草、银花。Zhurenkang(朱仁康)nWind-heat Type(风热型):nModified Yinqiao Powder:
121、 Yinhua,Lianqiao,Jingjiesui,Bohe, Chaoniubang,Danzhuye,Lugen,Chanyi, Zhijiangcan. 银翘散加减:银花、连翘、荆芥穗、薄荷、炒牛蒡、淡竹叶、芦根、蝉衣、炙僵蚕。Zhurenkang(朱仁康)nD-heat Type(湿热型):nModified Longdanxiegan Decoction: Longdancao,Chaozhizi,Huangqin,Chaihu,Mutong,Zexie,Cheqianzi,Cangzhu, Yinchen,Yiyiren.n 龙胆泻肝汤加减:龙胆草、炒栀子、黄芩、柴胡、木通、泽
122、泻、车前子、苍术、 茵陈、薏苡仁。 Zhurenkang(朱仁康)nPersistent stagnation of wind-heat 风热久羁nWushequfeng Decoction(self-made): Wushe,Chanyi,Jingjie,Baizhi,Qianghuo, Huanglian,Huangqin,Yinhua,Lianqiao, Gancao,Dahuang. 自拟乌蛇祛风汤:乌蛇、蝉衣、荆芥、 白芷、羌活、黄连、黄芩、银花、连翘、甘草、大黄。Zhurenkang(朱仁康)nBlood-heat and wind-excess type 血热风盛: Factit
123、ial Urticaria(人工荨麻疹) nIngredient:Shengdi,Danggui,Chishao, Zicao,Yuanshen,Zhimu,Shengshigao, Gancao. 药物:生地、当归、赤芍、紫草、元参、知母、生石膏、甘草。Zhurenkang(朱仁康)nInstability of the defensive qi 卫气不固 nIngredient:Zhihuangqi,Fangfeng, Chaobaizhu,Guizhi,Chaochishao, Shengjiang,Chinese date,Jingjie,Fuling. 药物:炙黄芪、防风、炒白术、桂
124、枝、炒赤芍、生姜、大枣、荆芥、茯苓。Zhurenkang(朱仁康)nDysfunction of the spleen in transport 脾失健运 nIngredient:Cangzhu,Chenpi,Zhuling, Zexie,Qianghuo,Fangfeng,Chaobaizhu, Muxiang,Wuyao. 药物:苍术、陈皮、猪苓、泽泻、羌活、防风、炒白术、木香、乌药。Zhurenkang(朱仁康)nStagnation of blood causing wind 血瘀生风 nIngredient:Dangguiwei,Chishao,Taoren, Honghua,Dan
125、shen,Jingjie,Chanyi,Gancao. 药物:当归尾、赤芍、桃仁、红花、丹参、荆芥、 蝉衣、甘草. Wind-heat:add Yinhua,Lianqiao; 风热加银花、连翘; Wind-cold:add Mahuang,Guizhi. 风寒加麻黄、桂枝。Chenhanzhang(陈汉章)nPathogenic factor invade Shaoyang 邪陷少阳nModified Dayuanyin: Binglang,Houpu,Caodoukou,Zhimu, Shaoyao,Huangqin,Gancao,Chaihu, Jingjie,Fangfeng. 达原饮
126、加减:槟榔、厚朴、草豆蔻、知母、芍药、黄芩、甘草、柴胡、荆芥、防风。Lizhenhua(李振华)nExogenous pathogenic wind-cold 外感风寒nJieduxiaozhen Decoction(self-made): Danggui,Chuanxiong,Chishao,Qianghuo,Jingjie,Fangfeng,Difuzi,Cangzhu, Baixianpi,Gancao. 自拟解表消疹汤: 当归,川芎,赤芍, 羌活,荆芥,防风,地肤子,苍术, 白鲜皮,甘草 。Lizhenhua(李振华)nExogenous pathogenic wind-heat 外感
127、风热nToubiaoxiaozhen Decoction: Danggui,Chuanxiong,Chishao,Jingjie, Bohe,Difuzi,Baixianpi,Digupi,Fuping, Juhua,Gancao. 透表消疹汤: 当归 ,川芎,赤芍 , 荆芥 ,薄荷 ,地肤子 ,白鲜皮 , 地骨皮 ,浮萍 ,菊花 ,甘草。Lizhenhua(李振华)nD-heat in intestines and stomach(肠胃湿热)nZaoshixiaozhen Decoction: Danggui,Chuanxiong,Chishao,Jingjie, Fangfeng,Difu
128、zi,Cangzhu,Huangbo, Guangmuxiang,Gancao.n 燥湿消疹汤: 当归,川芎,赤芍 ,荆芥 , 防风 , 地肤子 ,苍术 ,黄柏,广木香,甘草。Constipation:add Dahuang;n 大便秘结者加大黄;n Loosing stool:add Chaoyiyiren,Zexie.n 大便溏泄者加炒薏苡仁 、泽泻。Lizhenhua(李振华)nDeficiency of both Qi and Blood 气血虚弱nBuqixiaozhen Decoction(self-made): Huangqi,Dangshen,Baizhu,Fuling, Da
129、nggui,Chuanxiong,Chishao,Qianghuo,Fangfeng,Difuzi,Gancao.n自拟补气消疹汤: 黄芪,党参 ,白术 ,茯苓 ,当归 ,川芎,赤芍,羌活, 防风,地肤子 ,甘草 。Liusongan(刘松庵)nHeat-clearing and Detoxifying,Eliminating Dness, dispelling Wind,Relieving Itching.n 清热解毒、燥湿疏风止痒nZhuzhen Decoction(self-made): Daqingye,Gongying,Diding,Cangzhu,Chuanbai,Kushen,S
130、hechuangzi,Fangfeng,Jingjiesui,Chuanjun,Baixianpi,Danpi.n 自拟逐疹汤:大青叶、公英、地丁、苍术、川柏、苦参,蛇床子、防风、芥穗、川军、白鲜皮、丹皮。 Zhaobingnan(赵炳南)nChronic Urticaria(慢性荨麻疹)nWupiwutengyin:Mudanpi,Baixianpi, Digupi,Sangbaipi,Haitongpi,Yejiaoteng,Gouteng,Haifengteng,Qingfengteng, Tianxianteng. 五皮五藤饮组成:牡丹皮、白鲜皮、 地骨皮、桑白皮、海桐皮、夜交藤、 钩
131、藤、海风藤、青风藤、天仙藤。 Zhaobingnan(赵炳南)nIntractable Urticaria(顽固性荨麻疹)nDuopiyin:Wujiapi,Ganjiangpi,Chenpi, Dongguapi,Fulingpi,Dafupi,Bingdoupi, Baixianpi,Mudanpi,Digupi,Sangbaipi, Fuping,Danggui. 多皮饮:五加皮、干姜皮、陈皮、冬瓜皮、茯苓皮、大腹皮、扁豆皮、白鲜皮、 牡丹皮、地骨皮、桑白皮、浮萍、 当归。 Zhuliangchun(朱良春)nIntractable Urticaria(顽固性荨麻疹)nPersisten
132、t stagnation of wind-heat in nutrient phase(风热久郁营分)nWanguqianzhen Powder(self-made): Chishao,Jingjie,Zhijiangcan, Zhiwushaoshe,Xuchangqing,Baixianpi, Difuzi,Chanyi,Wumei,Shenggancao. 自拟顽固荨疹散:赤芍、荆芥、炙僵蚕、炙乌梢蛇、徐长卿,白鲜皮、地肤子,蝉衣、乌梅、生甘草。Zhangzhili(张志礼)nCold-heat Syndrome(风热证)nModified Jingfang Decoction: Jin
133、gjie,Fangfeng,Shuanghua,Niubangzi,Huangqin,Lianqiao,Danpi,Fuping, Jiangcan,Chanyi,Sangpi,Dongguapi. 荆防方加减:荆芥,防风,双花, 牛蒡子,黄芩,连翘,丹皮,浮萍, 僵蚕,蝉衣,桑皮,冬瓜皮。Zhangzhili(张志礼)nWind-cold syndrome(风寒证) Modified Mahuang Decoction: Mahuang,Xingren,Ganjiangpi,Fuping, Baixianpi,Danpi,Chenpi,Jiangcan, Chishao,Gancao. 麻黄
134、汤加减:麻黄,杏仁,干姜皮, 浮萍,白鲜皮,丹皮,陈皮,僵蚕, 赤芍,甘草。Zhangzhili(张志礼)nAttacked by wind due to the deficiency of blood (血虚受风)nModified Dangguiyinzi: Danggui,Chuanxiong,Shudi,Chishao, Baishao,Shouwuteng,Shenghuangqi, Cijili,Fangfeng,Fuping,Baixianpi. 当归饮子加减:当归,川芎,熟地, 赤白芍,首乌藤,生黄芪,刺疾黎, 防风,浮萍,白鲜皮。Zhangzhili(张志礼)nDeficie
135、ncy of Both Lung and Spleen,wind and cold restrict the exterior. 脾肺两虚,风寒束表nModified Yupingfeng Powder and Duopiyin: Huangqi,Taizishen,Baizhu,Fuling,Chenpi, Sangbaipi,Wujiapi,Baixianpi,Cijili,Fangfeng, Fuping,Danshen. 玉屏风散合多皮饮加减:黄芪,太子参,白术,茯苓,陈皮,桑白皮,五加皮,白鲜皮, 刺蒺藜,防风,浮萍,丹参。Thank you ! Eczema 湿疹Understan
136、ding of TCM(中医的认识)nBelong to Shichuang (or Naixian,Huangfeichuang, Siwanfeng,Jinyinchuang,Shennangfeng)of TCM. 属于中医学“湿疮”(奶癣、黄肥疮、四弯风、浸淫疮、肾囊风等)范畴。nThe latest record found in the Zhu Bing Yuan Hou Lun.The description of Huangfeichuang in it is the same to the performance of eczema in infancy. 最早的记载见于诸病
137、源侯论,其中关于“黄肥疮”的描述与湿疹的婴儿期表现是相同的。Related Viscera and Meridians相关的脏腑、经络nHeart Meridian心(经)nLung Meridian肺(经)nSpleen Meridian脾(经)nStomach Meridian胃(经)nLiver Meridian肝(经)nGallbladder Meridian胆(经) Acupuncture and Moxibustion Therapy针灸治疗Filiform Needling Techniques(毫针刺法)nPrinciple Points:Hegu,Ququan,Zusanli
138、,Xuehai,Sanyinjiao.n 选穴:合谷、曲池、足三里、血海、三阴交针刺。nSupplementary Points(配穴):n D-heat Syndrome:add Feishu,Fengshi,Yinlingquan,Shangjuxu.n 湿热证者加肺俞,风市,阴陵泉,上巨虚;n Symptom of heat syndrome is serious:add Dazhui;n 热甚加大椎;Filiform Needling Techniques(毫针刺法)nSeepage is serious:add Shuifen. 渗出滋水多加水分。nSpleen Deficiency
139、 Syndrome:add Pishu,Yinlingquan; Abdominal Distension:add Zhongwan; Loose Stool:add Tianshu. 脾虚证者加脾俞,阴陵泉,腹胀加中脘,便溏加天枢。nBlood Deficiency Syndrome:add Geshu,Pishu,Ganshu,Taixi; Itching serious in the evening:add Shenmen. 血虚证者加隔俞,脾俞,肝俞,太溪,入夜痒甚加神门。Moxibustion therapy(艾灸)nSuspended moxibustion on Guanyuan
140、 and the skin lesions with moxa stick. 艾条悬灸关元穴及皮损处.nHemorrhoids postoperative anal eczema:Dazhui,Quchi,Sanyinjiao,Shenmen. 取大椎、曲池、三阴交、神门治疗痔瘘术后肛门湿疹; Scrotal Eczema:Xuehai,Ququan,Ligou. 血海、曲泉、蠡沟等穴治疗阴囊湿疹。 Collateral-channel puncture and cupping therapy(刺络拔罐)nCommonly choose the skin lesions and back-sh
141、u points.First tapping bleeding, and then cupping。 多取患部皮肤及相应背俞穴,先叩刺出血,再拔罐。 Plum-blossom Needle Therapy(梅花针疗法)nPrinciple points : Dazhui,Xuehai,Fengshi. Tapping the corresponding Back-Shu points according to syndrome differentiation。 选穴:根据辩证叩刺相应俞穴,大椎、血海,风市为必选穴。nTapping Back-Shu points from up to down
142、 on both sides of back.Tapping with moderate intensity and for the degree of skin flushing. 先在背部两侧背俞穴自上而下纵行叩刺,以中等强 度,以皮肤潮红为度. Acupoint Injection(穴位注射)n取穴:曲池、足三里、三阴交、合谷等。nIngredients:Huangqi Injection, compound salvia injection,VB12, CCO,autologous blood. 药物:黄芪注射液,复方丹参注射液,VB12注射液,维D2果糖酸钙注射液或自血。 nAuto
143、hemotherapy自血穴位注射 Principle points:Quchi,Zusanli,Sanyinjiao,Hegu. 穴位多取曲池、足三里、三阴交、合谷等穴。 Common Points of Allergic Skin Diseases(过敏性皮肤病常用穴)nPrinciple points:Xuehai,Geshu,Zusanli, Sanyinjiao,Dazhui,Shenque,others Back-Shu Points. 血海、膈俞、足三里、三阴交、大椎、神阙,其它背俞穴等。nTherapy:Filiform Needling Techniques, Moxibus
144、tion Therapy,Collateral-channel puncture and cupping,Acupoint Injection. 可以针刺、艾灸、刺络拔罐、穴位注射等。 Chinese Medicine Therapy(中药治疗)D-heat Retention Skin Syndrome (湿热蕴肤证)nTherapeutic Principle :clearing heat,removing dness,relieving itchingn 治则:清热利湿止痒。nPrescription:Longdanxiegan Decoction and Bixiefenqingyin
145、.n 方药:龙胆泻肝汤和萆薢分清饮加减。D-heat Retention Skin Syndrome (湿热蕴肤证)nModification: more blisters and seepage is serious:add Tufuling,Yuxingcao; 水疱多,破后流滋多者,加土茯苓、鱼腥草; Symptom of heat syndrome is serious:add Huanglianjiedu Decoction; 热盛者,加黄连解毒汤; Itching seriously:add Zijingpi,Difuzi,Baixianpi. 瘙痒甚者,加紫荆皮、地肤子、白藓皮。
146、Stagnation of Dness Due to Deficiency of Spleen(脾虚湿蕴证)nTherapeutic Principle :Strengthening spleen,resolving dness,relieving itching。n 治法:健脾利湿止痒。nPrescription:Chushiweiling Decoction or Shenlingbaizhu Powder add Zijingpi,Difuzi,Baixianpi.n 方药:除湿胃苓汤或参苓白术散加紫荆皮、地肤子、白藓皮。Blood Deficiency and Wind Dryness
147、(血虚风燥证)nPrescription:Dangguiyinzi or Siwuxiaofengyin add Danshen,Jixueteng,Wushaoshe. 方药:当归饮子或四物消风饮加丹参、鸡血藤、乌梢蛇。 Too itching to fall asleep:add Zhenzhumu(decocted first),Xuchangqing, Yejiaoteng,Suanzaoren. 瘙痒不能入眠者,加珍珠母(先煎)、徐长卿、夜交藤、酸枣仁。Commonly Used Herbal Medicine湿疹常用药nShengdihuang,Danpi,生地黄、丹皮;nBaix
148、ianpi,Kushen,Huangqin,Huangbo; 白鲜皮、苦参、黄芩、黄柏;nDifuzi;地肤子;nDanggui;当归;nFuling,Zexie;茯苓、泽泻;nCangzhu.苍术。Commonly used for External Washing外洗常用药nHuanglian,Huangbo,Dahuang,Tufuling, Baixianpi,Kushen,Diyu,Cangzhu, Jinyinhua,Lianqiao. 黄连,黄柏、大黄、土茯苓、白鲜皮、苦参、地榆、苍术、金银花、连翘。Other Prescriptions for Chinese Medicine
149、其他中药方剂Zhurenkang(朱仁康)nInternal stasis of dness and heatn 湿热内蕴证nModified Longdanxiegan Decoction: Longdancao,Shengdi,Huangqin,Zexie, Chuanmutong,Cheqianzi,Fuling, Liuyi Powder.n 龙胆泻肝汤加减:龙胆草、生地、黄芩、泽泻、川木通、车前子、茯苓、六一散。Zhurenkang(朱仁康)nInternal dness and external dryness内湿外燥nModified Qinlianpingwei Decocti
150、on: Huangqin,Huanglian,Cangzhu,Chenpi, Houpu,Fuling,Shengdi,Danpi,Chishao, Liuyi Powder.n 芩连平胃汤化裁:黄芩、黄连、苍术、 陈皮、厚朴、茯苓、生地、丹皮、赤芍、六一散等。Zhurenkang(朱仁康)nInjury of yin due to the stasis of dness(阴伤湿恋证)nZiyinchushi Decoction: Shengdihuang,Xuanshen,Danggui, Fuling,Zexie,Danshen,Difuzi, Shechuangzi,Gancao.n 滋
151、阴除湿汤: 生地黄、玄参、当归、 茯苓、泽泻、丹参、地肤子、蛇床子、甘草等。Zhurenkang(朱仁康)nInjury of yin. 阴伤证。nIngredient:Shengdihuang,Xuanshen, Danggui,Danshen,Fuling,Zexie, Baixianpi,Shechuangzi. 生地黄,玄参,当归,丹参,茯苓, 泽泻,白鲜皮,蛇床子。 Zhurenkang(朱仁康)nBlood-heat Syndrome 血热证nModified Pixian Decoction: Shengdihuang,Danpi,Chishaoyao, Huangqin,Kus
152、hen,Baixianpi,Difuzi, Danshen,Gancao. 皮癣汤加减:生地黄,丹皮,赤芍药,黄芩,苦参,白鲜皮,地肤子,丹参,甘草。 Zhurenkang(朱仁康)nInjury of yin causing hematozemia 阴伤耗血证nModified Zizaoyangrong Decoction: Shengdi,Shudi,Danggui,Baishao, Maidong,Qinjiao,Fangfeng,Huangqi, Shanyao. 滋燥养荣汤化裁:生地、熟地、当归、 白芍、麦冬、秦艽、防风、黄芪、生山药等Zhurenkang(朱仁康)nWushequ
153、feng Decoction: Wushaoshe,Chantui,Jingjie,Fangfeng, Baizhi,Difuzi,Huangqin,Huanglian, Jinyinhua,Lianqiao,Gancao. 乌蛇驱风汤:乌梢蛇、蝉蜕、荆芥、防风、白芷、地肤子、黄芩、黄连、金银花、连翘、甘草。 Indication:Stubborn itching,pruritus of uneven location. 适用于顽固瘙痒,发无定处。Zhurenkang(朱仁康)nSelf-made Piyan Decoction: Shengdi,Danpi,Chishao,Shigao,Zh
154、imu, Huangqin,Jinyinhua,Lianqiao,Zhuye, Gancao. 自拟“皮炎汤”:生地、丹皮、赤芍、 生石膏、知母、黄芩、金银花、连翘、竹叶、甘草等。nIndication: the hot rash. 适用于以热为主的皮疹。Xuanguowei(禤国维)nBlood deficiency and Wind Dryness 血虚风燥型 nIngredient:Shengdihuang,Mudanpi,Baishao, Danggui,Fangfeng,Zisuye,Chishao,Zicao, Humaren,Baixianpi,Gouteng,Jixueteng
155、,Ezhu, Sumu(decocted first),Gancao. 生地黄、牡丹皮、白芍、当归、防风、紫苏叶、赤芍、紫草,胡麻仁、白鲜皮、钩藤, 鸡血藤,莪术、苏木(先煎),甘草。Xuanguowei(禤国维)nStagnation of dness due to deficiency of the spleen 脾虚湿困 nIngredient:Dangshen,Fuling,Shanyao, Buzhaye,Yiyiren,Baibiandou,Baizhu, Fangfeng,Yinchen,Xuchangqing,Gancao.n 党参、茯苓、山药、布渣叶,薏苡仁、白扁豆,白术、防
156、风、茵陈、徐长卿,甘草。Xuanguowei(禤国维)nDeficiency of yin and blood 阴虚血燥型 nIngredient:Shudihuang,Shengdihuang, Danshen,Heshouwu,Baixianpi,Zexie, Fuling,Wumei,Maidong,Nvzhenzi, Hanliancao,Danggui,Baishao,Chishao. 熟地黄、生地黄,丹参、何首乌、 白鲜皮、泽泻、茯苓、乌梅,麦冬、 女贞子、旱莲草、当归、白芍、赤芍。Xuanguowei(禤国维)nObstinate Eczema 顽固性湿疹。nPifujiedu
157、Decoction: Wumei,Ezhu,Tufuling,Baixianpi,Difuzi, Hongtiaozicao,Suye,Fangfeng,Shengdi,Danpi,Dilong,Kushen,Chantui,Gancao. 皮肤解毒汤:乌梅、莪术、土茯苓、白鲜皮、 地肤子、红条紫草、苏叶、防风、生地、丹皮、地龙、苦参、蝉蜕、甘草。Zhaobingnan(赵炳南)nAcute Eczema(D-heat Syndrome)n 急性湿疹(湿热证)nQingrechushi Decoction: Longdancao,Huangqin,Shengdi, Baimaogen,Daqi
158、ngye,Cheqiancao, Shengshigao,Liuyi Powder.n 清热除湿汤:龙胆草、黄芩、生地、白茅根、 大青叶、车前草、生石膏、六一散。n Lifuren(李辅仁)nExperience prescription: Cangzhu,Chaobaizhu,Huangqin,Yiyiren,Danpi,Fulingpi,Zicao,Zexie,Lianqiao,Fuping,Shengdi.n经验方:苍术,炒白术,黄芩,薏苡仁,丹皮,茯苓皮,紫草,泽泻,连翘,浮萍,生地。nModification: Strengthening Spleen:Yunling,Chenpi
159、健脾用云苓、陈皮;Lifuren(李辅仁)nClearing Heat:Huangbo,Yinhua; 清热用黄柏、银花; Cooling Blood:Chishao; 凉血以赤芍; Detoxification and Relieving Itching: Baixianpi,Difuzi. 解毒止痒用白鲜皮、地肤子等。Zhangzhili(张志礼)nBlood Deficiency and Wind Dryness 血虚风燥型nModified Yangxuerunfu Decoction: Danggui,Chuanxiong,Shouwuteng, Jixueteng,Danshen,
160、Chishao,Baishao, Shengdihuang,Shudihuang,Fuling, Baizhu,Baixianpi,Kushen,Zhuling. 养血润肤汤加减:当归,川芍,首乌藤, 鸡血藤,丹参,赤白芍、生熟地,茯苓, 白术,白鲜皮,苦参,猪苓。 Zhangzhili(张志礼)nAccumulation in the stomach and intestines 胃肠积滞型nIngredient:Baizhu,Zhike,Yiyiren, Jiaobinglang,Chaolaifuzi,Jineijin, Jiansanxian,Baixianpi,Machixian,
161、Huangqin. 白术,积壳,薏苡仁,焦槟榔, 炒莱服子,鸡内金,焦三仙,白鲜皮,马齿觅,黄芩。Zhangzhili(张志礼)nD Abundance Due to Spleen Asthenia Syndrome.n 适用于脾虚湿盛型。nModified Jianpichushi Decoction: Baizhu,Fuling,Zhike,Yiyiren,Bixie, Cheqianzi,Zexie,Baixianpi,Huangqin, Kushen.n 健脾除湿汤加减:白术,茯苓,积壳, 薏苡仁,川萆薢,车前子,泽泻, 白鲜皮,黄芩,苦参。Zhangzhili(张志礼)nCombin
162、ing with Thermal Image: Shengbaizhu,Shengzhike,Shengyiyiren; 有热象者,应用生白术、生积壳、 生薏苡仁;nNo combining with thermal image: Chaobaizhu,Chaozhike,Chaoyiyiren, Cangzhu,Houpu. 无热象者,则选用炒白术、炒枳壳、 炒薏苡仁,并可加苍术、厚朴。Zhangzuozhou(张作舟) nObstinate Eczema(顽固性湿疹)nD-heat Type(湿热型)nModified Yejuhua Decoction(self-made):Yejuhu
163、a,Jinyinhua,Huangqin,Cheqianzi,Zuyezi,Dengxincao,Jiegeng,Gancao, Jiaosanxian.n 自拟野菊花方加减:野菊花、金银花、 黄芩、车前子、竹叶、灯芯草、桔梗、生甘草、焦三仙。Zhangzuozhou(张作舟)nSpleen deficiency type(脾虚型) nModified Sijunzi Decoction or Baoyuan Decoction:Huangqi,Dangshen, Chaobaizhu,Fuling,Zexie,Cheqianzi, Baixianpi,Cijili,Qinjiao,Ganca
164、o. 常用四君子汤或保元汤加减:黄茂、党参、炒白术、茯苓、泽泻、车前子、白鲜皮、刺蒺藜、秦艽、甘草。Zhangzuozhou(张作舟)nDeficiency of Both Qi and Yin(气阴两虚型) nModified Dihuangyinzi or Zizaoyangrong Decoction:Shengdi,Heshouwu,Danggui, Dangshen,Huangqi,Baishao,Danshen,Qinjiao, Jiangcan,Baixianpi,Cheqianzi,Zexie,Gancao. 常用地黄饮子或滋燥养荣汤加减:干生地、 何首乌、当归、党参、黄芪、白
165、芍、丹参、 秦艽、僵蚕、白鲜皮、车前子、泽泻、甘草。Zhoumingqi(周鸣歧)nChronic Eczema(慢性湿疹)nQufenghuoluo Decoction: Danggui,Shengdi,Chuanxiong,Baixianpi,Jiangcan,Chantui,Taoren,Honghuo, Fangfeng. 祛风活络汤:当归,生地,川芎,白芍,白鲜皮,僵蚕,蝉蜕,桃仁,红花, 防风。Zhoumingqi(周鸣歧)nShenshihuoluo Decoction: Zexie,Zhuling,Fuling,Baizhu,Difuzi, Huangqi,Gancao,Tao
166、ren,Honghuo, Baixianpi. 渗湿活络汤:泽泻,猪苓,茯苓,白术,地肤子,黄芪,甘草,桃仁,红花, 白鲜皮。Zhoumingqi(周鸣歧)nQingrehuoluo Decoction: Danggui,Shengdi,Chuanxiong,Maidong,Mutong,Zhuye,Huangbo,Zhizi,Taoren, Honghuo,Difuzi,Baixianpi. 清热活络汤:当归,生地,川芎, 麦冬,木通,竹叶,黄柏,桅子, 桃仁,红花,地肤子,白鲜皮。Zhoumingqi(周鸣歧)nYangxuequfeng Decoction: Danggui,Shengdi,Baishao,Humafen, Bixie,Kushen,Chantui,Fangfeng,Huashi,Cangzhu,Baixianpi. 养血祛风汤:当归,生地,白芍, 胡麻仁,萆薢,苦参,蝉蜕,防风, 滑石,苍术,白鲜皮.Thank you !