身心同治过敏性紫癜
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摘要
过敏性紫癜发病率逐年上升,临床表现也从身体症状为主逐渐转向身体与心理症状并重,且心理症状和身体症状密切相关,二者互相影响,严重影响患者生活质量和心理健康。西医使用抗组胺制剂、糖皮质激素、非甾体抗炎药、免疫抑制剂。过敏性紫癜可归属"葡萄疫""肌衄""斑毒"等范畴,内因多禀赋不足,脏腑气血阴阳失调,气不摄血;外因为风湿、火热等外邪侵袭,血不循经逸出脉外;辨证分型用犀角地黄汤、牛蒡解肌汤、三妙散合四妙勇安汤、三仁汤、芍药甘草汤、金匮肾气丸合黄土汤等;酌加疏肝解郁、养心安神之品配合心理疏导可进一步改善症状,提高疗效。"社会-生理-心理"医学模式与中医形神合一、整体观、情志与五脏相关等高度契合,精神、意识和思维活动都是内在器官生理功能的反映,体现在疾病诊疗和预防中,"百病生于气""七情所伤,虽分五脏,但必归于心";治疗身体症状时身心同治,可取得更好疗效;心理干预,静心安神、说理开解、乐曲消愁、赏花解郁等,个体化心理疏导患者及家属,不仅可减轻心理压力,缩短病程,提高依从性,还可显著减少复发,显著提高疗效,特别是对于有明显心理症状的患者。
The incidence of allergic purpura has been increasing year by year, and the clinical manifestations have gradually shifted from physical symptoms to both physical and psychological symptoms,and the psychological symptoms and physical symptoms are closely related to each other, seriously affecting the quality of life and mental health of patients.Western medicine uses antihistamines, glucocorticoids,nonsteroidal anti-inflammatory drugs, and immunosuppressants.Allergic purpura can be attributed to the categories of "grape-like pestilence", "sweat pore bleeding", "Spot poison". Due to the lack of internal endowment, internal organs Qi and blood Yin and Yang imbalance, Qi does not absorb blood. External because of rheumatism, fire hot and other external evil invasion, blood does not follow the meridian out of the pulse. Syndrome differentiation type with xijiaodihuang decoction, Niubangjieji decoction, Sanmiao and simiaoyongan decoction, Sanren decoction, Shaoyaogancao decoction, Jinguishenqi pill and Huangtu decoction, etc. Soothing liver and soothing depression, nourishing heart and soothing spirit with psychological guidance can further improve the symptoms and the curative effect. The "social-physiologicalpsychological" medical model is highly consistent with the unity of form and spirit in traditional Chinese medicine, the view of the whole body, the relationship between emotion and the five Zang organs, and so on. Spirit, consciousness and thinking are the reflection of the physiological function of the internal organs,which are reflected in the diagnosis, treatment and prevention of diseases. "All diseases born of Qi" "seven feelings hurt, although divided into five internal organs, but will be attributed to the heart." When treating physical symptoms, treating body and mind can achieve better effect,such as mental intervention、meditation and tranquillity、reasonable interpretation、music dispeling sorrow, appreciating flowers and relieving depression.Individualized psychological counseling can not only lighten the psychological stress, shorten thecourse of disease, improve compliance, but also significantly reduce the recurrence and improve the curative effect, especially for patients with obvious psychological symptoms.
The incidence of allergic purpura has been increasing year by year, and the clinical manifestations have gradually shifted from physical symptoms to both physical and psychological symptoms,and the psychological symptoms and physical symptoms are closely related to each other, seriously affecting the quality of life and mental health of patients.Western medicine uses antihistamines, glucocorticoids,nonsteroidal anti-inflammatory drugs, and immunosuppressants.Allergic purpura can be attributed to the categories of "grape-like pestilence", "sweat pore bleeding", "Spot poison". Due to the lack of internal endowment, internal organs Qi and blood Yin and Yang imbalance, Qi does not absorb blood. External because of rheumatism, fire hot and other external evil invasion, blood does not follow the meridian out of the pulse. Syndrome differentiation type with xijiaodihuang decoction, Niubangjieji decoction, Sanmiao and simiaoyongan decoction, Sanren decoction, Shaoyaogancao decoction, Jinguishenqi pill and Huangtu decoction, etc. Soothing liver and soothing depression, nourishing heart and soothing spirit with psychological guidance can further improve the symptoms and the curative effect. The "social-physiologicalpsychological" medical model is highly consistent with the unity of form and spirit in traditional Chinese medicine, the view of the whole body, the relationship between emotion and the five Zang organs, and so on. Spirit, consciousness and thinking are the reflection of the physiological function of the internal organs,which are reflected in the diagnosis, treatment and prevention of diseases. "All diseases born of Qi" "seven feelings hurt, although divided into five internal organs, but will be attributed to the heart." When treating physical symptoms, treating body and mind can achieve better effect,such as mental intervention、meditation and tranquillity、reasonable interpretation、music dispeling sorrow, appreciating flowers and relieving depression.Individualized psychological counseling can not only lighten the psychological stress, shorten thecourse of disease, improve compliance, but also significantly reduce the recurrence and improve the curative effect, especially for patients with obvious psychological symptoms.
引文
[1]汪受传,虞坚尔.中医儿科学[M].北京:中国中医药出版社,2012:281.
[2]陈丽萍.过敏性紫癜的研究进展[D].南昌:南昌大学,2017.
[3]林鹃.远方教授治疗过敏性紫癜性肾炎经验撷萃[D].沈阳:辽宁中医药大学,2012.
[4]姚淑一.心理护理干预在小儿过敏性紫癜中的护理效果分析[J].中国现代药物应用,2016,10(3):244-245.
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[11]王肯堂.证治准绳[M].北京:人民卫生出版社,2014:451
[12]张燚,展昭新.田素琴皮肤病临证经验集[M].沈阳:辽宁科学技术出版社,2016:157
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[14]姜晶.过敏性紫癜患儿血清白细胞介素-10、-13、-15的水平变化及意义[D].银川:宁夏医科大学,2012.
[15]罗小莲.心理护理在临床护理中的应用[J].中国医药指南,2010,8(5):125-126.
[16]刘枫.代谢型谷氨酸受体5-脂多糖作用小胶质细胞的全新靶点初步研究[D].重庆:第三军医大学,2013.
[17]史丽荣,张建华,李涛,等.心理干预对过敏性紫癜患儿情绪及细胞免疫功能的影响[J].护理研究,2017,31(18):2218-2221.
[18]王旭梅,张巧巧,冯敏芝.心理护理在过敏性紫癜治疗中的作用[J].基层医学论坛,2015,19(27):3829-3830.
[19]孙元元,孙欣,李艳,等.过敏性紫癜患者心理状况调查[J].中国卫生产业,2017,14(27):152-153.
[20]王见宾.过敏性紫癜中医证治规律初探[J].中国中医急症,2004,13(5):301-302.
[21]赵辩.中国临床皮肤病学[M].南京:江苏科技出版社,2010:873.
[22]蒋惠芳.中医整体观身心同治的临床意义[C]//浙江省中西医结合学会.浙江省中西医结合学会保健与康复医学专业委员会第六次学术年会暨国家级继续教育学习班资料汇编.浙江省中西医结合学会,2008:6.
[23]陈晓鹏.中医五脏藏情理论研究[D].福州:福建中医药大学,2011.
[24]李杨杨.浅谈躯体疾病所致精神障碍患者的护理体会[J].中国医药指南,2018,16(32):239-240.
[25]齐秀琴,杨丽萍.优质护理在小儿过敏性紫癜护理中应用[J].世界最新医学信息文摘,2016,16(105):212.
[26]赵华,杨春香,刘小娟,王永利.腹型过敏性紫癜患者的护理[J].护理学报,2009,16(22):24-25.
[27]王珂,张燚.张燚“分期-身心同治”银屑病[J].实用中医内科杂志,2018,32(3):6-9.
[2]陈丽萍.过敏性紫癜的研究进展[D].南昌:南昌大学,2017.
[3]林鹃.远方教授治疗过敏性紫癜性肾炎经验撷萃[D].沈阳:辽宁中医药大学,2012.
[4]姚淑一.心理护理干预在小儿过敏性紫癜中的护理效果分析[J].中国现代药物应用,2016,10(3):244-245.
[5]李心天.医学心理学[M].北京:人民卫生出版社,1991:44.
[6]沈渔邥.精神病学[M].第5版.北京:人民卫生出版社,2009:186.
[7]朱志先,梁虹.现代心身疾病治疗学[M].北京:人民军医出版社,2002:99.
[8]李丽.黄帝内经素问[M].北京:人民卫生出版社,2012:104.
[9]灵枢经[M].北京:人民卫生出版社,2012:113.
[10]陈实功.外科正宗[M].胡晓峰,整理.北京:人民卫生出版社,2007:62
[11]王肯堂.证治准绳[M].北京:人民卫生出版社,2014:451
[12]张燚,展昭新.田素琴皮肤病临证经验集[M].沈阳:辽宁科学技术出版社,2016:157
[13]崔庆科.小儿紫癜疹消(免煎)粒对过敏性紫癜兔模型血清免疫分子影响的研究[D].长春:长春中医药大学,2017.
[14]姜晶.过敏性紫癜患儿血清白细胞介素-10、-13、-15的水平变化及意义[D].银川:宁夏医科大学,2012.
[15]罗小莲.心理护理在临床护理中的应用[J].中国医药指南,2010,8(5):125-126.
[16]刘枫.代谢型谷氨酸受体5-脂多糖作用小胶质细胞的全新靶点初步研究[D].重庆:第三军医大学,2013.
[17]史丽荣,张建华,李涛,等.心理干预对过敏性紫癜患儿情绪及细胞免疫功能的影响[J].护理研究,2017,31(18):2218-2221.
[18]王旭梅,张巧巧,冯敏芝.心理护理在过敏性紫癜治疗中的作用[J].基层医学论坛,2015,19(27):3829-3830.
[19]孙元元,孙欣,李艳,等.过敏性紫癜患者心理状况调查[J].中国卫生产业,2017,14(27):152-153.
[20]王见宾.过敏性紫癜中医证治规律初探[J].中国中医急症,2004,13(5):301-302.
[21]赵辩.中国临床皮肤病学[M].南京:江苏科技出版社,2010:873.
[22]蒋惠芳.中医整体观身心同治的临床意义[C]//浙江省中西医结合学会.浙江省中西医结合学会保健与康复医学专业委员会第六次学术年会暨国家级继续教育学习班资料汇编.浙江省中西医结合学会,2008:6.
[23]陈晓鹏.中医五脏藏情理论研究[D].福州:福建中医药大学,2011.
[24]李杨杨.浅谈躯体疾病所致精神障碍患者的护理体会[J].中国医药指南,2018,16(32):239-240.
[25]齐秀琴,杨丽萍.优质护理在小儿过敏性紫癜护理中应用[J].世界最新医学信息文摘,2016,16(105):212.
[26]赵华,杨春香,刘小娟,王永利.腹型过敏性紫癜患者的护理[J].护理学报,2009,16(22):24-25.
[27]王珂,张燚.张燚“分期-身心同治”银屑病[J].实用中医内科杂志,2018,32(3):6-9.