基于伏邪理论探讨小儿过敏性紫癜的发病特点
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摘要
从伏邪理论溯源、伏邪成因、伏邪致病三个方面阐述伏邪在小儿过敏性紫癜发病中的重要作用。认为伏邪既可从外而感,亦能从内而生。外感伏邪可由外感六淫蕴酿而成,也可直接感受疫气而发,表现为"伏邪于冬,至春发病"和"伏邪于夏,至秋发病";内伤伏邪主要包括伤食、湿热、胎毒;外感伏邪与内伤伏邪是相互交感的,可以继发病理邪气,导致病情缠绵难愈。根据伏邪发病的病机,提出临床治疗小儿过敏性紫癜应在辨证施治的基础上重视祛除伏邪。内伤伏邪多采用清热解毒、清热凉血、清热利湿、清热消食等治法;外感伏邪则要充分考虑外感伏邪作为致病之源,注意祛除外因,同时给予疏风、透郁、祛暑等治法,且应根据其反复发作具有明显季节性的特点,重视预防,防其复发。
The important role of hidden pathogen in the pathogenesis of henoch-schonlein purpura( HSP) in children was expounded from the three aspects of the theoretic origin,the cause and the pathogenesis of hidden pathogen. It was believed that the hidden pathogen can be exogenous and can also be generated from the inside. The exogenous hidden pathogen can be transformed from six climatic factors,and can also occurred directly from epidemic factors,which is expressed as "the hidden pathogen in the winter,the onset of spring"and "the hidden pathogen in the summer,the onset of autumn"; The hidden pathogen of internal damage includes food damage,dampness heat,and fetal toxicity; exogenous hidden pathogen and internal damage hidden pathogen are mutual contracted,which can induce pathological pathogens,leading to a lingering disease. According to the pathogenesis of the disease,it is proposed that the clinical treatment of HSP in children should pay attention to the elimination of hidden pathogen on the basis of syndrome differentiation. Internal damage hidden pathogen are mostly treated with clearing heat and removing toxicity,clearing heat and cooling blood,clearing heat and promoting diuresis,clearing heat and eliminating food stagnation. The exogenous hidden pathogen should fully consider the exogenous hidden pathogen as the source of the disease,pay attention to the removal of external factors,and at the same time treated with dispelling wind,promoting stagnation,dispelling summer-heat,and should pay attention to prevention for recurrence based on the obvious seasonal characteristics of its repeated attack.
The important role of hidden pathogen in the pathogenesis of henoch-schonlein purpura( HSP) in children was expounded from the three aspects of the theoretic origin,the cause and the pathogenesis of hidden pathogen. It was believed that the hidden pathogen can be exogenous and can also be generated from the inside. The exogenous hidden pathogen can be transformed from six climatic factors,and can also occurred directly from epidemic factors,which is expressed as "the hidden pathogen in the winter,the onset of spring"and "the hidden pathogen in the summer,the onset of autumn"; The hidden pathogen of internal damage includes food damage,dampness heat,and fetal toxicity; exogenous hidden pathogen and internal damage hidden pathogen are mutual contracted,which can induce pathological pathogens,leading to a lingering disease. According to the pathogenesis of the disease,it is proposed that the clinical treatment of HSP in children should pay attention to the elimination of hidden pathogen on the basis of syndrome differentiation. Internal damage hidden pathogen are mostly treated with clearing heat and removing toxicity,clearing heat and cooling blood,clearing heat and promoting diuresis,clearing heat and eliminating food stagnation. The exogenous hidden pathogen should fully consider the exogenous hidden pathogen as the source of the disease,pay attention to the removal of external factors,and at the same time treated with dispelling wind,promoting stagnation,dispelling summer-heat,and should pay attention to prevention for recurrence based on the obvious seasonal characteristics of its repeated attack.
引文
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[5]刘吉人.中国医学大成:伏邪新书[M].上海:上海科学技术出版社,1990:30.
[6]王燕昌.王氏医存[M].王新华,点注.南京:江苏科学技术出版社,1985:108-109.
[7]考希良,刘喆.伏邪致痹学说探讨[J].传统医学,2008,17(16):70-71.
[8]唐宽裕,于俊生.从伏毒论治过敏性紫癜性肾炎初探[J].中华中医药杂志,2013,28(6):1779-1781.
[9]罗光亮,何微,林国彬,等.朱锦善学术思想浅述[J].中医药通报,2018,17(2):15-18.
[10]蒋文杰,杨进.运用温病治法辨治过敏性紫癜体会[J].中医杂志,2015,56(2):163-165.
[11]任献青,郭庆寅,管志伟.丁樱教授治疗小儿过敏性紫癜性肾炎经验介绍[J].新中医,2010,42(12):141-142.
[12]王孟英.温热经纬[M].北京:人民卫生出版社,2018.
[13]钱乙.小儿药证直诀[M].北京:人民卫生出版社,2014:11-13.
[14]庞安时.伤寒总病论[M].上海:商务印书馆,1937:99.
[15]杨濛,翟文生,任献青,等.小儿过敏性紫癜辨治九法[J].中医学报,2015,30(10):1450-1451.
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[17]严冰.温病条辨析评[M].北京:中医古籍出版社,2007:49.
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