“塞”上风雪,披荆斩“激”——1例白塞病验案讨论
Discussion on A Case of Behcet's Disease
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1.武汉市中医医院重症医学科,武汉 430050
2.湖北省中医院风湿病科,武汉 430060
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李汉永,张羽.“塞”上风雪,披荆斩“激”[DB/OL].(2023-12-07)[2023-12-07].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=45208651&Fpath=home&index=0&lang=zh
LI Hanyong,ZHANG Yu.Discussion on A Case of Behcet's Disease[J].,
李汉永,张羽.“塞”上风雪,披荆斩“激”[DB/OL].(2023-12-07)[2023-12-07].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=45208651&Fpath=home&index=0&lang=zh DOI:
LI Hanyong,ZHANG Yu.Discussion on A Case of Behcet's Disease[J]., DOI:.
病史摘要,2,患者,男,49岁,因“反复性口腔溃疡伴生殖器溃疡3年”就诊,患者3年前出现反复口腔溃疡、生殖器溃疡,及面、颈部痤疮样皮疹,就诊于多家医院,完善各项检查后排除了结核、感染、肿瘤等,最终均诊断为白塞病,曾被给予甲泼尼龙联合多种西药治疗,病情可得到控制,但每当甲泼尼龙减量至16mg以下时出现病情反复,初诊时患者口腔内两处溃疡,舌红,苔白腻,脉滑,大便黏滞感,日2~3次,不成形,按2014年修订的白塞病国际研究小组发布的《白塞综合征诊疗规范》,该患者西医诊断为白塞病,《金匮要略·百合狐惑阴阳毒病》中有提到口腔及二阴溃疡的症状:“狐惑之为病,状如伤寒,默默欲眠,目不得闭,卧起不安,蚀于喉为惑,蚀于阴为狐,恶闻食臭,甘草泻心汤主之”,该患者中医诊断为狐惑病,辨证为湿热内蕴证,治以清热利湿,佐以温阳益气,予以四妙勇安汤合甘草泻心汤加减,14剂后患者溃疡好转,出现右下腹疼痛,行肠镜检查提示肠白塞,二诊调整用药为参苓白术散合乌贝散加减,扶中益气,制酸止痛,14剂后患者症状好转,激素减量至12 mg,病情平稳无复发,后期随诊甲泼尼龙逐渐减量至4 mg并长期维持。,摘要,2,白塞病也称贝赫切特病(Behcet disease,BD),是一种不明病因的以口腔和外阴溃疡、眼炎及皮肤损害为临床特征的慢性复发性自身免疫性疾病,根据其内脏系统的损害不同可分为血管型、神经型、胃肠型等,肠白塞是一种以胃肠道表现为主的一种特殊性白塞病,该患者初诊时以口腔溃疡为主,热相较为显著,方选四妙勇安汤合甘草泻心汤加减清热利湿,益气和胃,患者激素减量困难,佐以党参、黄芪、白术等品扶中益气,二诊时出现腹痛及大便性质改变,肠镜提示肠白塞,患者此时热相较前减退,方选参苓白术散合乌贝散加减扶中益气,制酸止痛,经治疗溃疡及腹痛均好转,后期随诊激素减量病情平稳无复发,本文以肠白塞案例一则,报道其诊疗经过,并结合文献学习其诊疗进展。中医诊断 狐惑病(湿热内蕴证)西医诊断 白塞病干预措施 中药、激素、慢性抗风湿药疗效转归 激素减量的同时病情好转
Summary of case history, A 49-year-old male patient, he has had recurrent oral ulcers with genital ulcers for 3 years, but his condition has not been effectively controlled after seeking medical treatment in multiple hospitals. Every time the hormone is reduced, his condition recurs. He wanted to seek treatment with traditional Chinese medicine, so he came to our hospital. When he was treated, he had two ulcers in his mouth, with a red tongue, white and greasy fur, slippery pulse, frequent and unformed stools. According to the "Diagnosis and Treatment Guidelines for Behcet's Syndrome", the patient was diagnosed as "Behcet's Disease", According to the " Synopsis of the Golden Chamber", the patient was diagnosed as "Huo Hu", The syndrome differentiation is "dampness heat internal accumulation syndrome", which is treated with clearing heat and promoting dampness, accompanied by warming yang and tonifying qi. Si Miao Yong An Tang and Gan Cao Xie Xin Tang are added or reduced, after taking 14 doses of medication, the patient's ulcer improved, but there was pain in the lower right abdomen. the colonoscopy examination showed intestinal congestion, so the medication was adjusted to Shenling Baishu San combined with Wubei San, which helps to nourish the middle and nourish qi, and stops acid and pain, after taking 14 doses of medication, the symptoms of the patient improved, and the hormone was reduced to 12mg, the condition remained stable without recurrence. In the later stage, the dosage of methylprednisolone was gradually reduced to 4mg and maintained for a long time.,Abstract, Behcet's disease is a chronic recurrent autoimmune disease characterized by oral and vulvar ulcers, ophthalmitis, and skin damage of unknown etiology. It can be divided into vascular, neurological, and gastrointestinal types based on the damage to its internal organs. Intestinal Behcet's disease is a special type of Behcet's disease that mainly manifests in the gastrointestinal tract. This article reports the diagnosis and treatment process of intestinal Behcet's disease, and combines literature to study its diagnosis and treatment progress.,TCM diagnosis, Huo Hu, dampness heat internal accumulation syndrome.,Western medicine diagnosis, behcet disease.,Therapeutic methods, Traditional Chinese Medicine, Hormones, Chronic Antirheumatic Drugs.,Clinical outcomes, Improvement of the condition while reducing hormone levels.
肠白塞病辨证论治激素减量
intestinal behcet's diseasesyndrome differentiation and treatmenthormone reduction
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