The etiology and pathogenesis of SS are complex, and the treatment methods are diverse. According to the characteristics of SS, clinical symptoms can be treated according to the syndrome differentiation of viscera, triple energizer, qi and blood, body fluid, eight classes and six meridians.
abstract:
This paper summarizes the syndrome differentiation and treatment of Sjogren's syndrome, including the differentiation of viscera, triple energizer, qi and blood, body fluid, eight classes and six meridians, and analyzes the characteristics of various syndrome differentiation and treatment methods and their guiding role in clinical syndrome differentiation and treatment of Sjogren's syndrome.
Key words:
Sjogren's syndrome; Treatment based on syndrome differentiation; Syndrome differentiation of zang-fu organs; Syndrome differentiation of triple energizer; Syndrome differentiation of qi, blood, body fluid; Eight types of syndrome differentiation; Syndrome differentiation of six meridians; summary
Sjogren's syndrome (Sjogren's syndrome) is a diffuse connective tissue disease, which invades exocrine glands such as lacrimal gland and salivary gland, and is characterized by lymphocyte infiltration and specific autoantibodies. The main clinical manifestations are keratoconjunctivitis sicca and xerostomia, which can involve other organs and show complex system damage [1]. SS can be divided into primary and secondary. The peak of the disease is 45-55 years old, which is more common in women, and with the increase of age, the systemic involvement is obvious [2]. SS has no corresponding disease name record in Chinese medicine. According to its clinical symptoms, it is mostly attributed to? Sjogren's syndrome Dry joint pain? Stubborn category of equality. As the essence of traditional Chinese medicine, treatment based on syndrome differentiation is of great value in the treatment of SS. This paper summarizes the research progress of TCM syndrome differentiation and treatment in recent years.
1 differentiation and treatment of five internal organs
The pathogenesis of SS can involve the five internal organs, which is closely related to the liver, spleen, lung and kidney. Based on syndrome differentiation and treatment of zang-fu organs, the specific zang-fu organs of SS can be defined and more targeted syndrome differentiation and treatment can be carried out.
1. 1 Treating from the liver
The liver is just dirty, the body is used for yin and yang, and the liver stores blood, which belongs to yin, so the liver is yin; The liver governs the release of qi, is naturally full of joy, conducts internal fire, and has active liver qi, so the liver is yang. SS patients often have blood deficiency and body fluid deficiency, which are characterized by dry nose and mouth and dry eyes. By nourishing liver yin, liver blood and body fluid are abundant. Junhua Gu et al. [3] discussed the relationship between SS and liver from the aspects of viscera function, anatomical position and meridian distribution, restraint of five elements, exterior and interior of liver and gallbladder, and the relationship between woman and liver. SS is divided into liver depression (Chaihu Shugan Powder), hyperactivity of heart and liver (Zhizi Qinggan Decoction or Xiexin Decoction), stagnation of liver and gallbladder (Zuojin Pill and Longdan Xiegan Decoction), liver depression and spleen deficiency (Guishao Liujunzi Decoction combined with Chaihu Shugan Powder), convergence of liver qi (Muli Powder or Jinsuogujing Pill) and yin deficiency of liver and kidney (Yiguanjian or Liuwei Decoction). Equal people in Zhou Dan [4] believe that from the epidemiological point of view of SS, women account for more than 90%, while? Women are born with livers? Deficiency of liver blood, loss of the function of circulating qi, and abnormal conduction of body fluid resulted in this disease. The main clinical syndromes include liver and kidney yin deficiency, liver stagnation and qi stagnation, liver blood deficiency, liver stagnation and spleen deficiency. Treatment methods include soothing the liver and regulating qi, nourishing blood and softening the liver, calming the liver and suppressing yang, nourishing yin and promoting fluid production, benefiting qi and nourishing yin, removing blood stasis and dredging collaterals.
1.2 Treatment from Spleen
Spleen controls the wet transport of water, thus regulating the metabolic balance of water and liquid in the body. A strong spleen will transport Shui Gu's subtle functions, and the spleen will clear up and activate qi and blood. Spleen deficiency is most likely to cause dampness, and excess dampness is most likely to trap the spleen. Xie Youhong [5] thinks that SS is caused by abnormal production, operation and transportation of body fluid, and spleen plays an important role in the production and transportation of body fluid. The onset of SS is closely related to spleen deficiency. Treatment should be based on invigorating spleen and qi, with Radix Astragali, Radix Pseudostellariae, Rhizoma Atractylodis Macrocephalae, Rhizoma Dioscoreae, Radix Angelicae Sinensis, Radix Bupleuri, Pericarpium Citri Tangerinae, Radix Salviae Miltiorrhizae, Rhizoma Cimicifugae, and Radix Glycyrrhizae as basic prescriptions, which can be summarized into methods of invigorating spleen and qi, promoting fluid production, invigorating spleen and qi, activating yang, invigorating spleen and nourishing lung, and invigorating spleen and qi to remove blood stasis. Jing Wong and others [6] discussed the influence of the imbalance of heart and spleen, lung and spleen, liver depression and spleen deficiency, deficiency of kidney and spleen, and imbalance of qi, blood and body fluid on SS, and thought that the treatment of SS should pay attention to the nursing of spleen and stomach, the balance of yin and yang, the adjustment of qi, the adjustment of qi, blood, body fluid and mood. Feng et al. [7] analyzed the relationship between SS and spleen from three aspects: damage of both qi and yin, blood stasis and dryness of yin, dryness and toxin generating wind, and from spleen deficiency (benefiting qi and strengthening spleen, nourishing yin and moistening dryness, warming yang and dredging pulse; Dampness and spleen, qi and body fluid), spleen yin deficiency (spleen yin, stomach and body fluid; Nourishing yin and moistening dryness, benefiting qi and promoting fluid production; Benefiting stomach and nourishing yin, clearing away heat and promoting fluid production).
1.3 Treating from Lung
The lung is fine and dirty, and it likes dampness and hates dryness. When the lung is in the yang position, its qi reaches the sky, and the weather goes down, then heaven and earth can meet and everything can be transformed. The lung is cool, and its qi dominates the stagnation, so that it can be unobstructed. Dane and others [8] think that? Is the dragon the source of Haruki on the water? The body fluid regulated by the spleen depends on the function of lung qi to expand and descend, thus ensuring the smooth flow of qi in zang-fu organs and meridians. Therefore, normal lung function plays a vital role in ensuring the normal delivery of body fluids. Treating from the lung, invigorating qi and nourishing yin, dispersing lung qi and dredging collaterals, taking Ophiopogon japonicus, Adenophora adenophora, Lily, American ginseng, Radix Astragali, Cortex Moutan, Trichosanthis Radix, Rhizoma Anemarrhenae, Radix Rehmanniae, Radix Salviae Miltiorrhizae, Radix Arnebiae and Scolopendra as basic prescriptions, has achieved good curative effect in treating SS. According to Jin [9], the key pathogenesis is yin deficiency, collateral stagnation and lung dysfunction. The treatment methods are dispersing lung qi, nourishing body fluid and dredging collaterals. The drugs are divided into dispersing lung qi (Radix Asteris, Radix Platycodi and Radix Glycyrrhizae), moistening lung qi (Radix Adenophorae, Radix Ophiopogonis and Mume Fructus) and clearing lung qi (Semen Persicae, Cortex Moutan and Gypsum Fibrosum) to form dispersing lung qi and nourishing body fluid.
1.4 Treatment from Kidney
Kidney governs yin and yang, and kidney yin and kidney yang are mutually restrictive, interdependent and beneficial, maintaining the dynamic balance of human physiology. Kidney is the foundation of storage, and its storage function can prevent excessive excretion and loss of essence, qi, blood and body fluid, while maintaining the stability and depth of respiratory movement. Zhangyan and others [10] think that kidney water is kidney yin, also known as Yuan Yin and true yin, which plays a role in nourishing viscera and tissues. In the treatment of SS, it is proposed that kidney yin should be taken as the basis, and the five internal organs should be supplemented on the basis of tonifying kidney, and the treatment should be carried out according to the different causes and pathological products. Wu Shengyuan [1 1] thinks that the fundamental cause of SS is the disorder of body fluid metabolism caused by deficiency of kidney yang. Kidney essence with gasification function plays an extremely important role in the transport and excretion of body fluid and maintaining the balance of metabolism, and the transpiration and gasification function of kidney can not be separated from the warmth of kidney yang. Therefore, warming kidney to help yang and invigorating body fluid should run through SS treatment, and Yishen Juanbi Pill is the basic prescription.
2 Differentiation and treatment from triple energizer
Sanjiao is an important channel of water-liquid metabolism, and its benefits are closely related to the rise and fall of qi and the transport and transformation of body fluid. The basic etiology of SS is closely related to the transport of body fluids. Syndrome differentiation of triple energizer is helpful to identify the lesion sites of upper, middle and lower triple energizer and treat them according to their functional characteristics. Liu Wei and others [12] think that the treatment of SS should be based on nourishing yin and protecting body fluid, and according to the different disease positions of triple energizer, the prescription should be selected, and the upper energizer should focus on lung and stomach, the middle energizer should focus on spleen and stomach, and the lower energizer should focus on liver and kidney, and at the same time pay attention to the protection of qi and blood, so as to achieve better curative effect. Gao Long and others [13] think that the function of Sanjiao is to run water and liquid, circulate various gases and promote the gasification of body fluid. Whether the triple energizer is discharged or not not not not only affects the slow movement of water and liquid, but also affects the regulating effect of lung, spleen, kidney and other related organs on water and liquid. Treatment can be based on the idea of upper lung dryness, middle spleen and stomach dryness and lower liver and kidney dryness, so as to achieve the harmony of qi, blood, yin and yang. Zheng Li [14] thinks that the upper jiao is in the lung, the upper jiao is like feather, the middle jiao is like balance, the lower jiao is like liver and kidney, and the lower jiao is like force. At the same time, we should pay attention to the concept of protecting qi and nourishing blood from the exterior to the interior and viscera. Zhang et al. [15] think that the loss of qi in triple energizer and fluid transport are the fundamental pathogenesis of SS. The gasification function of Sanjiao is closely related to the metabolism of water and fluid in human body, and according to this relationship, the method of transforming qi and tonifying body fluid is established to treat SS, and Wuling powder can be used as the main prescription to benefit yang water and supplement body fluid. The basic pathogenesis of Wuling powder syndrome is the loss of qi in triple energizer, disharmony between water and liquid, and dryness due to heat loss of body fluid. By using the method of transforming qi into body fluid, the function of triple energizer is normal, the body fluid is orderly, and the skin of mouth and eyes is moist.
Differentiation and treatment from qi, blood and body fluid
Qi, blood and body fluid are the basic substances that constitute the human body. Syndrome differentiation of SS according to the syndromes of qi, blood and body fluid can clarify the relationship between diseases and qi, blood and body fluid, and determine that the pathological changes of SS are qi, blood and body fluid, so as to judge the rise and fall of qi, blood and body fluid and guide the treatment of diseases. Pan Li et al. [16] think that qi is closely related to body fluid, when qi is abundant, body fluid is full, and when qi is well regulated, body fluid is transported and excreted normally. The pathogenesis of SS is related to qi disorder and qi deficiency, so the treatment of SS should be mainly based on benefiting qi and smoothing qi, including dispersing lung qi, regulating spleen and stomach, soothing and nourishing liver, tonifying kidney qi and dredging meridian qi. Xu Chao and others [17] think that the pathological basis of SS is yin deficiency and body fluid deficiency, which leads to insufficient blood biochemical sources, so dryness syndrome is often mixed with clinical manifestations of blood deficiency. The reason why blood can flow endlessly in the whole body depends not only on the promotion of qi and the warming effect of yang, but also on sufficient blood volume. If blood deficiency is caused by blood deficiency, although it is promoted by Qi-moving machine and the yang is warm, it will be delayed, leading to qi stagnation and blood stasis. Blood stasis toxin blocks collaterals, and the body fluid is disorganized, which aggravates the attack of dryness syndrome [18- 19]. Qin Changlin and others [20] think that both body fluid and blood are derived from nourishing qi, and the exhaustion of body fluid leads to blood exhaustion, which leads to blood stasis and hinders qi movement. Body fluid cannot rise with qi, and dryness becomes more intense, so it circulates, so it becomes dryness.
4. Treatment based on eight types of syndrome differentiation.
Syndrome differentiation of the eight cardinal principles can guide the treatment by determining the disease category, or yin or yang, analyzing the disease location or exterior and interior, and distinguishing the characteristics of the disease, or heat syndrome or cold syndrome, or excess syndrome or deficiency syndrome. Xiong Jing and others [2 1] think that the basic pathological basis of dryness syndrome is the damage of yang qi and the deficiency of body fluid of yin and yang. Only the interaction of yin and yang can maintain the normal physiological function of the body. However, deficiency of Yang Qi leads to mutual loss of Yin and Yang, abnormal metabolism of essence, qi, blood and body fluid, resulting in dryness syndrome. Rehmannia decoction is the basic prescription in treatment, and it is used to warm and tonify kidney-yang, nourish yin and promote fluid production, and moisten dryness. Lu [22] divided dryness into internal dryness and external dryness. External dryness refers to improper nursing. Internal dryness is due to the imbalance of yin and yang of zang-fu organs and meridians. External dryness is divided into cool dryness and warm dryness. ss is distinguished from external factors, internal factors, cold and heat, and exterior and interior. Ma et al. [23] collected the clinical research literature on TCM syndrome differentiation and treatment of SS, and found that in patients with 13 16 SS, deficiency syndrome accounted for 50.99%, excess syndrome accounted for 16.34%, and excess syndrome accounted for 32.67%. Using the method of differentiation of symptoms and signs based on eight principles, we can fully understand the occurrence and development of diseases from the angles of yin and yang, exterior and interior, cold and heat, deficiency and excess, and thus provide accurate treatment methods for diseases.
5 Differentiation of Six Meridians
According to the syndrome characteristics of SS, combined with the pathological changes of meridians and viscera, the method of six meridians is used to differentiate syndromes, which is conducive to accurately grasping the condition and selecting prescriptions in clinic. Ji Guangming [24] thinks that the chief culprit is Yangming, which enters through the mouth and nose, and ss patients often have symptoms such as dry throat, dry mouth and thirst in the early stage. He proposed that Yangming syndrome differentiation be the center, and analyzed the characteristics of Yangming dryness-heat affecting Shaoyang, Shaoyang, Taiyin, Shaoyin and Jueyin, and summarized that bitter cold and sweet cold should be used to eliminate Yangming heat toxicity. Chen Yabing et al. [25] applied six meridians syndrome differentiation, combined with the characteristics of SS with symptoms of thirst quenching, and according to the theory of thirst quenching in the Outline of Jueyin Disease, Wu Mei Pill was used to treat Jueyin disease, and satisfactory results were obtained. Xu Xiaofang [26] identified SS as a syndrome of storing water in the sun according to its complication of dry mouth and dysuria, and selected Wuling Powder, which has the functions of promoting diuresis and eliminating dampness, warming yang and transforming qi, and achieved good curative effect. Differentiation of Six Meridians has a certain guiding effect on SS, mainly according to the different symptoms, and the angle of differentiation of Six Meridians is also different, which is flexible and changeable, and can play a good role in cooperation with syndrome differentiation and treatment.
6 conclusion
The etiology and pathogenesis of SS are complex, and the treatment methods are diverse. According to the characteristics of SS, clinical symptoms can be treated according to the syndrome differentiation of viscera, triple energizer, qi and blood, body fluid, eight classes and six meridians. Syndrome differentiation of zang-fu organs mostly focuses on the study of liver, spleen, kidney and lung. According to the physiological characteristics of zang-fu organs, the corresponding treatment methods can achieve ideal results. Syndrome differentiation of triple energizer is mostly based on the physiological characteristics of upper energizer like fog, middle energizer like retting and lower energizer like filth, so as to choose appropriate drugs to unblock triple energizer and dredge waterways, thus achieving the purpose of treatment. Syndrome differentiation of qi and blood starts with the relationship between qi and blood and body fluid, and it is considered that deficiency of qi and blood is an important cause of SS, and it is necessary to replenish qi and promote fluid production and nourish yin and blood stasis to moisten dryness. Eight-class syndrome differentiation can comprehensively analyze SS and provide clear treatment methods. Syndrome differentiation of six meridians has the characteristics of corresponding prescriptions and syndromes, and any disease of six meridians has special prescriptions and medicines. According to the different properties and different parts of SS, the corresponding syndrome differentiation method is selected to obtain the most suitable treatment method.
References:
[1] Ge Junbo, Xu Yongjian. Internal medicine [M]. The eighth edition. Beijing: People's Health Publishing House, 20 13:826-827.
Li Ya, Li Xiaofeng, Huang Cibo, et al. Clinical features of primary Sjogren's syndrome at different ages in China [J]. China Journal of Clinical Immunology and Allergy, 2013,7 (2):129-133.
Junhua Gu, Liu Shanshan, Chen Xiaoyun, et al. Analysis of TCM syndrome types distribution of 300 cases of Sjogren's syndrome from the perspective of viscera differentiation [J]. Rheumatism and Arthritis, 2014,3 (1): 25-30.
Zhou Danping, Sun,. Treating Sjogren's syndrome from the liver [J]. Jilin Traditional Chinese Medicine, 2015,35 (3): 241-244.
Xie youhong Discussion on treatment of Sjogren's syndrome from spleen [J]. Shaanxi Traditional Chinese Medicine, 20 10/0,31(6): 710-712.
Jing Wong, Liu Wei. Discussion on treatment of Sjogren's syndrome from spleen [J]. China Journal of Traditional Chinese Medicine Information, 20 12, 19 (3): 9 1-92.
Feng, Liu Jian. General situation of treating Sjogren's syndrome from spleen [J]. Journal of Internal Medicine of Practical Chinese Medicine, 2012,26 (5):1-13.
Dane, come on, Wang Qingsheng. Experience of treating Sjogren's syndrome from lung [J]. Journal of Gansu College of Traditional Chinese Medicine, 2005,22 (2): 9-10.
Han shanhang. Professor Jin Shi's experience in treating Sjogren's syndrome from lung [J]. Sichuan traditional Chinese medicine, 2012,30 (12):17-18.
[10] Zhang Yan, Huang Jiyong, Wang Xinchang. Sjogren's syndrome is treated from kidney yin deficiency [J]. Journal of Zhejiang University of Traditional Chinese Medicine, 20 1 1, 35 (4): 5112.
Luo Shiwei. Wu Shengyuan's experience in treating Sjogren's syndrome [J]. Journal of traditional chinese medicine, 2013,54 (10): 821-822.
[12] Liu Wei, YUANYUAN Ding. Treating Sjogren's syndrome from triple energizer [J]. China Journal of Traditional Chinese Medicine Information, 2013,20 (3): 87-88.
Yao Zhonghua, Xiao Su and Gao Long. On the treatment of Sjogren's syndrome from triple energizer [J]. Journal of Liaoning University of Traditional Chinese Medicine, 20 13, 15 (4): 22 1-222.
Zheng Li. Study on Syndrome Differentiation of Three Intersections [J]. journal of changchun university of traditional chinese medicine, 2016,32 (1): 71-74.
Zhang. The application of "Hua Qi Bu Jin" in the treatment of Sjogren's syndrome [J]. A new Chinese medicine, 20 1 1 43 (10):137-138.
Pan Li, Decai Yang. Discussion on the idea of treating Sjogren's syndrome from qi [J]. Journal of traditional chinese medicine, Hubei, 2005,27 (10):15-16.
[17] Xu Chao, Qian Xian. Analysis on the treatment of Sjogren's syndrome by nourishing yin, nourishing blood and activating blood [J]. Journal of Liaoning University of Traditional Chinese Medicine, 201,13 (3): 44-45.
[18] Ping Zeng, He, Ma, et al. Poison and stasis? Experience in treatment of Sjogren's syndrome [J]. Journal of Guiyang College of Traditional Chinese Medicine, 2016,36 (2): 73-74.
He, Ping Zeng, et al. Professor Ma's experience in treating Sjogren's syndrome from toxic stasis [J]. Rheumatism and Arthritis, 2015,4 (11): 38-39.
[20] Qin Changlin. Sjogren's syndrome Dry will enter the blood? Pathological features of [J]. Journal of traditional chinese medicine, Shandong, 2000,19 (12): 710-712.
Xiong Jing, Yao Meiyu, Hou. Experience in treating Sjogren's syndrome by supplementing yin and yang [J]. Journal of changchun university of traditional chinese medicine, 2009,25 (6): 857.
[22], Bian Yongjun, et al. Professor Lu discusses the pathogenesis of Sjogren's syndrome from the deficiency of both qi and yin [J]. Chinese Journal of Traditional Chinese Medicine, 2008,26 (9):1903-1905.
[23] Ma,,, et al. Clinical literature research on TCM syndrome classification of Sjogren's syndrome [J]. journal of traditional chinese medicine, China, 2013,28 (2): 482-485.
[24] Ji Guangming. Study on TCM syndromes of Sjogren's syndrome based on the theory of six meridians differentiation [D]. Jinan: Shandong University of Traditional Chinese Medicine, 20 12.
[25] Chen Yabing, Chen Yifeng. Examples of clinical application of Wu Mei Pill [J]. Zhejiang Journal of Traditional Chinese Medicine, 2007,42 (2):108.
[26] Xu Xiaofang. Clinical Experience of Wuling Powder in Treating Rheumatism [J]. journal of changchun university of traditional chinese medicine, 2012,28 (6):11-102.
;