国医大师梅国强从少阳辨治复发性多软骨炎的经验

National medical master MEI Guoqiang's experience in treating recurrent polychondritis from shaoyang discrimination

关键词:  复发性多软骨炎  少阳  少阳主骨  湿热蕴毒  罕见病

Key words:  recurrent polychondritis  shaoyang  shaoyang governs the bones  dampness-heat accumulation and toxin formation  rare disease

摘要:

复发性多软骨炎（RP）是一种罕见的自身免疫性炎症性疾病，病变主要累及耳廓、鼻、喉和关节软骨等组织，常表现为病变部位的局部红肿、压痛、疼痛等症状，具有反复发作和进行性破坏的病理特点。国医大师梅国强教授基于少阳主骨学说，结合少阳与耳鼻喉窍膜病位皆属半表半里，手、足少阳经的循行及少阳之气属火的特性，认为少阳不舒，甲木上冲，郁热烁耳；少阳不利，湿热蕴毒，损蚀骨络为复发性多软骨炎的主要病机，治疗以和解少阳，清热利湿，解毒通络为根本大法，以自拟柴胡四土汤为主方。并在此基础上灵活运用风药以祛风胜湿，散邪透络；虫类药以走窜攻邪，解毒剔络；润药以滋阴涵木，补虚宁络。可为探索复发性多软骨炎的病机内涵及治疗提供一定的思路启发。

Abstract:

Relapsing polychondritis(RP)is a rare autoimmune inflammatory disease, mainly affecting the cartilage of the auricle, nose, larynx, and joints, often presenting with local redness, swelling, tenderness and pain at the affected sites, and characterized by recurrent attacks and progressive destruction. Professor MEI Guoqiang, a master of traditional Chinese medicine, based on the theory of "shaoyang governing the bones"and considering that both shaoyang and the orifices(ears, nose, and throat)belong to the half-exterior-half-interior disease location, as well as the pathways of the hand and foot shaoyang meridians and the fire nature of shaoyang qi, proposed that the main pathogenesis of relapsing polychondritis involves shaoyang dysfunction, with upsurge of jiamu and stagnation- heat scorching the ears, as well as shaoyang disharmony leading to dampness-heat accumulation and toxin formation, which erodes the bones and collaterals. The fundamental treatment principles are harmonizing and resolving shaoyang, clearing heat and draining dampness, and detoxifying and unblocking collaterals, with the self- prescribed Chaihu Situ Decoction as the main formula. On this basis, wind-dispelling herbs are flexibly used to expel wind, overcome dampness, and disperse pathogens to penetrate the collaterals; insect drugs are employed to attack pathogens through their mobile nature, detoxify, and scour the collaterals; and moistening herbs are applied to nourish yin, restrain wood, tonify deficiency, and calm the collaterals. This approach may provide certain insights for exploring the pathological connotation and treatment of relapsing polychondritis.