Sjögren's syndrome is a systemic autoimmune disease characterized by high lymphocytic infiltration of exocrine glands, which causes extraglandular multi-organ damage. The main clinical manifestations are dry mouth, dry eyes, and dry eyes, and it is easy to have damage to the lungs, stomach, liver, and kidneys. At present, it is believed that Sjögren's syndrome is the result of the interaction of various factors such as infection, genetics, and endocrine, and some data show that the occurrence and development of this disease may be related to Epstein-Barr virus, retrovirus, hepatitis C virus, etc. Epidemiological studies have shown that the age of onset of the disease is 40 to 50 years, the ratio of males to females is about 1 9, and the prevalence is 029%～0.77%, and the prevalence is increasing year by year.
There is no record of this disease in the TCM literature. According to its pathogenic characteristics, and combined with the theoretical basis of traditional Chinese medicine that "the paralyzed person is closed, the occlusion is blocked, and the pain is not passed", the term "dry paralysis" is proposed, which is equivalent to the traditional Chinese medicine name of Sjogren's syndrome. For its pathogenic mechanism, "The Yellow Emperor's Neijing" has the view that "dryness is better than dryness", and "Suwen Xuanji Original Disease Formula" says that "all astringency and dryness, and enthusiasm are revealed, all belong to dryness". Lu Zhizheng believes that the formation of dryness is due to the evil of internal dryness or external dryness, which leads to the depletion of the body's qi and jin, and its pathogenesis is the deficiency of yin and yang qi and blood, and the depletion of jin and fluid. Li Diangui is the third master of traditional Chinese medicine, engaged in traditional Chinese medicine clinical, teaching and scientific research for more than 50 years, advocating the theory of turbidity and poison, and is good at using turbidity and detoxification methods to detoxify a variety of diseases. He believes that the cause of Sjögren's syndrome should be turbidity, and clinical treatment should use the method of turbidity and detoxification from the spleen and stomach. The experience of the company is summarized as follows.
Weakness of the spleen and stomach is the core pathogenesis of Sjögren's syndrome.
If the spleen and stomach are weak, there is a lack of metaplasia of qi and blood
Miscellaneous Evidence Huixin Record" cloud: "If there is an external cause of dryness, one of the six prostitutions; Those who have internal causes will also wither their blood. "The Twenty-two Difficulties" cloud: "The blood lord is wet." "Blood runs throughout the body and has the effect of nourishing **, muscles, pores, and viscera. If the blood is deficient and cannot perform the function of nourishment, it is prone to signs of dryness. The spleen and stomach play a vital role in the production of blood. The spleen and stomach are the foundation of the day after tomorrow, the source of qi and blood biochemistry, and the generation of blood depends on the subtlety of the water valley transported by the spleen and stomach. If various factors cause the spleen and stomach to be healthy, the source of qi and blood biochemistry is lacking, and the blood is deficient to moisturize, nourish the skin, pores, etc., the symptoms of dryness will appear.
If the spleen and stomach are weak, the fluid will be lost
Lingshu Wuyu Jin Liquid Farewell" said: "The Jin liquid goes its own way, so the three cokes vent out, warm the muscles, fill the **, for the Jin, and the flow is not the liquid." "The Theory of the Spleen and Stomach: The Rise and Fall of the Spleen and Stomach" says: "The fluid and qi enter the heart, penetrate the lungs, enrich the fur, and disperse in the hundred veins." "The liquid spreads all over the body and has a moisturizing effect. If the fluid is not produced enough or the operation is impaired, it will appear dry. The spleen mainly transports and transforms the fluid, such as the cloud in the "Su Wen Meridian Treatise" "Drink into the stomach, overflow the essence and qi, and lose it to the spleen, the spleen disperses the essence, and returns to the lungs, and the water channel is channeled, and the bladder is infused down, and the water essence is distributed in four parts, and the five meridians are parallel", and the spleen has the function of dispersing the essence and qi and performing its fluid for the stomach. The spleen qi can directly run the fluid around the body, or it can be infused into the lungs, and spread it around through the movement of the lungs, or through the rise and fall of the spleen and stomach qi, the fluid will flow with it. If the spleen and stomach lose their health, there is no way to metabolize the fluid, or cause the water to stop accumulating, it is difficult to nourish the ** and pores, and the phenomenon of dryness occurs.
If the spleen and stomach are weak, the qi and machine mediation are abnormal
Li Dongyuan said: "The air is less dry, and there is no saliva in the mouth." Tears are also fluid, and the rise of the qi is ......If you don't offer it today, you will have less tears and dry mouth and eyes. "The spleen and stomach are the hub of the lifting of the middle coke qi machine, the spleen is healthy by ascending, the stomach is descending to shun, the spleen is rising and the stomach is descending, one rises and one falls, which plays a smooth role in the whole body's qi. If the function of the spleen and stomach is impaired, on the one hand, the spleen and stomach are deficient in qi and lack of energy, resulting in insufficient fluid; On the other hand, qi deficiency leads to the imbalance of qi and qi, and the jin and blood cannot be transmitted throughout the body with qi, resulting in dryness and other symptoms.
Turbidity is the causative agent of Sjögren's syndrome.
Li Diangui believes that turbidity poison is not only a kind of first-class agent that causes serious damage to the human body's internal organs and meridians, qi, blood, yin and yang, but also a pathological product caused by the abnormal operation of qi, blood, and water. The evil of turbidity and poison uses qi and blood as the carrier, and flows with it to the skin, pores, etc. It is mostly caused by poor diet (clean), poor mood, or invasion of external evils, which hurts the spleen and stomach, the spleen and stomach are abnormal, the water and liquid are not running smoothly, and the accumulation and dampness are generated. The pathogenesis lies in the damage of the spleen and stomach, which affects the function of the spleen and stomach biochemical blood, running fluids, and mediating qi. In addition, the turbidity and heat of the evil substance of turbidity and poison will consume the yin fluid over time, and the qi deficiency will not be able to run the fluid, and the yin deficiency will lack the source of moisturizing things, so the appearance of dryness appears. The "Clinical Guide to Medical Cases" says: "Dafan is the main qi, the main blood, and the blood stasis of long-term illness. "The evil of turbidity and poison has been suppressed for a long time, and the flow of qi, blood, and water has been blocked, and it has lost its nourishment and moisture and turned dry, and stasis has also turned into heat for a long time, further aggravating the symptoms of dryness.
Sjögren's syndrome often presents with a pattern of dryness, which is superficially due to the deficiency of qi, blood and jin, but in fact it is caused by the evil criminals of turbidity and poison, spleen and stomach, dampness and heat, blood stasis, qi stagnation and other factors, or single or multiple effects that damage qi, blood and jin. Therefore, the disease is often marked by the deficiency of qi, blood and Jin, and the disease is caused by turbidity and poison. Li Diangui emphasized that it is necessary to treat the disease in clinical practice, grasp the main pathogenesis of the disease, and use the method of turbidity and detoxification, in order to eliminate turbidity and poison, restore qi and blood, flow fluid, and dry.
Turbidity, detoxification, and treatment from the spleen are the main treatments for Sjögren's syndrome.
Li Diangui believes that "turbidity poison" is formed by the mixing and cementation of various factors such as dampness, stasis, poison, stagnation, etc., and the use of turbidity theory Sjogren's syndrome should be based on turbidity and detoxification as the basic treatment method, respectively, from the aspects of dampness, qi regulation, blood activation, heat clearing, etc., and at the same time with the methods of nourishing yin, replenishing qi, and nourishing blood, so as to achieve the purpose of treating the disease and seeking the root cause, and treating both the symptoms and the root causes. In clinical use, it is also necessary to combine the sexual taste of the drug with the efficacy to resolve turbidity and relieve symptoms.
Dampness blocks, dissolves dampness and dispels turbidity
The spleen likes dryness and dislikes dampness, the invasion of dampness evil or the spleen and stomach are deficient, the function of transporting water and liquid is abnormal, the water and dampness stop accumulating, the turbidity evil is self-generated, the dampness and turbidity are blocked, and the fluid cannot run and flow to the skin and pores, so dryness occurs. It is advisable to dissolve dampness and remove turbidity. If the dampness is trapped in the spleen, and the spleen is not empty, you can choose to add or subtract from the self-simulated pandan turbidity drink. Fangzhong Huoxiang and Peilan aromatize to awaken the spleen. The fragrance of the herb is spicy, the sex is slightly warm, the spleen, stomach, and lung meridians, the taste of the spicy can disperse the water and dampness of the gathering, and the sexual temperature can warm and dampness. Peilan has a pungent taste, flat nature, returns to the spleen, stomach, and lung meridians, and can dissolve dampness and medium. The two medicines must be used for use, to promote water and dampness, warm and damp, and awaken the spleen and stomach. If the spleen and stomach are deficient, unable to transport water, resulting in dampness and endogenous, it can be supplemented with raw atractylodes, its temperament is warm, sweet and bitter, and it can be returned to the spleen and stomach meridians, and the spleen can be strengthened to benefit dampness. Tuwang is good at purifying the air, and the subtlety is good, the turbidity is good at removing, and the dross is lost." Damp and sticky, the course of the disease is lingering and difficult to heal, long-term illness will be weak, in the process of pathogenesis, spleen deficiency and dampness evil are mutually ill, so often Huoxiang, Peilan, and Shengbaizhu are used together, one is to strengthen the spleen and stomach, invigorate the righteousness, and then dissolve dampness and remove turbidity, clear the source of the disease. When applying, it is necessary to adjust the dosage of the three flavors of Chinese medicine according to the difference between virtual and real.
Turbidity and poison condensate, clear away heat, dissolve turbidity and detoxify
Turbidity toxic heat, injuring the spleen and stomach, causing the spleen and stomach to contain heat, fiery evil steaming contains spleen and stomach fluid, suppressed for a long time, consumes and hurts yin and jin, stomach yin is insufficient, deficiency is easy to attract evil, and evil qi aggravates the degree of turbidity and poison. The more turbidity poison prevails, the more Yin and Jin are lost, and the more severe the symptoms. In response to this situation, Li Diangui often adds or subtracts from his own Shilian decoction. Fang Zhongsheng gypsum is cold, spicy and sweet, returns to the lungs and stomach meridians, and has the effect of clearing heat and expelling fire, removing annoyance and quenching thirst. Dampness is the gradual turbidity, poison is the extreme of heat, Coptis chinensis is bitter and cold, and it returns to the stomach, large intestine and small intestine meridians, which can clear away heat and dampness and detoxify. Half branch lotus is cold, bitter in taste, returns to the lungs, liver and kidney meridians, and has the effect of clearing heat and detoxifying. The combination of three medicines plays the role of turbidity and detoxification. Li Diangui often used 30g of gypsum in the clinical examination, one is to clear away heat, dissolve turbidity and poison and nourish yin, and then to prevent the medicinal bitter cold and yin of Coptis chinensis and half-branch lotus, and aggravate the degree of dryness. At the same time, it is equipped with wheat winter, dendrobium and other medicines to nourish the liquid, and the specimens are taken into account, but there is some emphasis, in order to achieve the effect of turbidity and detoxification, clear the source of its disease, remove the turbidity and poison, eliminate the fiery heat, and recover the fluid.
The gas machine is stagnant, and the gas machine is sparse
The liver is mainly discharged, the spleen qi is mainly raised, and the stomach qi is mainly reduced. If the turbidity and poison are coagulated, the liver is out of order or the spleen and stomach qi machine is abnormal, the spleen cannot be raised, the stomach cannot be lowered, and the qi cannot be used to promote the operation of the fluid, and dryness may occur. Clinically, it is often added or subtracted by self-simulated double incense powder**. Fangzhong incense is flat, the taste is spicy, slightly bitter, sweet, and returns to the liver and Sanjiao meridians, which has the effect of soothing the liver and regulating qi. Woody fragrance, warm in nature, pungent and bitter in taste, returning to the spleen, stomach, liver, and large intestine meridians, with the effect of qi. The "Compendium of Materia Medica" says, "Wood incense is the medicine of the three coke qi, which can raise and fall all qi." All qi is depressed, all belong to the lungs, so those who are stagnate in the scorching qi are also vented when they are depressed; If the middle qi is unlucky, it belongs to the spleen, so those who are stagnate in the middle of the qi will also ...... the spleen and stomach like aromaLiver depression is pain, so it is advisable for those who are stagnate in the lower coke qi, and it is also for those who are plugged", this medicine can be used for three coke qi and five visceral qi. When Li Diangui was suffering from this disease, he often had all the three focal points, and the qi of each viscera was taken care of, giving the qi machine a way to rise and fall. If the three-coke gas machine is smooth, then "the veins are open and the water channel is good".
Blood stasis obstructs the meridians, activates blood and dissolves blood stasis
The evil of turbidity and poison blocks the spleen and stomach, the qi is not smooth, the qi stagnation and blood stasis, and the blood stasis is blocked, and the jin cannot rise with the qi, so that the symptoms of dryness appear, such as the "blood evidence theory" says that "if there is blood stasis, the qi is blood obstruction, and it must not rise, and the water and jin cannot be clothed with the qi." Clinically, Erdan drink is often added or subtracted**. Fangzhong peony skin is slightly cold, bitter and pungent in taste, returns to the heart, liver and kidney meridians, and has the effect of clearing heat and cooling blood, invigorating blood and removing blood stasis; Salvia miltiorrhiza is slightly cold, bitter in taste, returns to the heart, liver meridian, has the effect of invigorating blood, cooling blood, and removing stasis. The combination of the two medicines can play the role of invigorating blood and removing blood stasis, cooling blood and dissolving poison.
Case Examination. The patient, a 56-year-old female, was first seen on 18 July 2016. Chief complaint: dry mouth and eyes with fatigue for more than 9 years, aggravated for 1 week. History of present illness: The patient had dry mouth, dry eyes and dry nasal cavity for no obvious reason 9 years ago, and did not pay attention to it at that time, and felt that the whole body was dry and rough with occasional joint pain after half a year. Check anti-SSA antibody (+) anti-SSB antibody (+) ESR 4000 mm h, Sjögren's syndrome was diagnosed. During the period, drugs such as hydroxychloroquine, methotrexate, and ibuprofen** were taken (the exact dosage is unknown). After taking the drug for 3 months, the patient felt vague stomach pain from time to time, and the symptoms of stomach pain and dryness became more obvious when the mood was not good. Post-examination electronic gastroscopy showed chronic atrophic gastritis. After taking omeprazole (the exact dosage is unknown), stomach pain symptoms can be mild and severe. Diagnosis: dry mouth, dry eyes, dry and rough body, fatigue, no desire to speak, vague pain in the stomach, occasional heartburn, acid reflux, poor appetite, sleep, sticky stool, self-consciously inexhaustible, once a day, urine adjustment; The tongue is dark red, yellow and greasy, and the pulse is smooth and slightly thin.
Western medicine diagnosis: Sjögren's syndrome, chronic atrophic gastritis.
Traditional Chinese medicine diagnosis: dryness and paralysis (turbidity and poison accumulation).
Rule: turbidity and detoxification.
Prescription: raw gypsum 15g (decoction first), Coptis chinensis 9g, Half branch lotus 15g, Lily 12g, Angelica sinensis 9g, Chuanxiong 9g, White peony 30g, Jineijin 15g, Xiangfu 12g, Muxiang 9g, Huoxiang 9g, Peilan 9g, Fabanxia 9g, Citrus aurantium 12g, Ophiopogon 12g, Peony peel 15g, Salvia miltiorrhizae 15g. 14 doses, 1 dose per day, decoction divided into 2 times in the morning and evening. No other medications will be taken during this period.
Second diagnosis on August 2: the dryness of the whole body was slightly relieved, the pain in the stomach was relieved, the symptoms of fatigue were reduced, the stool was smooth, once a day, but there was still a sticky feeling and poor appetite. The tongue and pulse are the same as those at the initial diagnosis. The first prescription added 12g of fried sulforaphane seeds and 15g of pot-bellied skin. 14 doses, 1 dose per day, decoction divided into 2 times in the morning and evening.
Third diagnosis on August 16: stomach pain disappeared, dry mouth and eyes were significantly reduced, whole body dryness was relieved, no fatigue, feeling relaxed, and appetite improved. The tongue is dark red, thin yellow, sparse, and slightly thin. The second prescription is to remove Huoxiang, Peilan, Fa Banxia, fried sulforaphane seeds, add 9g of Radix Radix and 6g of Atractylodes. 20 doses, 1 dose per day, decoction divided into 2 times in the morning and evening.
Fourth diagnosis on September 5: dry mouth and eyes, dry body symptoms were significantly relieved, sleep was OK, and bowel movements were smooth, once a day. The tongue is red, thin and yellow, and the veins are stringy and slightly thin. Recipe: 15g of raw gypsum (fry first), 12g of lily, 12g of angelica, 30g of white peony, 12g of incense, 12g of ophiopogon vulgaris, 12g of mulberry, 12g of schisandra. 14 doses, 1 dose per day, decoction divided into 2 times in the morning and evening.
After taking the prescription for half a year, the symptoms of dryness have basically disappeared. Follow-up to August 30, 2019 was not **, and there was no abnormality in SSA antibody and anti-SSB antibody after multiple tests.
According to the patient's weak spleen and stomach, insufficient spleen and spleen yin, unable to transport the subtlety of water valley, one is insufficient fluid production, the second is lack of blood source, and the third is qi deficiency and poor qi. The evil of turbidity poison is caused by the deficiency of the spleen and stomach, and the abnormal operation of qi, blood and water, which uses qi and blood as the carrier, and flows through the skin and pores with the rise and fall of qi, and at the same time, as a pathological product, it can aggravate the symptoms of insufficient spleen and stomach qi and blood. Turbidity poison condenses the spleen and stomach, resulting in abnormal function of the spleen and stomach fluid, and then the turbidity poison burns the spleen and stomach, the fluid is deficient, and the operation is not smooth, resulting in the loss of nourishment of the skin and pores, and the symptoms of dry mouth, dry eyes, and dryness of the whole body.
Fangzhong Shilian soup clears heat and dissolves turbidity and detoxification, pandan dissolves turbidity drink to strengthen the spleen and dispels dampness, double incense disperses liver and qi, and two Dan drinks invigorate blood and dispel stasis. Lily is sweet and slightly cold, and can clear heat; Angelica, Chuanxiong, and white peony nourish the liver and blood, and soften the liver body, so as to prevent the liver from over-attacking the spleen and stomach, and the liver is smooth and the stomach is safe. The chicken is sweet and cold, strengthens the spleen and consumes food. Fa Banxia strengthens the spleen and dampness. In the second diagnosis, the symptoms of dryness and stomach pain were slightly relieved, but other symptoms were not relieved. The three diagnoses of dampness, heat, and turbidity gradually disappear, remove Huoxiang and Peilan, add Xuanshen to cool blood and nourish yin, relieve fire and detoxify, and atractylodes to nourish the spleen and stomach, and take care of righteousness. The turbidity poison has been eliminated in the four diagnoses, but the fluid slowly recovers, and the mulberry is added to nourish the blood and benefit the yin, and the schisandra berry is beneficial to the qi and the jin, and the two play the role of nourishing the yin and rejuvenating the jin. Throughout the whole process, the early stage is mainly to dissolve turbidity and detoxify, taking into account the qi and yin, and the turbidity and poison have been removed in the later stage.
Content**: China Journal of Traditional Chinese Medicine.