Wen | Dr. Liang
Editor|knotweed
Ankylosing spondylitis (AS) is a refractory autoimmune disease, which mainly invades the sacroiliac and spinal joints, and can be accompanied by extraarticular manifestations, with bone destruction and ectopic osteogenesis as the main pathological characteristics, severe cases can be disabled, adverse effects on the quality of life of patients.
The number of cases of AS in mainland China is as high as 4 million, which is more common in young and middle-aged men, which aggravates the burden on families and society. At present, the cause of AS is not clear, Western medicine believes that genetic, infectious, and environmental factors are dominant, and there is a lack of targeted treatment.
The theoretical connotation of "kidney xuanfu-qi-liquid-chord"
The word Xuanfu begins in the "Yellow Emperor's Internal Classic", "the so-called Xuanfu, Khan Kongye", and believes that Xuanfu is Khan Kong. Later Liu Wansu inherited and developed its connotation on this basis, and believed: "Those who are Xuanfu are also called Xuanwei Mansion."
However, there is nothing in the Xuanfu, the internal organs, fur, muscles, fascia, bone marrow, minions, and all things in the world, and they are the gateway of the road in and out of the earth."
Modern medical scholars summarize it and believe that Xuanfu is the gateway to the operation of qi, blood and liquid, lifting and exiting, omnipresent, omnipresent, omnipresent, universal, microscopic, circulating, with form and function.
There is also a Xuanfu in the kidney, and the Xuanfu and Xuanfu are essentially the same, and they are also the gateway for the operation of qi and liquid. The kidney contains essence, the foundation of life, contains the qi of one body, is the root of qi, the main qi, and the kidney vaporization helps to run qi, blood and liquid to the whole body.
In addition, the main water of the kidney, on the one hand, the gasification of the kidney can promote the rise and clearing of the jin fluid, on the other hand, the opening and closing of the kidney bladder helps to reduce turbidity. Kidney Xuanfu concretizes Xuanfu, which is more conducive to in-depth exploration of the essence of disease.
The meridian is the channel of qi and liquid operation, and the meridian is first found in the "Lingshu Meridian Pulse Degree", "the meridian is the inside, the branch and the horizontal are the network, and the other person in the network is the sun".
The meridian is a branch of the meridian, which is a supplement and extension of the meridian, which is subdivided into Sun Luo, Fuluo, and Other Network, distributed in the internal organs, limbs and nine tips, everywhere.
The Lingshu Sutra Small Needle Interpretation says: "Those who have 365 festivals and branches will also permeate the festivals in the vein." "The veins cross and cross, which is the passage for the circulation of qi, blood, and fluid throughout the body, and is the channel for the operation of qi and liquid.
The "Analogue Sutra" says: "The blood is in the middle, and the qi is outside." "According to its functional characteristics, the meridians are divided into yin and yang, which follow qi and liquid respectively, explaining the role of meridians in the human body as a pathway for running qi, blood, jin and liquid.
The renal Xuanfu and the meridians complement each other to help the smooth operation of the qi and liquid, and the renal Xuanfu and the meridians are tiny structures, which combine the internal organs and reach the muscle surface outside.
The two complement each other, complement each other, and accompany each other, jointly run qi, blood, jin liquid, and maintain the normal distribution of human nutrients. There is no hierarchical relationship between the two, only differences in structural characteristics.
The Kidney Xuan Mansion is the portal of qi and liquid operation, and the meridian is the channel of qi and liquid operation, and the opening and closing of the Kidney Xuan Mansion is beneficial to the smoothness of the meridian, and the meridian infiltration and irrigation of qi and blood also ensures the orderly opening and closing of the Kidney Xuan Mansion.
The kidney Xuanfu is depressed, the qi and fluid are unsmooth, the veins are damaged for a long time, the kidney Xuanfu is open and closed, and the subtle substances such as human qi, blood, jin and liquid run through the "portal" gasification function of the kidney Xuanfu to play the nourishing function of the surrounding body.
If the kidney Xuanfu is overopened, the qi and blood are dissipated too much, resulting in empty veins over time; If the renal Xuanfu is overly closed, the qi and blood cannot be dispersed normally, and it is easy to cause the accumulation of pathological products such as dampness, phlegm, and stasis for a long time, resulting in choroid stasis for a long time.
At the same time, the loss of qi and fluid and the damage of the veins will in turn further aggravate the dysfunction of the opening and closing of the renal Xuanfu, forming a vicious circle.
Pathogenesis of AS from the perspective of "renal Xuanfu-gas-liquid-choroid"
AS belongs to the categories of "low back pain", "bone paralysis" and "big" in Chinese medicine. "Kidney deficiency is the mainstay, humid heat and paralysis are the standard, and bruising runs throughout" as the main cause.
Based on the theory of "renal Xuanfu-qi-liquid-meridian", it is believed that the renal xuanfu is depressed, the qi-liquid is unsmooth, and the choroid is not connected as its core pathogenesis, which is the same source as the pathogenesis of AS, which is actually a deeper explanation of macroscopic etiology with microstructure.
Renal depression is the basic pathogenesis of AS, AS mainly invades bone, the main bone of the kidney, and renal depression is the basic pathogenesis of AS. The smooth opening and closing of the kidney Xuanfu is beneficial to the normal circulation of qi, blood and fluid in the bones, and plays a nourishing role.
Renal Xuanfu depression is not occlusion in a narrow sense, but a dysfunction of the renal Xuanfu in a broad sense, resulting in subtle inability to play a physiological role. Kidney Xuanfu Yu closed has two ends of the virtual and real, the virtual is not honorable and closed, but in fact the Xuanfu is blocked and closed.
AS is closely related to genetic factors, and Chinese medicine believes that hereditary diseases are inseparable from congenital deficiency, and kidney essence storage is the innate foundation, so kidney deficiency is the root of the disease. The kidney is the root of yin and yang, and the veins follow the waist and kidney, and the yang qi of the whole body is closely related to the kidney.
AS is based on the deficiency of the kidney governor, the waist is the house of the kidney, the pulse of the kidney is followed by the waist, the kidney governor is difficult to run the subtle substances to the lumbar spine, the Xuanfu is not honored and closed, the lumbar spine cannot get the effective nourishment of the kidney governor Xuanfu, and the waist cannot be turned.
"Where evil is made, its qi will be empty", the kidney contains the true yuan of the human body, and the deficiency of vitality is more likely to be invaded by external wind, cold, humidity and heat.
The foreign evil caused the kidney governor Xuanfu to be blocked and closed, a qi, blood, jin and liquid did not run smoothly, and pathological products such as moist heat and blood stasis gathered in the lumbar spine and the waist pain; The second is subtle and cannot be applied normally, and the lumbar spine is difficult to stretch.
These two are two ends of the virtual and the real, pathologically they are each other's cause and effect, and they affect each other inseparably, and if they are not common, they are not honorable, and vice versa, they will also cause confusion, and both will induce diseases.
Gas-fluid dysfunction is the pathological key to AS, and poor gas-fluid operation caused by renal depression is the pathological key to the pathogenesis of AS. The Kidney Xuan Mansion is the gateway for the lifting and exiting of qi and liquid, regulating the body's qi machine and maintaining the normal physiological activities of the human body.
The "Suwen Six Micro Purpose Treatise" puts forward: "In and out of waste, the divine machine will be destroyed, and the lifting and lowering will be lonely." "The evil of external wind, cold, humidity and heat blocks the portal, which is easy to cause the kidney Xuanfu qi machine to rise and fall into and out disorder.
Renal gasification function is lost, so that the function of gas, liquid generation, fluid and liquid intake is unsmooth, and it is easy to change pathological products such as dampness, phlegm, and stasis, among which wet evil is the most. Patients with AS often present with morning stiffness and heavy low back, which is inseparable from the characteristics of wet viscosity.
Because most of the people affected by the disease are young and middle-aged men, Suyu is yang, and the disease is located in the sea of yang veins, which is more likely to turn from yang to heat. Wind cold and wet evil fever and kidney deficiency are combined to form kidney deficiency humid heat, which is characterized by lingering and difficult to heal, joint redness, swelling and pain.
In addition, the main water of the kidney and the depression of the kidney Xuanfu make the water run poorly, and the water cannot play the physiological function of carrying gas and nourishing qi. It not only leads to poor gasification, but also is more likely to leave turbidity and moisture, aggravating the progression of the disease.
Qi and liquid physiologically blend with each other, rely on each other, pathologically affect each other, and gas-fluid patency is the pathological key to the pathogenesis of AS. Lack of connection is the final link of AS, and "Quasi-Evidence Treatment" says: "For a long time, there will be turbid phlegm, septica, stagnant meridians." ”
AS patients have closed kidneys, qi, blood, and fluid cannot follow normally, humid heat and long-term brewing, stasis over time, long-term illness into the network, and the veins are not connected.
There are two ends of the virtual and the real, cold and hot: the kidney is deficient, and the gasification is not as good as the void; moist heat cementation, deep into the blood is divided into real heat and does not pass; Wind chill and obstruction, poor qi machine is real cold, and eventually it will dissolve stasis and block the vein.
In addition, blood stasis is not only a pathological product, but also the cause of the disease, blood stasis can aggravate the depression of the kidney Xuanfu and poor qi and liquid, making the disease lingering and difficult to heal. The clinical manifestations are often heavy pain at night, fixed in the site, and mainly tingling.
Studies have also confirmed that the blood of AS patients is in a state of hypercoagulability, and blood hypercoagulability is closely related to blood stasis and network connection in traditional Chinese medicine.
With the deepening of the disease, the depression and intensification of qi-liquid obstruction in Xuanfu eventually lead to further damage to the chords, forming typical clinical manifestations, and the choroidal obstruction runs through the entire pathogenesis of AS.
Tonifying the kidney, regulating the qi fluid, and activating the channel gradually are the basic treatment
Solitary parasitic soup - tonify the kidney and open the xuan to cure the root, solitary parasitic soup from "Emergency Essentials", which is widely used in clinical practice to feel the wind cold and dampness and do not heal for a long time, and the consumption of qi and blood paralysis. The basic pathogenesis of AS renal depression is consistent with it.
Symptoms include cold pain in the lower back, soreness of the waist and knees, palpitations and shortness of breath, pale tongue, thin and white moss, and dull or weak pulse.
Fang Zhong Duhuo, Xiexin, Windproof, Qin Jiao, Guizhi scatter wind and cold and wet evil to open Xuan, mulberry parasitism, eucommia, ox knee to nourish the liver and kidney to open Xuan, Rehmania, angelica, peony, Chuanxiong, ginseng, poria to replenish qi and blood to open Xuan, licorice harmonizes medicines.
This party dispels wind and evil spirits, circulates qi and blood, soothes tendons and veins, and plays the role of tonifying the kidney and opening up the mysteries. Angelica pain soup - adjust the qi liquid to treat the symptoms, angelica pain soup originated from the "Medical Enlightenment", as a treatment of pain, widely used in clinical practice for moist heat paralysis.
The pathological key to gas-fluid poor gas and fluid in AS is just right. This method is especially suitable for rheumatic evil from yang heat or humid heat inside, complex feeling external evil, symptoms include joint redness, swelling, hot pain, heavy back, red tongue, moss white or yellow greasy, pulse slippage or string slippery.
Fang Zhongyin Chen, Pig Ling, Ze Diarrhea, Scutellaria baicalensis, and Bitter Ginseng together form the function of dehumidifying and clearing heat, and the fruit of dissolving qi and liquid; Qiang live, windproof, cohosh, kudzu, cangshu, and baishu dispel wind and dampness, and dissolve the cause of poor qi liquid.
Ginseng, licorice, angelica, Zhimu tonic qi liquid, the source of unsmooth dissolving liquid. This party takes regulating the qi and liquid and opening the Xuanfu as the treatment principle, aiming at the pathological key of AS qi and liquid failure, so that the evil can go to the right peace.
Body pain and stasis soup - the activation of the stasis runs through the beginning and end, and the body pain and stasis soup is a classic prescription for activating blood circulation and removing stasis in Wang Qingren's "Medical Forest Correction", and is often used in clinical practice to block the meridians with blood stasis. This is an important cause of infiltration in the course of AS disease.
Clinical evidence is widely used in Qi stagnation, wind cold and wet caused by blood stasis blocking meridian AS, the symptoms are severe pain at night, pain is like needle pricking and the site does not move, long-term healing, dark tongue or ecchymosis petechiae, tight or astringent pulses.
Fangzhong peach kernel, safflower, Chuanxiong, red peony, angelica live blood to remove stasis and relieve pain, open the Xuanfu Yushu work; Ox knee and earth dragon live blood circulation, the effect of the veins are not connected; Qiang Huo, Qin Jiao, Incense Disperses Cold and Dampness, Regulates Qi and Blood, and has the ability to clear Xuan Mansion and regulate Qi Liquid.
The combination of various medicines plays the role of revitalizing the network. It should be pointed out that tonifying the kidney, regulating the qi liquid and activating the network are a whole and cannot be completely separated.
Prescription drugs in clinical evidence need to be treated dialectically, not rigidly, if the disease is complex, it can be combined with multiple parties, flexible addition and subtraction, and jointly promote the improvement of the condition.