基于《黄帝内经》“五体痹”探析“乳蛾”

To Explore “Rue” Based on the “Five-Body Impediments” in Huangdi Neijing

摘要: 扁桃体炎属中医“乳蛾”范畴，分急、慢两型，对应西医急性、慢性扁桃体炎，多发于儿童及青少年，急性者春秋季常见，迁延可致风湿热、肾炎等并发症，西医抗生素治疗与手术切除存在反复发作、术后出血等困境，且中西医病理与辨证相关性研究较少。本文从《内经》“三痹”“五体痹”“五脏痹”理论探析乳蛾及其并发症传变规律：乳蛾发病始于风寒湿三邪直袭或伏邪引动，与“三痹”致病特点一致；其发展中喉核肿大、充血、糜烂等表现，暗合“五体痹”从皮至骨的传变规律；其诱发的痹证、水肿等并发症，对应“五脏痹”(肺痹、肾痹、心痹等)的传变，且脏痹间以相乘为主。综上，从“痹”理论视角可为乳蛾临床中医诊疗提供新思路，以实现“扶正祛邪，调和阴阳”的治疗目的。

Abstract: Tonsillitis, known as “Rue” in Traditional Chinese Medicine (TCM), falls into acute and chronic types, corresponding to acute and chronic tonsillitis in Western medicine. It predominantly affects children and adolescents, with acute cases frequently occurring in spring and autumn. If prolonged, it may lead to complications such as rheumatic fever and nephritis. Western medical treatments, including antibiotics and surgical removal, face challenges such as recurrence and postoperative bleeding. Moreover, there is limited research on the correlation between Western and TCM pathology and syndrome differentiation. This article analyzes Rue and its pattern of complication progression based on the theories of “Three Impediments”, “Five-Body Impediments”, and “Five Zang-Organ Impediments” from Huangdi Neijing. The onset of Rue begins with direct invasion by wind, cold, and dampness pathogens or the activation of latent pathogens, aligning with the pathogenic characteristics of the “Three Impediments”. Its progression, manifested as tonsillar swelling, congestion, and erosion, corresponds to the transmission pattern of the “Five-Body Impediments” from the skin to the bones. Complications such as impediment syndrome and edema reflect the progression of “Five Zang-Organ Impediments” (e.g., lung impediment, kidney impediment, heart impediment), with the transmission primarily following the overcoming sequence among the zang-organs. In summary, exploring Rue from the perspective of “impediment” theory may provide new insights for its clinical diagnosis and treatment in TCM, aiming to achieve the therapeutic goal of “strengthening the body’s resistance and eliminating pathogens, harmonizing yin and yang”.