带状疱疹后遗神经痛的中西医研究进展

Research Progress on Postherpetic Neuralgia from Traditional Chinese and Western Medicine Perspectives

摘要: 带状疱疹后遗神经痛(PHN)病机复杂，中医多从“不通则痛”与“不荣则痛”立论，常见证型包括气滞血瘀、肝经郁热、气虚血瘀及阴虚血瘀，强调辨证施治，内服方剂如血府逐瘀汤、龙胆泻肝汤、补阳还五汤等，配合针灸、火针、穴位注射、中药外敷及熏蒸等外治法，临床疗效确切，且不良反应少，尤适于老年及慢性病患者。现代医学认为PHN与水痘–带状疱疹病毒所致神经损伤及中枢敏化相关，治疗以药物镇痛为主，一线药物如普瑞巴林、加巴喷丁起效快，但易致头晕、嗜睡及认知障碍；二线药物如阿片类及三环类抗抑郁药亦受限于副作用。物理疗法如臭氧、微波、低温冲击等为辅助选择。相较而言，中医药立足整体调节，在有效缓解疼痛的同时，或可降低PHN发生与复发风险，其多靶点、个体化干预策略在长期管理中展现出独特优势，值得深入研究与推广。

Abstract: Postherpetic neuralgia (PHN) has a complex pathogenesis. Traditional Chinese Medicine (TCM) primarily theorizes it based on “pain due to obstruction” and “pain due to malnourishment,” with common syndrome patterns including qi stagnation and blood stasis, liver channel depression-heat, qi deficiency and blood stasis, and yin deficiency and blood stasis. TCM emphasizes syndrome differentiation and treatment, employing internal prescriptions such as Xuefu Zhuyu Decoction, Gentiana Scabra Liver-Draining Decoction, and Buyang Huanwu Decoction, combined with external therapies like acupuncture, fire needling, acupoint injection, herbal external application, and fumigation. These methods demonstrate definite clinical efficacy with few adverse reactions, making them particularly suitable for elderly and chronic patients. Modern medicine attributes PHN to nerve injury and central sensitization caused by the varicella-herpes zoster virus, with treatment primarily focused on pharmacological analgesia. First-line drugs like pregabalin and gabapentin act rapidly but may cause dizziness, drowsiness, and cognitive disorders. Second-line drugs such as opioids and tricyclic antidepressants are also limited by side effects. Physical therapies like ozone, microwave, and cryo-impact serve as auxiliary options. In comparison, TCM adopts a holistic regulatory approach, effectively alleviating pain while potentially reducing the risk of PHN occurrence and recurrence. Its multi-target, individualized intervention strategy exhibits unique advantages in long-term management, warranting further research and promotion.