基于“因虚致瘀”辨治老年带状疱疹相关性 疼痛

Diagnosis and Treatment of Senile Herpes Zoster Pain Based on the “Caused by Virtual Stasis”

摘要: 带状疱疹相关性疼痛在临床是老年人常见疾病，尤其是罹患各类慢性疾病的老年人，疼痛迁延不除。历代医家学者在辨治本病时，多以实证为主，重视活血化瘀等方法，然而仅仅以祛实邪的治疗效果参差不齐。通过临床实践的深入观察，结合老年人群独特的体质特征，笔者提出老年人罹患ZAP的核心在于正气虚弱，卫外功能不固，从而易于感受外邪引发疱疹。基于此，本文从“虚”与“瘀”两个维度出发，构建了“因虚致瘀”的理论框架，将虚证与瘀证视为该病病机辨证的核心要素，同时强调需细致区分气、血、阴、阳的不同虚损状况，以实现正虚与血瘀两方面辨证的紧密结合。这一理论创新旨在为中医药治疗老年ZAP患者开辟新的思路与途径。

Abstract: Herpes zoster-associated pain (ZAP) frequently occurs in elderly patients, especially those complicated with multiple chronic diseases, and the pain often persists and is refractory to treatment. Historically, most physicians and scholars diagnosed and treated this disease centering on excess syndromes and mainly adopted therapies for activating blood circulation and resolving blood stasis. Nevertheless, satisfactory curative effects cannot be consistently achieved if treatment only focuses on eliminating excess pathogenic factors. On the basis of long-term in-depth clinical observations and the unique constitutional characteristics of the elderly, the author proposes that the core pathogenesis of ZAP in aged patients is deficiency of healthy qi and insecurity of defensive qi at the exterior, which renders the body vulnerable to invasion by exogenous pathogenic factors and eventually triggers herpes zoster. Accordingly, this paper establishes a theoretical framework of “deficiency inducing blood stasis” from the two dimensions of deficiency and blood stasis. Deficiency syndrome and blood-stasis syndrome are identified as the core components for the pathogenic syndrome differentiation of ZAP. Meanwhile, it is emphasized that distinctions should be meticulously made among deficiency of qi, blood, yin and yang, so as to realize the organic combination of syndrome differentiation targeting healthy qi deficiency and blood stasis. This theoretical innovation provides novel ideas and therapeutic approaches for the traditional Chinese medicine management of elderly patients with ZAP.