基于络病学说探讨带状疱疹后遗神经痛的中医辨治思路

Exploration of TCM Syndrome Differentiation and Treatment Approaches for Postherpetic Neuralgia Based on Collateral Disease Theory

摘要: 带状疱疹后遗神经痛是带状疱疹最常见且最棘手的并发症，以持续性、顽固性神经病理性疼痛为主要特征，严重影响患者生活质量。络病学说是中医学阐释疾病发生发展的重要理论体系，其“久病入络”“毒损络脉”“络以通为用”等核心命题为理解PHN的病机演变和辨治规律提供了独特视角。本文以络病学说为纲，系统梳理了络脉的生理定位与功能特性，阐释了“久病入络”理论从带状疱疹急性期向PHN的临床映射，提出了以“毒损络脉”为核心的PHN病机模型。在此基础上，将PHN归纳为毒邪滞络、络血瘀阻、络脉失养三大证型，并围绕“络以通为用”的治法总纲，提出凉血解毒净络、活血化瘀通络、辛润养血濡络、搜风剔络止痛四大通络治法。同时，对火针密刺、刺络拔罐、毫针围刺、艾灸温通等外治法在络病框架下进行了系统理论阐释。本文力图构建基于络病学说的PHN中医辨治体系，为临床诊疗提供理论依据。

Abstract: Postherpetic neuralgia (PHN) is the most common and challenging complication of herpes zoster. It is primarily characterized by persistent and refractory neuropathic pain, which severely affects patients’ quality of life. Collateral disease theory is an important theoretical framework in traditional Chinese medicine (TCM) for explaining the occurrence and progression of diseases. Its core propositions, including “prolonged illness entering the collaterals,” “toxin damaging the collaterals,” and “the collaterals function through unobstructed circulation,” provide a unique perspective for understanding the pathogenesis and treatment principles of PHN. Guided by collateral disease theory, this paper systematically reviews the physiological distribution and functional characteristics of the collaterals, elucidates the clinical progression from the acute phase of herpes zoster to PHN based on the theory of “prolonged illness entering the collaterals,” and proposes a PHN pathogenesis model centered on “toxin damaging the collaterals.” On this basis, PHN is classified into three syndrome types: toxin stagnation in the collaterals, blood stasis in the collaterals, and malnourishment of the collaterals. Centered on the general therapeutic principle that “the collaterals function through unobstructed circulation,” four major collateral-unblocking treatment approaches are proposed: cooling the blood, detoxifying, and cleansing the collaterals; invigorating the blood, removing stasis, and unblocking the collaterals; using acrid and moistening methods to nourish the blood and enrich the collaterals; and expelling wind, dredging the collaterals, and relieving pain. In addition, external therapies, including dense fire-needle needling, bloodletting with cupping, surrounding needling with filiform needles, and moxibustion for warming and unblocking, are systematically interpreted within the framework of collateral disease theory. This paper aims to establish a TCM syndrome differentiation and treatment system for PHN based on collateral disease theory, thereby providing a theoretical basis for clinical diagnosis and treatment.