Leukoaraiosis, also known as Behçet’s syndrome, is a systemic, chronic, vascular inflammatory disease that mainly manifests clinically as recurrent oral ulcers, genital ulcers, ophthalmia and skin damage, and can also involve blood vessels, nervous system, gastrointestinal tract, joints, lungs, kidneys and other organs. The disease has a high incidence in East Asia, the Middle East and the Mediterranean region and is known as Silk Road disease. There is no exact information on the incidence in China, and the disease can occur at any age, with a prevalence of 16 to 40 years. Most of our patients are female, and male patients have more vascular, neurological and ocular involvement than female and the disease is more severe. The clinical characteristics of leukoaraiosis are similar to those of “fox disease” in Chinese medicine.
I. Etiology and pathogenesis in Chinese medicine.
The disease is caused by the dysfunction of the liver, spleen and kidneys, as well as by the invasion of external evil, resulting in dampness and heat, and stagnation of qi and blood.
1, excessive fatigue, poor diet, damage to the spleen and stomach, the spleen and stomach dysfunction of transporting water and drink, water and dampness within the stagnation, and over time contained and turned into heat, damp-heat obstruction, internal attack on the internal organs, external steam skin; on the burn in the mouth, the lower eclipse in the yin.
2, excessive worry, damage to the liver and spleen, liver loss of drainage, liver qi stagnation, depression for a long time into fire; spleen loss of health, water and dampness within the stagnation, day after day and heat; liver fire through the meridian, up smoked in the eyes. Liver fire and damp-heat steam, damp-heat injection, down erosion in the yin.
3. Excessive strain and desire, damage to the kidney essence. Liver and kidney yin deficiency, deficiency heat within. Deficiency fire upward inflammation, redness and astringency of the eyes, ulceration of the mouth and tongue. Deficiency fire downward, Yin ulceration and anal erosion.
Second, Chinese medicine treatment.
(A) Identification treatment.
1. Identification points.
Clinical symptoms are characterized by oral ulcers, anterior yin ulcers and redness of the eyes. In the course of the disease, the liver, spleen and kidneys are dysfunctional, and then attacked by external evil, so that dampness and heat intermingle and stagnation of Qi and blood. Therefore, the disease is mainly caused by damp-heat interruptions. The anterior yin erosion is due to damp-heat poisonous evil injecting down through the liver meridian and fumigating the perineum. The liver meridian of foot fructus yin goes up to the pharynx, and its liver fire and heat toxins go up through the meridian, then oral ulcers appear. The clinical evidence should be divided into two categories: deficiency and reality. In the acute attack period, the heat is disturbing and the dampness and toxicity are fumigating, so the evidence is more solid and the treatment is more effective. In the middle and late stages, the qi and blood are blocked in the meridians, the deficiency of the liver and kidney yin deficiency, deficiency of fire on the inflammation, the original deficiency and the symptoms are real, the disease is often difficult to heal, which is the key to identify the evidence. According to the location and course of the disease can be identified as the spleen and stomach damp-heat evidence, liver damp-heat evidence and liver and kidney yin deficiency evidence.
2. Treatment points.
Chinese medicine treatment is based on the principle of supporting the righteous and eliminating the evil. The symptoms should be treated first, and then the root cause should be taken care of; start with eliminating the evil first, and then help the righteous. Unblocking the qi is the principle of treatment for white stuffy disease. It is important to prevent the progression of the disease and other complications. In clinical treatment, we should distinguish the real from the virtual, the real evidence is based on dredging the liver and Qi, and the virtual evidence is based on benefitting Qi and nourishing Yin to support the righteousness.
3.Treatment by evidence.
3.1 Damp-heat evidence of spleen and stomach.
Symptoms: oral ulceration, and more and deep, saliva dripping, swelling, pain and discomfort, not allowed to eat; vulva ulceration pain, red and white belt; anal erosion burning; double lower limbs erythema, swelling and pain; body heat does not raise, stuffy and dull, tongue red, tongue coating yellow greasy, pulse slippery.
Treatment: Clearing heat, relieving dampness and dipping fire.
Remedy: Glycyrrhiza glabra plus reduction.
Raw licorice, Huang Lian, Scutellaria, Radix Codonopsis , Dry ginger, Gardenia, Tu Fu Ling, Coix seed, Zhi Mu, Xi Cao, Pierced Mountain Dragon, etc.
Add and subtract: swelling of the lower limbs, erythema, add Salvia miltiorrhiza, Chrysanthemum, Radix Bupleurum; chest tightness, epigastric abdominal gangrene, dullness, add Hou Pu, Poria, Cardamom; anal ulceration, add Bupleurum, Bitter Ginseng.
3.2 Damp-heat evidence of liver meridian.
Symptom characteristics: eye pain, eye pain, redness, photophobia and shame, blurred vision. Redness and swelling of vulva ulceration, discharge, joint pain, skin boils, swelling and pus; with bitter mouth and dry throat, irritability, short and red urine, dry stools. The tongue is red, with thin yellow coating and string pulse.
Treatment: Clearing the liver and diarrhea of fire, regulating Qi and relieving depression.
Radix: Gentian and Liver Dispersion with Si Miao San, plus or minus.
Gentian Herb, Gardenia, Scutellaria, Chai Hu, Che Qian Zi, Sheng Di, Sheng Gan Cao, Tu Fu Ling, Angelica Sinensis, Huang Bai, Atractylodes, Coix Seed, Papaya, Niubizi, Fang Feng, etc.
Add and subtract: add Gou Jing Cao, Celosia argentea, Mimong Hua; add Dahurica dahurica, Chai Hu and Chrysanthemum for headache; add Fructus sabdariffa, Tu Fu Ling and Chrysanthemum for vulva ulcer; add Honeysuckle, Zingiber officinale and Red Peony for skin boils; add Hai Feng Vine, Eucommia lucidum and Pierced Mountain Dragon for joint pain.
3.3 Liver and kidney yin deficiency evidence.
Symptoms: headache, red eyes, dry eyes, shyness and tearing, blurred vision; ulcerated mouth and tongue, dry and sore throat, hoarse voice; dizziness and tinnitus, irritable heat in the five hearts, hot flashes in the afternoon; yellow urine, dry stools, red tongue, little moss, thin pulse.
Treatment: Tonifying the liver and kidney, nourishing Yin and clearing heat.
Remedy: Zhi Bai Di Huang Tang with Addition.
Zhi Mu, Huang Bai, Shu Di Huang, Cornus officinalis, Shan Yao, Ze Xie, Fu Ling, Dan Pi, Tu Fu Ling, etc. Add and subtract: add Fructus Lycii, Chrysanthemum, Cao Zhi Ming; add Calcined Dragon Bone, Dog Root, Cuscuta; add Angelica Sinensis, Motherwort, Chuan Xiong for menstrual disorders.
(II) Identification and treatment of diseases.
1. Leigongtang Polyglucoside Tablets.
The Chinese medicine Leigongteng multi-glucoside tablets for the treatment of leukodystrophy is fast-acting and effective, with fewer side effects than glucocorticoids and no rebound after discontinuation of the drug. It is usually taken orally 20mg per time, twice daily. However, since this product is prone to toxic side effects on the reproductive system, women mainly show reduced menstruation, amenorrhea and ovarian atrophy; men show reduced sperm, sperm malformation, reduced motility or azoospermia. Therefore, it is contraindicated during the reproductive period and for patients with fertility requirements.
2, the total glucoside of peony: commonly used dose of 600mg, 2-3 times a day orally. Toxic side effects are small, its adverse reactions are increased number of stools, mild abdominal pain, poor performance, etc.
3, external treatment method.
3.1 Mouth ulcers: golden lotus, honeysuckle, maitake decoction with water and gargle; external use of watermelon cream, pearl yellow powder, tin class powder.
3.2 vulvar ulcers: bitter ginseng, snake bed seeds decoction external wash; external use of tin class powder or white pearl powder.
There is no recognized effective radical cure for this disease. A variety of drugs are effective, but most of them are prone to recurrence after stopping. The aim and principle of treatment is to control the existing symptoms, prevent and control important organ damage, and slow down disease progression.