Dry syndrome is a chronic autoimmune disease that affects exocrine glands, especially salivary glands and lacrimal glands. If only exocrine glands are involved, it is called primary dry syndrome; if it is accompanied by other connective tissue damage or secondary autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis, it is called secondary dry syndrome. Clinically, dry mouth and eyes are the main symptoms.
This disease is a global disease, it is most common in women, more than 90% of the age of onset is 30~40 years old, the youngest is 9 years old, the ratio of men to women is 1:9~17. Foreign data reported that the prevalence of the elderly is 3~4%, second only to rheumatoid arthritis. Early dry mouth and eyes are not easy to be taken seriously and easily misdiagnosed, and its course is long, and the prognosis is generally good. Most of those with visceral damage can be relieved by proper treatment. Those with serious organ lesions, malignant lymphoma and secondary dryness syndrome with serious connective tissue diseases have poor prognosis.
The etiology of this disease is still unclear, it may be related to genetic, immune, sex hormone, viral infection and other factors. 1. Genetic basis: there is family history, the frequency of HLAB8 and DR3 genes is very high in primary patients, and the frequency of HLAR2 is very high in secondary patients. 2. 3.Sex hormones: Mostly seen in females, it may be related to the ability of sex hormones to regulate the immune response, and estrogen makes the immune activity too strong. 4.Immune abnormalities: There are complex humoral and cellular immune abnormalities, and patients often have a variety of autoantibodies in the serum, such as anti-nuclear antibody, anti-SS-A antibody, anti-SS- B antibodies, anti-salivary gland antibodies, etc.; often combined with certain autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, chronic active hepatitis, Hashimoto’s thyroiditis, etc.; application of adrenocorticotropic hormone or other immunosuppressive agents may be in remission. The basic pathological changes are a large infiltration of lymphocytes in the lacrimal, submandibular, parotid and other exocrine glands, marked atrophy of the glands, narrowing and dilatation of the ducts, and in late cases, the glands are replaced by connective tissue.
In the Jin-Yuan period, Liu Wansu added in “Suwen Xuanji Original Disease Style” that “all astringent and dry, dry and chapped, all belong to Dryness” of the disease mechanism. From the analysis of its pathogenesis and clinical characteristics, it can be classified as “dryness” in Chinese medicine, and if it is accompanied by joint pain, it can be called “paralysis of the week” or “dryness paralysis”. The cause of the disease is congenital deficiency of endowment, Yin deficiency, dryness and heat of the body; acquired fatigue, long-term illness without nourishment; external exposure to wind, summer, dryness, fire four evils, Yang-heat, resulting in fluid depletion, Yin and blood deficiency, clear orifices lose moistening, blood stasis paralysis over time, the veins are blocked, involving the skin, tendons and bones, deep into the internal organs and the cost of the disease. The basic pathological mechanism is deficiency of yin and fluid, the pathological factor is mainly dryness, heat and blood stasis, the pathological nature of the deficiency and the symptoms are real.
[Diagnostic basis].
The disease starts insidiously and has various clinical symptoms. Primary patients mostly have dry mouth and eyes as early symptoms, and some have a certain systemic damage as prominent manifestation. Secondary patients have mild local symptoms, and systemic symptoms are mostly accompanied by their coexisting autoimmune diseases. Local symptoms include dry mouth, low saliva, rampant dental caries, dry, cracked tongue, atrophy of tongue papillae, oral ulcers, often unilateral or bilateral enlargement of parotid and submandibular glands; dry eyes, foreign body sensation, no tears when crying in severe cases; dry, itchy and flaky skin, dry and itchy vagina, difficulty and burning pain during intercourse; dry nose and throat or chronic cough. Systemic symptoms include joint pain, rheumatoid arthritis in about half of the patients, generalized myalgia, fatigue and muscle weakness; different types of skin rash, erythema nodosum and purpura; neurological system may show psychoneurological symptoms, seizure-like episodes, hemiplegia and hemianopia, ataxia, etc.; renal lesions are highlighted by renal tubular acidosis and renal uremia, and hypokalemic paralysis may occur; due to dryness of the pharynx and esophagus, it may Gastroscopy 63-70% have atrophic gastritis, hepatosplenomegaly and elevated serum glutathione aminotransferase are not uncommon, and occasionally chronic pancreatitis; lymphoid tissue hyperplasia is generally benign and can extend to extra-glandular tissues such as reticuloendothelial system, kidney, muscle, and lung, and the incidence of malignant lymphoma is significantly higher.
Laboratory tests commonly show orthocytic orthochromic anemia, leukopenia in a few patients, mild eosinophilia, and increased hematocrit in 90% of patients. Half of the patients have hypergammaglobulinemia and all immunoglobulins are increased, mainly IgG. A variety of autoantibodies can be detected in the serum, including rheumatoid factor, antinuclear antibody, anti-SS-A antibody, anti-SS-B antibody, and anti-RNP antibody, but anti-SS-A and anti-SS-B antibodies are the most important. Saliva levels of IgM and IgG are increased, and salivary b2 microglobulin concentrations are higher than in serum. Complement levels are generally normal and can be significantly lower in combined vasculitis.
There is no universally accepted diagnostic and classification criteria for this disease. The European criteria proposed in 1992 have taken into account the clinical manifestations, immunological and pathological factors in the diagnosis and are expected to be accepted for reference.
1. Dry eyes for more than 3 months; recurrent ocular gritty sensation; use of tear substitutes more than 3 times a day. Any one of these factors is considered positive.
2. Dry mouth for more than 3 months; recurrent and persistent salivary gland enlargement; swallowing dry food requiring frequent drinking of liquid. Anyone with any one of these items is considered positive.
3, filter paper test £5mm/5 points; corneal staining index ³4 is positive. at least 1 of the 2 items is positive.
4, mononuclear cell infiltration foci of lower lip mucosa biopsy ³1/4mm2 positive.
5, parotid imaging: salivary gland isotope scan; saliva flow rate. Those with any 1 positive item.
6. Positive serum anti-SS-A and anti-SS-B antibodies.
The diagnosis of primary dry syndrome is confirmed if at least 4 of the above 6 items are present, and another connective tissue disease, lymphoma, AIDS, nodular disease, graft-versus-host disease is excluded. If there is a certain definite connective tissue disease with 1 or 2 items mentioned above and two positive items among 3, 4 and 6, it can be taken as the diagnostic criteria of secondary dry syndrome.
[Identification and treatment]
1. Hyperthermia type
Symptoms: dry mouth and lips, dry throat and nose, broken mouth and tongue, dry eyes with few tears, red eyes with many mucus, short and red urine, dry stools, red and hot face, or low heat retention, dry and red tongue without fluid or cracked, little or yellow dry moss, thin and stringy pulse.
Treatment: Clearing heat and cooling the blood, protecting yin and moistening the bath.
Formula: Rhizoma Dihuang Tang with Addition.
Commonly used herbs: water hyacinth, raw earth, tannin, red peony, xuan shen, dan shen, maitong, aconite, Zhi mu, huang lian.
For painful ulceration of the mouth and tongue, add Ganzhong Huang, Bai Ruhua, Qing Dai, and Sheng Gypsum; for red eyes with many discharge, add Gardenia and Temperate Bamboo Leaves; for dry stools, add Fire Ma Ren and Gua Gua Ren; for low fever that does not subside, add Ground Bone Bark and Yin Chai Hu; for red and dry tongue without fluid, add Wu Mei, Bai Shao, and Sheng Gan Cao; for painful joints, add Tiger Balm, Lonicerae, and Mulberry Branch; for damp and fire inflammation, bitter and sticky mouth, and thin yellowish greasy coating, add Huo Xiang and Perilla.
This is the more serious type of symptom in dry syndrome, caused by exogenous wind, summer heat, dryness and fire, with hyperactive Yang heat, dry heat breeding poison, burning fluids and depleting Yin and Blood. Therefore, the treatment is to clear the heat and fire, cool the blood and detoxify the toxin, and nourish the Yin and moisten the dryness. If the disease is difficult to control, small doses of Radix et Rhizoma can be added as appropriate.
2.Yin deficiency internal heat type
Symptoms: dry mouth and throat, especially at night, dry and cracked lips, dry mouth and desire to drink or drink does not quench thirst, dry eyes, few or no tears, blurred vision, dizziness and tinnitus, hoarseness, five heartburn, constipation, red tongue with little or no moss, thin pulse.
Treatment: Nourishing Yin and promoting fluid, clearing heat and removing annoyance.
Recipe: Qiju Dihuang Tang with Consistent Decoction plus reduction.
Commonly used drugs: Bei Sha Shen, Mai Dong, Sheng Di, Fructus Lycii, Fructus Chasteberry, Chrysanthemum, Cornu Cervi Pantotrichum, Dan Pi, Dry Lotus Grass, Tian Tian Fan.
If the internal heat of yin deficiency is very serious, add Dioscorea, Baiwei, Gonglao leaf, and turtle nail; for restless sleep at night, irritable heat, and burning palms, add Wuweizi, ZhiMu, and Lily; for blurred vision, add Dendrobium, GuJingCao, and Cassia; for constipation, add XuanShen and ShengShouWu; for joint pain, add MuGuo, ShiNanTeng, and QingFengTeng.
This type of dry syndrome is the most common, caused by yin deficiency in the body or yin liquid depletion due to various reasons. The main pathogenesis is liver and kidney yin deficiency, dryness and internal heat, this is deficiency heat, deficiency fire, clinical use of medicine should not be bitter cold straight fold.
3.Qi and Yin deficiency type
Symptoms: dry mouth and throat, tiredness and fatigue, shortness of breath and lazy speech, loss of appetite, insubstantial stools, red tongue with little coating and thin pulse.
Treatment: Benefit qi, strengthen spleen, nourish yin and generate fluid.
Recipe: Tonifying Zhong Yi Qi Tang plus reduction.
For dry eyes, add Fructus Lycii and Dendrobium Chuan; for insubstantial stools, add Radix et Rhizoma Huaiyang and Radix et Rhizoma Puerariae; for loss of appetite and gastric discomfort, add Fried Grain Malt, Raw Cha Pork and Green Plumeria.
This type is mostly seen in those who have a long course of dry syndrome. It is caused by long-standing disease and organs, lung and kidney yin deficiency, and spleen qi deficiency. The spleen and stomach are the essence of the latter, so the treatment is to take care of the spleen and stomach.
4.Blood deficiency and dry heat type
Symptoms: dry mouth and throat, dry nose and eyes, less florid face, dizziness and weakness, scanty menstrual blood, anxiety and irritability, insomnia and dreaminess, dry skin and hair, tender red tongue with little fluid, little moss, thin pulse.
Treatment: Nourishing Blood, softening the Liver, generating fluid and moistening dryness.
Formula: Siwu Tang with Consistent Decoction plus reduction.
For dizziness and headache, add asparagus, Tribulus terrestris, bitter tea; for anxiety and restlessness, night sleep, add Huang Lian, Agaricus blazei, Shu Zao Ren; for dry skin and hair, add Huang Jing, Shou Wu; for red face and rising fire, add Bai Wei, Gong Lao Ye; for blurred vision, add Zhen Zhen Zi, Mulberry.
This type of evidence is mostly seen in middle-aged women and menopausal women. women over 40 years of age, with gradual depletion of the heavenly sap and deficiency of essence and blood. In women, the liver is the precursor, the deficiency of Yin and Blood, the blood does not nourish the liver, resulting in blood deficiency and liver exuberance and internal heat. Treatment should pay attention to nourishing the liver and softening it, so as to achieve the purpose of generating fluid and moistening dryness.
5.Blood stasis blocking the ligament type
Symptoms: dry mouth and throat, dry eyes, rough skin, dark spots, scorched hair, pain in the joints of the limbs, unfavorable flexion and extension, deformity, purple and dark finger ends, low menstrual flow, dark tongue with little fluid, petechiae and stasis, thin and astringent pulse.
Treatment: Invigorate blood circulation to resolve blood stasis, remove paralysis and promote circulation.
Recipe: Peach and Red Four Animals Soup with Addition and Reduction.
Commonly used herbs: peach kernel, safflower, angelica, Chuanxiong, red peony, henbane, perforated ginseng, salvia, raw earth, ghost arrow feather.
If the ends of the fingers are purple and cold, add Xian Ling Spleen, Deer Antler Cream and Lutong; if the menstrual flow is low and dark, add Yimu Cao and Ze Lan; if the joints are deformed and the skin is rough, add Turtle Worm, Leech, Turtle Nail and Ling Xiao Hua; if the mouth is dry and throat is obvious, add Tian Tian Tian Fan and Xuan Shen.
This type is seen in those with long duration of illness or combined with scleroderma, and often appears in combination with the aforementioned. Because of the low amount of fluid and astringent blood transport, weak qi and weak blood transport, resulting in blood stasis, blood vessels, which further aggravates the obstruction of fluid distribution. Treatment focuses on activating blood circulation and removing blood stasis.
[Single prescription]
1.Yu Liquid Tang: 30 grams each of Astragalus, Yam and Xuan Shen, 15 grams each of Zhi Mu, Mai Dong and Sheng Di, 10 grams each of Wu Wei Zi, Smallpox Powder and Wu Mei, 6 grams each of Ji Nei Jin and Ge Gen. It is used for all types of dryness syndrome, with the function of tonifying Qi, generating fluid, moistening dryness and quenching thirst.
It has the function of nourishing the spleen and benefiting the lung, and clearing fire and eyes, and is used for those who have lung and spleen deficiency in dry syndrome.
3.Nourishing Yin and nourishing fluid formula: 12 grams of adamantine thorns, 10 grams each of raw earth, smallpox powder, dendrobium, yucca, yellow essence, celandine, prunus and yam, 5 grams of lotus leaf. It has the function of nourishing yin and moistening dryness, softening and relieving pain, and is used for dry syndrome seen with joint pain.
4, Chinese wolfberry and fire marijuana pill: Chinese wolfberry 15 grams, sage, mulberry, dogwood, maitake, angelica, mulberry each 30 grams, raw earth 60 grams, black sesame 15 grams, fire marijuana 12 grams. The above medicine is mixed with powder and refined honey into pills, each pill weighing 10 grams, 3 times a day, 2 pills each time, served with boiled water. It has the function of nourishing kidney yin and filling yin and blood, and is used for dry syndrome with loss of yin and blood and loss of skin moistening.
5, two ginseng and dendrobium soup: prince’s ginseng, saxifrage, maitake, astragalus, dry lotus grass 30 grams each, raw earth 60 grams, yu zhu 12 grams, wolfberry, wu wei zi, dendrobium, yellow essence 15 grams each. It has the function of benefiting qi and nourishing yin, strengthening water and moistening dryness, and is used for dry syndrome with deficiency of both qi and yin.
6, Beneficial Stomach and Jade Woman Decoction: 15 grams each of Sha Shen, Yu Zhu and Mai Dong, 10 grams each of Dendrobium, Sheng Di, Bai Shao, Zhi Mu, Gan Cao and Xuan Shen. It has the function of strengthening the spleen and stomach, nourishing yin and generating fluid, and is used for those who have deficiency of spleen and stomach yin in dry syndrome.
7.Elderly wheat soup: 60 grams of raw earth, 30 grams of ground bark, 30 grams of dendrobium, 12 grams of Zhi Mu, 12 grams of yu zhu and smallpox powder, 30 grams of Chinese wheat, 30 grams of jujube and artemisia, 15 grams of shou wu and turtle shell, 10 grams of licorice. It has the function of sweet-cooling and moistening, generating fluid and saving dryness, and is used for dry syndrome with Yin deficiency and internal heat.
8.Qing Xuan Yi Lung Soup: 30 grams of mulberry leaf, 20 grams of almond and Zhi Mu, 30 grams of sage, raw earth, maitong, scutellaria and panax quinquefolium, 15 grams of chrysanthemum, dendrobium and wolfberry.
9.Legendan polyside tablets: 10 mg each time, 3 times a day, 1 month as a course of treatment. It has the functions of clearing heat and detoxifying, dispelling wind and dampness, relieving swelling and pain, activating blood circulation and resolving blood stasis, and is used for various types of dry syndrome.
10, mulberry branch paste: young mulberry branch made of paste, each time 15 grams, 2 ~ 3 times a day, fasting water punch. It has the function of dispelling wind, invigorating and promoting paralysis, and is used for those who have joint pain in dry syndrome.
[Diet therapy]
1, honey mulberry cream: 100 grams of fresh mulberry, 25 grams of honey. Mulberry with cold boiling water wash clean, press the juice, into a pot of slow simmering to gradually thicken, while adding honey while stirring Yang, to become a paste that is, put into a bottle, daily morning and evening each take 1 spoon, boiling water down. It has the effect of nourishing kidney and liver, and is used for those who have liver and kidney yin deficiency in dry syndrome.
2.Xuan Shen Lian Jujube Drink: 90 grams of Xuan Shen, 30 grams of Dan Pi and fried jujube seeds, 9 grams of Phellodendron and lotus seeds. Wash with water, put into a casserole, add 300ml of water, decoct for 30 minutes on low heat, remove the dregs, add water and decoct again, strain the juice, combine the juice obtained 2 times, add a little sugar, take in 3 times, 1 dose daily. It has the effect of nourishing Yin and lowering fire, used for dry syndrome Yin deficiency fire, mouth ulcers.
3, duck head drink: 1 salted duck head. Soak the dried salted duck head in water, wash it, put it into a small sand pot, add the right amount of water, first boil it with a high fire, and then simmer it slowly with a low fire for about 30 minutes, drink it once, 2 times a day. It has the effect of clearing heat and diarrhea of fire, and is used for dry syndrome with internal heat of yin deficiency or internal damp heat accumulation, fire and heat upward, and mouth and tongue sores.
4, mung bean porridge: 100 grams of mung beans, 150 grams of round-grained rice, 15 grams of sugar. Mung beans, round-grained rice, cleaned with water, into the pot, add water, slowly cooked into porridge, porridge into the sugar, served every morning and evening as a meal. It has the effect of harmonizing the spleen and stomach and dispelling internal heat, and is used for those who have dry syndrome with disharmony of spleen and stomach and loss of appetite.
5.Dry lotus paste: dry lotus grass 3000 grams. Boil the above medicine with spring water for 3 times, combine the 3 decoctions and boil it into paste with a gentle fire. Each serving of 1 spoon, morning and evening boiled water transfer down. It has the effect of benefiting kidney and nourishing yin, used for dry syndrome kidney and yin deficiency, waist and knee soreness and weakness.
6, Chinese wolfberry porridge: 30 grams of Chinese wolfberry, 100 grams of round-grained rice. Wash the Chinese wolfberry, rice clean, with into the pot, add the right amount of water, cooked into porridge, eat immediately. It has the effect of benefiting kidney and nourishing liver, nourishing blood and brightening eyes, used for dry syndrome liver and kidney deficiency, both eyes dry and faint vision.
7, papaya soup: 4 papaya, steamed and peeled, research rotten as mud, white honey 1 kg, refining clean. Blend the two things well, put into a clean porcelain container. Every morning, drink 1 spoonful with boiling water. It is used for those who have joint pain in dry syndrome.
[Acupuncture therapy]
Use adjacent acupuncture points as the main point, supplemented by taking acupuncture points following the meridian, it is advisable to use the technique of flat tonic and flat diarrhea.
1. For dry mouth and eyes with liver and kidney yin deficiency, acupuncture points should be used for Liver Yu, Kidney Yu, Baihui, Neiguan and Yinlingquan; for dry eyes and decreased vision, acupuncture points should be used for Sibai, Fish Waist and Hegu; for dry mouth and little fluid, acupuncture points should be used for Dicang, Cheek Chee and Foot Sanli.
2. For swollen parotid glands, needles should be applied to Zhongzhu, Taichong and Yanglingquan.
3. For joint pain, acupuncture: Quchi, Dazhi, Zhizhong, Kunlun, Laogong, and Blood Sea.
4. For vulva atrophy or itching, acupuncture: Quchi, Guilai, Guanyuan.
[External treatment]
1, dipping formula: leech 30 grams, earth yuan, peach kernel, Su Mu, safflower, blood exhaustion, frankincense, myrrh 10 grams each, Chuan Niu Knee, Fructus Herba 15 grams each, Gui Zhi 20 grams, Di Long 30 grams, raw licorice 45 grams. Decocted with water to obtain the liquid and poured into a wooden bucket for bathing, 1~2 times a day, 1 dose daily. It has the function of invigorating blood and promoting circulation, and is used for dry syndrome stasis and blood obstruction type.
2.Anti-spasmodic and pain relief: 25 grams each of Chuan Wu, Cao Wu, Hesperidin and Trigonella, 50 grams each of Turbinicarpus, Cinnamomum, Safflower, Sumac and Peach kernel. The above medicine is crushed into un, decoction first fumigation and then washing, 20 minutes each time, 1 dose per day, 1 time per day, 10~15 days for a course of treatment. It has the function of warming the meridians and dispersing cold, activating blood circulation, and is used for those who have dry syndrome with cyanotic finger ends.
[Exercise therapy]
For dry syndrome, it is advisable to practice the method of swallowing fluid, that is, sitting in the morning every day, concentrating the mind and resting the mind, holding the tongue against the palate, closing the mouth and regulating the breath, the fluid will be produced by itself and gradually become full in the mouth, swallowing it in 3 times, which will be beneficial in the long run. Dry eyes can practice eye work, lightly close both eyes, two thumbs finger back each other rub heat, lightly rub the two eyelids each 18 times, and rub the eyebrows each 18 times, and then make the eyes turn 18 times each. In addition, choose feasible fitness programs according to specific situations, such as taijiquan, taiji arrows, jogging, etc.
[Preventive care]
I. Prevention
1, the disease is easy to repeat, should avoid mental tension and excessive fatigue.
2, careful living, adjust the cold temperature, avoid wind, summer, dryness, fire four evil attack.
Second, care
1, the more serious cases, to rest properly, to ensure adequate sleep.
2, maintain a certain humidity in the room.
3, diet should be thin and soft, light, avoid eating fat, sweet, thick and spicy products, such as onion, mustard, leek, garlic, citrus and mutton, dog meat, eel, etc..
4, often eat Yin food, such as silver fungus, wheat, pears, grapes, mulberries, bird’s nest, bee’s milk, duck, fresh root, water chestnuts, etc..
5, should not take health products that are on the warm side.