A case report of primary angiitis of the central nervous system treated adjuvantly with the dispelling pathogen and reinforcing healthy qi method

ZHANG Xinning; CHEN Zhigang; CAI Yingli; LI Nannan; REN Shan; CHEN Lu; KANG Shenghua

doi:10.3969/j.issn.2095-6606.2023.04.024

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A case report of primary angiitis of the central nervous system treated adjuvantly with the dispelling pathogen and reinforcing healthy qi method

Case Reports | 更新时间：2023-08-07

- A case report of primary angiitis of the central nervous system treated adjuvantly with the dispelling pathogen and reinforcing healthy qi method
- Modern Chinese Clinical Medicine Vol. 30, Issue 4, Pages: 112-116(2023)
- 作者机构：
  
  1.北京中医药大学　北京　100029
  2.北京中医药大学东方医院
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.2095-6606.2023.04.024
  CLC： R259
- Received：31 August 2022，
  
  Published：30 July 2023
- 稿件说明：
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ZHANG Xinning, CHEN Zhigang, CAI Yingli, et al. A case report of primary angiitis of the central nervous system treated adjuvantly with the dispelling pathogen and reinforcing healthy qi method[J]. Modern Chinese Clinical Medicine, 2023, 30(4): 112-116.
DOI：

ZHANG Xinning, CHEN Zhigang, CAI Yingli, et al. A case report of primary angiitis of the central nervous system treated adjuvantly with the dispelling pathogen and reinforcing healthy qi method[J]. Modern Chinese Clinical Medicine, 2023, 30(4): 112-116. DOI： 10.3969/j.issn.2095-6606.2023.04.024.

摘要

原发性中枢神经系统血管炎(PACNS)是一种主要累及脑实质、脊髓和软脑膜的中小血管的重度免疫炎性疾病，因该病的罕见性和异质性，目前尚缺乏有效治疗策略。本例PACNS患者在使用激素冲击治疗及免疫抑制治疗后，病情仍持续进展，笔者临证以祛邪扶正为总法，审标本、分主次，以痰、热为主要病邪要素，结合邪实向本虚演变的核心病机变化，先予清热豁痰开窍以祛邪，待患者病势渐缓，又予培元补虚之品加强扶正固本之力。使用中医药祛邪扶正治疗后，患者病情稳定，症状逐渐好转，取得良效，为中医药治疗PACNS提供思路。

Abstract

Primary angiitis of the central nervous system (PACNS) is a severe immunoinflammatory disease mainly affecting small and medium blood vessels in the brain parenchyma

spinal cord and pia mater. Due to its rarity and heterogeneity

effective treatment strategies are currently lacking. In this study

the disease progression was not halted in the patient with PACNS after pulse glucocorticoid therapy and immunosuppressive therapy. In the adjuvant treatment with TCM

the overall principle was to dispel pathogen and reinforce healthy qi

prioritizing the differentiation between the manifestations and root causes and identification of the primary problems. It was consequently found that phlegm and heat were the main pathogenic factors

and the core pathogenesis change was pathogenic excess evolving into deficiency of healthy qi. The first step adopted was to dispel pathogen by clearing heat

eliminating phlegm

and opening the orifices. Qi-nourishing and deficiency-supplementing herbs were used later when the patient’s progression started to slow down. After TCM treatment

the patient’s conditions gradually improved

and remarkable efficacy was achieved

which provided a new perspective for TCM treatment of PACNS.

关键词

Keywords

references

SALVARANI C ， BROWN R J ， CHRISTIANSON T ， et al . An update of the Mayo Clinic cohort of patients with adult primary central nervous system vasculitis: description of 163 patients [J/OL]. Medicine (Baltimore) , 2015 , 94 ( 21 ): e738 [ 2022-02-28 ]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616419/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616419/ .

HAJJ-ALI R A ， CALABRESE L H . Diagnosis and classification of central nervous system vasculitis [J/OL]. J Autoimmun , 2014 , 48-49 : 149 - 152 [ 2022-02-28 ]. https://www.sciencedirect.com/science/article/pii/S0896841114000092？via%3Dihub https://www.sciencedirect.com/science/article/pii/S0896841114000092？via%3Dihub .

BEUKER C ， SCHMIDT A ， STRUNK D ， et al . Primary angiitis of the central nervous system：diagnosis and treatment [J/OL]. Ther Adv Neurol Disord , 2018 , 11 : 1756286418785071 [ 2022-04-10 ]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048610/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048610/ .

BERLIT P ， KRAEMER M . Cerebral vasculitis in adults：what are the steps in order to establish the diagnosis? Red flags and pitfalls [J]. Clin Exp Immunol ， 2014 , 175 ( 3 ): 419 - 424 .

GIANNINI C ， SALVARANI C ， HUNDER G ， et al . Primary central nervous system vasculitis：pathology and mechanisms [J]. Acta Neuropathol ， 2012 , 123 ( 6 ): 759 - 772 .

DANVE A ， GRAFE M ， DEODHAR A . Amyloid beta-related angiitis－－a case report and comprehensive review of literature of 94 cases [J]. Semin Arthritis Rheum ， 2014 , 44 ( 1 ): 86 - 92 .

BOYSSON H ， ZUBER M ， NAGGARA O ， et al . Primary angiitis of the central nervous system：description of the first fifty-two adults enrolled in the French cohort of patients with primary vasculitis of the central nervous system [J]. Arthritis Rheumatol ， 2014 , 66 ( 5 ): 1315 - 1326 .

KRAEMER M ， BERLIT P . Primary central nervous system vasculitis － an update on diagnosis，differential diagnosis and treatment [J/OL]. J Neurol Sci , 2021 , 424 : 117422 [ 2022-04-10 ]. https://www.sciencedirect.com/science/article/pii/S0022510X21001155？via%3Dihub https://www.sciencedirect.com/science/article/pii/S0022510X21001155？via%3Dihub .

SALVARANI C ， BROWN R J ， CALAMIA K T ， et al . Primary central nervous system vasculitis：analysis of 101 patients [J]. Ann Neurol ， 2007 , 62 ( 5 ): 442 - 451 .

GOERTZ C ， WEGNER C ， BRUCK W ， et al . Primary angiitis of the CNS with pure spinal cord involvement：a case report [J]. J Neurol ， 2010 , 257 ( 10 ): 1762 - 1764 .

BHATELE P ， VIBHA D ， SINGH RK ， et al . Tripathi M. primary CNS vasculitis presenting with spinal cord involvement：a rare presentation [J]. Neurol Sci ， 2022 , 43 ( 1 ): 727 - 730 .

POWERS W J . Primary angiitis of the central nervous system：diagnostic criteria [J]. Neurol Clin ， 2015 , 33 ( 2 ): 515 - 526 .

中国免疫学会神经免疫学分会，中华医学会神经病学分会神经免疫学组，中国医师协会神经内科医师分会神经免疫专员委业会 . 原发性中枢神经系统血管炎诊断和治疗中国专家共识 [J]. 中国神经免疫学和神经病学杂志， 2017 , 24 ( 4 ): 229 - 239 .

LIMAYE K ， SAMANIEGO E A ， ADAMS H J . Diagnosis and treatment of primary central nervous system angiitis [J/OL]. Curr Treat Options Neurol , 2018 , 20 ( 9 ): 38 [ 2022-03-23 ]. https://link.springer.com/article/10.1007/s11940-018-0522-5 https://link.springer.com/article/10.1007/s11940-018-0522-5 .

SALVARANI C ， BROWN R J ， CALAMIA K T ， et al . Efficacy of tumor necrosis factor alpha blockade in primary central nervous system vasculitis resistant to immunosuppressive treatment [J]. Arthritis Rheum ， 2008 , 59 ( 2 ): 291 - 296 .

PATEL S ， ROSS L ， OON S ， et al . Rituximab treatment in primary angiitis of the central nervous system [J]. Intern Med J ， 2018 , 48 ( 6 ): 724 - 727 .

PARAMASIVAN N K ， SUNDARAM S ， SHARMA D P ， et al . Rituximab for refractory primary angiitis of the central nervous system：experience in two patients [J/OL]. Mult Scler Relat Disord , 2021 , 51 : 102907 [ 2022-04-12 ]. https://www.sciencedirect.com/science/article/pii/S22-11034821001747？via%3Dihub https://www.sciencedirect.com/science/article/pii/S22-11034821001747？via%3Dihub .

成无己 . 伤寒明理论 [M]. 张国骏，校注. 北京：中国中医药出版社， 2007 : 41 .

秦景明 . 症因脉治 [M]. 冷方南，王齐南，点校. 上海：上海科学技术出版社， 1990 : 33 .

吴仪洛 . 本草从新 [M]. 朱建平，吴文清，点校. 北京：中医古籍出版社， 2001 : 5 .

金芳芳，蔡永敏 . 真气、正气与元气(原气)考辨 [J]. 中华中医药杂志， 2019 , 34 ( 1 ): 78 - 80 .

马婷婷，张甘霖，张博然，等 . 半枝莲和白花蛇舌草药对的研究现状 [J]. 中华中医药杂志， 2021 , 36 ( 6 ): 3491 - 3494 .

岳晓宁，施扬，臧师竹 . 白花蛇舌草对巨噬细胞Cxcl1基因表达的影响及机制的初步研究 [J]. 北京中医药大学学报， 2016 , 39 ( 7 ): 580 - 585 .

王倩，周改莲，周文良，等 . 蜂房的研究进展及其质量标志物预测分析 [J]. 中华中医药学刊， 2021 , 39 ( 1 ): 254 - 258 .

付琳，付强，李冀，等 . 黄连化学成分及药理作用研究进展 [J]. 中医药学报， 2021 , 49 ( 2 ): 87 - 92 .

王立娜，王颖，朱明珠，等 . 土鳖虫的活性成分及药理研究进展 [J]. 化工时刊， 2017 , 31 ( 6 ): 34 - 36 .

陈辉霞，李国毅，程记伟，等 . 全蝎的药理作用及其在脑病中的应用 [J]. 中西医结合心脑血管病杂志， 2021 , 19 ( 18 ): 3137 - 3140 .

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