{"id":9280,"date":"2024-06-06T01:52:56","date_gmt":"2024-06-06T01:52:56","guid":{"rendered":"https:\/\/tcmdrma.com\/%e3%80%90%e5%8c%bb%e6%a1%88%e3%80%91%e4%b8%ad%e8%8d%af%e6%b2%bb%e7%96%97%e5%b0%8f%e5%84%bf%e6%8c%81%e7%bb%ad%e9%ab%98%e7%83%ad%e7%ba%a2%e7%96%b9%ef%bc%88%e7%96%91%e4%bc%bc%e5%b7%9d%e5%b4%8e%e7%97%85\/"},"modified":"2025-05-09T10:01:33","modified_gmt":"2025-05-09T00:01:33","slug":"%e3%80%90%e5%8c%bb%e6%a1%88%e3%80%91%e4%b8%ad%e8%8d%af%e6%b2%bb%e7%96%97%e5%b0%8f%e5%84%bf%e6%8c%81%e7%bb%ad%e9%ab%98%e7%83%ad%e7%ba%a2%e7%96%b9%ef%bc%88%e7%96%91%e4%bc%bc%e5%b7%9d%e5%b4%8e%e7%97%85","status":"publish","type":"post","link":"https:\/\/tcmdrma.com\/zh-hans\/%e3%80%90%e5%8c%bb%e6%a1%88%e3%80%91%e4%b8%ad%e8%8d%af%e6%b2%bb%e7%96%97%e5%b0%8f%e5%84%bf%e6%8c%81%e7%bb%ad%e9%ab%98%e7%83%ad%e7%ba%a2%e7%96%b9%ef%bc%88%e7%96%91%e4%bc%bc%e5%b7%9d%e5%b4%8e%e7%97%85\/","title":{"rendered":"\u3010\u533b\u6848\u3011\u4e2d\u836f\u6cbb\u7597\u5c0f\u513f\u6301\u7eed\u9ad8\u70ed\u7ea2\u75b9\uff08\u7591\u4f3c\u5ddd\u5d0e\u75c5\u53ca\u65b0\u51a0\u540e\u9057\u75c7\uff09"},"content":{"rendered":"

患儿，男，三岁，突发高热，胸口后背出红疹，初次服用药物后烧退、疹消。再去幼儿园一天后，又开始持续高热难退，大片红疹出现在四肢，双脚肿胀及局部疼痛，双目外侧通红，唇鲜红干燥起皮，一侧颈部淋巴结肿大，舌体鲜红，无汗，无食欲，精神倦怠，尿黄而无大便，容易激动。右脉浮洪数上越，左关强。<\/p>\n

单从症状来看，此病符合西医对于川崎病（Kawasaki disease，KD）的典型诊断指标（多见于5岁以下儿童，持续高烧不退，结膜充血，淋巴腺炎，足部肿胀疼痛，皮疹，草莓舌和嘴唇干燥）。川崎病是一个存在一定危险性的儿科疾病。约 50% 的儿童会出现心脏问题，如快速或不规律的心跳，通常开始于该病发作后 1 至 4 周时。若不治疗，半数有心脏问题的儿童（总计约为五分之一）会发展为最严重的心脏问题，即冠状动脉壁膨出（冠状动脉瘤）。这些动脉瘤可能会破裂或产生血凝块，从而导致心脏病发作和猝死。<\/strong><\/p>\n

目前西医界还有另外一个看法，就是随着新冠病毒的流行，川崎病的发生率明显上升。它类似于Covid-19引起的全身多个器官炎症反应。由于症状的些许差异，它可能不被归入川崎病，而另外称之为 Multisystem inflammatory syndrome in children （MIS-C）。<\/p>\n

从服用中药效果来看，该患者服药第二天红疹消退了80%，高烧降了下来；第三天红疹消退了90%以上，几乎看不出来了，转为低烧或不烧；到第四天红疹已经基本看不出来了，但是唇红舌红未完全消退，这说明热邪退了大部分，但是潜藏起来仍然蓄势待发，仍需坚持服药，以免伏热不除，造成后患。由于病情的危险性，要等到热完全除掉再停药为妥。后期又出现了咳嗽症状，随证加减治之。<\/p>\n

 <\/p>\n

下面谈一谈中医对川崎病的认识和治疗。
\n<\/p>\n

对于中医来讲，区分西医的病名和病理的意义不大，不会影响到对此类疾病的治疗。中医把这类症状划入温病学的范畴。具体来看，患儿脉在浮中位都是洪数的，这代表气分有热。同时，大量皮疹代表热同时也入了营分，代表热邪的位置比较深，已经到了营血的层次。也正因为热入营分，故而在中医看来病情是有危险性的，这种热毒对心包开始产生影响。这符合西医的观察和验证。<\/p>\n

在治疗方面，中医温病学的看法，我大概可以认为患儿的情况属于“气营两燔”，就是气分和营分都有热。由于脉的浮越，我认为包括卫分的热都要一并考虑，同时也要考虑六经层面少阳的问题。处方大概为从银翘散、麻杏石甘汤、小柴胡汤和清营汤加减化裁。治疗原则就是透热转气以及和解少阳。<\/p>\n

这个病案有多个角度值得思考和推敲。<\/p>\n

其一，该患儿大概2、3个月前得过新冠，后面又在幼儿园多次感染流感发热。那么看似病愈，实则余热（温邪）未除，是否是造成后面病入营血的伏笔呢？如果是的话，也许我们确实要注意余毒未清，蛰伏体内所造成的风险。<\/p>\n

其二，我们习惯于把新冠病毒和其他流感分开来看，但事实上，新西兰放开管控之后，是各类病毒包括新冠、流感病毒不断在广泛而交叉传播导致多次反复感染。从这个案例来看，我们不应该只关注单一新冠的危害，而是应该综合考虑这种反复感染温邪的综合效应对人类特定人群的危害。<\/p>\n

其三，西医的治法是发病后10天内静脉注射免疫球蛋白，属于激发患者免疫力的疗法，据统计可以有效降低动脉瘤的发生率。这可以理解为让入里的邪气，通过增强抵抗力往外排，但很遗憾西医遇到这种营血分的疾病是一直缺乏像中医这样直接针对病机的手段的。<\/p>\n

其四，该病要及早发现、及早治疗，否则危害颇大。所以，遇到持续不退的高烧时，一旦出现红疹，患者应该有所警觉，去寻找最恰当的治疗方法。如果只按照中医的气分卫分病治疗，或者西医的流感治疗，等对心脏造成实质性伤害了，无论中西医方法，未免亡羊补牢，造成遗憾。<\/p>\n

 <\/p>\n

注意：中医根据个体差异所采取的治疗手段和治疗效果亦有差异，医案分享不构成治疗建议。<\/p>\n

\n

医案编号：085<\/p>\n","protected":false},"excerpt":{"rendered":"

患儿，男，三岁，突发 […]<\/p>\n","protected":false},"author":1,"featured_media":9281,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","footnotes":""},"categories":[76],"tags":[],"class_list":["post-9280","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-76"],"acf":[],"uagb_featured_image_src":{"full":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5.jpg",1243,1023,false],"thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-150x150.jpg",150,150,true],"medium":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-300x247.jpg",300,247,true],"medium_large":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-768x632.jpg",768,632,true],"large":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-1024x843.jpg",1024,843,true],"1536x1536":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5.jpg",1243,1023,false],"2048x2048":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5.jpg",1243,1023,false],"blog-large":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-669x551.jpg",330,272,true],"blog-medium":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-320x263.jpg",246,202,true],"recent-posts":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-700x576.jpg",536,441,true],"recent-works-thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-66x54.jpg",66,54,true],"fusion-200":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-200x165.jpg",200,165,true],"fusion-400":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-400x329.jpg",400,329,true],"fusion-600":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-600x494.jpg",600,494,true],"fusion-800":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-800x658.jpg",800,658,true],"fusion-1200":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-1200x988.jpg",1200,988,true],"portfolio-full":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-940x774.jpg",486,400,true],"portfolio-one":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-540x444.jpg",331,272,true],"portfolio-two":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-460x379.jpg",358,295,true],"portfolio-three":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-300x247.jpg",260,214,true],"portfolio-five":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-177x146.jpg",172,142,true],"woocommerce_thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-500x412.jpg",500,412,true],"woocommerce_single":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-700x576.jpg",700,576,true],"woocommerce_gallery_thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/06\/\u5ddd\u5d0e\u75c5-100x100.jpg",100,100,true]},"uagb_author_info":{"display_name":"Max Ma","author_link":"https:\/\/tcmdrma.com\/zh-hans\/author\/tcmdrma-com\/"},"uagb_comment_info":0,"uagb_excerpt":"患儿，男，三岁…","_links":{"self":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts\/9280","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/comments?post=9280"}],"version-history":[{"count":1,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts\/9280\/revisions"}],"predecessor-version":[{"id":13840,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts\/9280\/revisions\/13840"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/media\/9281"}],"wp:attachment":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/media?parent=9280"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/categories?post=9280"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/tags?post=9280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}