基于体质调查的小柴胡汤加减治疗系统性红斑狼疮临床研究
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摘要
[目的]总结陈纪藩教授治疗风湿病的学术思想和临床经验,以及对系统性红斑狼疮(SLE)证治的精辟见解,结合历代医家对SLE病因病机和证治方药的认识,形成以体质研究为基础的SLE中医治疗思路,通过对SLE患者的体质研究,探讨SLE患者的体质特点、体质因素和发病的关系,并根据患者的不同体质运用小柴胡汤加减治疗。目的在于探索SLE的病因病机,并观察小柴胡汤加减治疗SLE的临床疗效,为实现运用小柴胡汤加减调养体质的方法防治SLE、改善预后和防止复发等提供理论依据。
[方法]在中医体质理论的指导下,对广州中医药大学第一附属医院2010—-2011年门诊及住院部120例系统性红斑狼疮患者,从性别、年龄、体质类型等方面采用问卷调查的方式进行调查,并对其结果进行统计学分析；并将患者随机分成三组,第一组单纯使用醋酸泼尼松15mg/天,第二组用醋酸泼尼松15mg加小柴胡汤加减(小柴胡汤组以小柴胡汤为基础方,药物组成为：柴胡10g,党参15g,法半夏10g,黄芩10g,大枣10g,生姜5g,甘草5g。根据不同体质类型适当加味,平和质用原方；气虚质加黄芪30g；阳虚质加附子10g(先煎)；阴虚质加女贞子15g、旱莲草15g；痰湿质加茯苓15g、杏仁15g；湿热质加黄柏15g、苍术10g；瘀血质加田七10g；特禀质加升麻10g、防风10g。汤药统一由广州中医药大学第一附属医院煎药室煎煮,每方加入500m1清水,文火煎煮45分钟至150m1,每天一剂。如需用附子则加入750m1清水,先煎附子20分钟,再放入其它药物文火煎煮45分钟至150m1。),第三组用MPC组予醋酸泼尼松15mg/天+甲氨蝶呤片10mg/周+硫酸羟氯喹片400mg/天；记录三组治疗前及治疗后12周的SLEDAI评分、ANA、ds-DNA、CRP、ESR、C3、C4等数值、临床症状改变及服药后的各种不良反应,从而对三种治疗方案的有效性和安全性进行评价。
[结果]1.陈纪藩教授从事中医药临床、教学、科研和管理工作近50年,学识渊博,治学严谨,为人清廉,在中医药防治风湿病领域辛勤耕耘,擅长运用《金匮要略》及《内经》、《伤寒论》等经典著作的理法方药进行辨证论治,辨证上主张注重整体,治疗上推崇从本论治,调和阴阳,平补平泻。陈教授认为,风湿病的辩证须以整体观为指导思想,脏腑经络学说为基本理论；虚是风湿病发病的根本内因,多种病邪交错是其病机特点；调和阴阳是风湿病的治疗大法；辨病与辨证相结合,具体治法因人而异,具体包括攻补兼施、寒温并用、燥润互济等；方药运用上主张针对病因病位选药,加减重在精妙,且惯用药对,巧用虫药,不离藤类；注重功能锻炼和心理疏导。对于SLE,陈教授推崇调理不同SLE患者的不同体质,从而增强患者的抗病及修复能力,提高了临床疗效,降低死亡率,延长疾病的稳定期和缓解期；治疗上擅长用小柴胡汤加减治疗SLE,认为全方寒热并用,攻补兼施,升降协调,有和解少阳,疏利三焦,调达气机,宣通内外,运转枢机之效,为中医经典名方,因其用药精炼,配伍严谨,功效周全,进可攻,退可守,兼顾表里,调和阴阳。陈教授认为,小柴胡汤是SLE治疗的适合选方,根据患者不同体质适当加减,每每见效。
2.体质调查：性别在SLE发病上有极其显著差异,女性发病明显高于男性(P<0.01)；在21—40岁的发病与其它各年龄段有极显著差异(P<0.05)；对SLE患者体质类型调查中发现多见于气虚质、阳虚质、阴虚质及气郁质；年龄大小对阳虚体质、湿热体质的患者有显著影响,病程长短对阳虚体质的患者有显著影响。
3.在治疗轻、中度活动的系统性红斑狼疮患者,激素联合免疫抑制剂治疗方案可取得较好的疗效,但同时也较多的出现胃肠反应、骨髓抑制、感染等不良反应。单纯使用激素,虽也可取得一定疗效,但效果较弱。激素联合中药,一方面可增强临床疗效,另一方面也避免了使用免疫抑制剂常见的不良反应,特别使用于不能耐受免疫抑制剂的患者。
[结论]性别在SLE发病上有极显著性差异,女性发病明显高于男性；在各年龄段系统性红斑狼疮发病有着显著差异,以青中年发病率较高,一般多发生在21—40岁之间；在九种体质中,多见相兼体质,其中气虚质、阳虚质、阴虚质及气郁质发病人较多,年龄大或病程长患者多见阳虚质。在治疗轻、中度系统性红斑狼疮患者的方案中,从有效性及安全性方面考虑可优先选用激素联合小柴胡汤治疗方案,并可根据患者的体质对方药进行加减。
Objection:To summarize Professor Chen Jifan's academic ideas and clinical experience on rheumatism treatment, as well as his incisive opinion of diagnosis and treatment over the systemic lupus erythematous (SLE). Professor Chen Jifan realizes by combining the ancient doctors'knowledge about the pathogenesis of the sickness and the medicine of the treatment over SLE. This has formed the traditional Chinese treatment ideas of SLE based on constitutional research. By researching the constitution of the SLE patients, probing into the physical characteristics, factors and the cause of the disease of the SLE patients. Then apply the Revised Xiaochaihu decoction treatment onto the patients according to their different constitution. Purposeis to explore the pathogenesis of SLE, and observe the clinical efficacy of Revised Xiaochaihu decoction treatment of SLE, to achieve the use of Revised Xiaochaihu decoction to aftercare constitution.
METHORD:Follow the outline that has been laid out within the traditional Chinese constitutional theory. The research for120SLE patients who had the medical treatment in the outpatient department and inpatient department of the1st affiliated TCM hospital of Guangzhou TCM University from2010to2011. This investigation with the questionnaire survey based off gender, age, constitution aspects and so on. Then do the statistical analysis to the result; all the patients are randomly divided into three groups:The first group use Prednisone acetate15mg per day. The second group would use Prednisone acetate15mg and Revised Xiaochaihu decoction (Xiaochaihu decoction group is basically with Xiaochaihu decoction, including bupleurumlOg, lanceolata15g, prepared pinellia tuber10g, scutellaria lOg, jujube10g, ginger5g, glycyrrhiza5g. This will mix together with some of the medicine according to different constitutions. Gentleness type constitution just follow the original soup; Qi-deficiency constitution will need to be mixedwith Astragalus30g. Yang-deficiency constitution will need to mix with prepared aconite root lOg (boil first) and then the Yin-deficiency constitution will need to mix with ligustrum lucidum15g、eclipta prostrata15g.After that the phlegm and dampness constitution will need to mix with tuckahoe15g、almond15g; and dampness-heat constitution will need to mix with cortex phellodendri15g、finally the chinese atractylodes10g; combined with the Blood stasis constitution will need to mix with pseudo-ginseng lOg and special diathesis type constitution will need to mix with black cohosh10g、divaricate saposhnikovia root10g. All of this medicine soup should be boiled in the medicine boiled room of the1st affiliated TCM hospital of Guangzhou TCM University. After that place500ml water into each prescription and boil it for45minutes. Please make sure the fire is set at a low setting and only leave150ml of water and take one prescription each day. If it needs to be mixed with prepared aconite root, then you should place750ml of water into each prescription. Then boil the prepared aconite root for20minutes after that mix the other medicine with it and boil it for45minutes with a low fire setting and only leave150ml water.The third group will use MPH group with Prednisone15mg and Hydroxychlorquine400mg per day, and MTX10mg per week. The record of the SLEDAI score should be taken, and the figure of ANA、 ds-DNA、CRP、 ESR、C3、C4and so on. The changes in clinical symptoms and the variety of adverse reactions should be noted after taking the medicine from the three different groups. This should be noted before the treatment and six months after the treatment, so that we can evaluate the efficacy and safety to the three treatment options.
RESULT:1. Professor Chen Jifan has been engaged in clinical medicine, teaching, resear-ch and management for nearly50years. Professor Jifan is a very knowledgeable person when it comes to the field of traditional medicine and alternative treat-ments. A person who prides himself with bringing honestly as well as hard work to the workplace. Professor Jifan has a strong background in the field of rheum-atism traditional Chinese medicine prevention and treatment. Using the "Synopsis of Golden Chamber","Inner Canon of Huangdi" and "Treatise on Cold Pathogenic Diseases"and otherclassics'methods and prescriptions to diagnosis and treatment. He advocates pay close attention to the entirety diagnose also stresses highly that treatment should be fundamental and reconciles the Yin and Yang reinforcing and reducing. Professor Chen thinks that Deficiency is a fundamental internal cause of rheumatismand the characteristics of its pathogenesis are various sicknesses mixed together. Thus the best method of a rheumatism treatment is to reconcile the Yin and Yang, combine diseases and symptoms. The treatment is different from person to person, including toxic-purgitive methods, cold-warm drugs and dry-moist drugs etc. Prescription drugs are highly suggested selecting the medicine base on the cause and the current status of the disease, cautiously revise, use parallel medications, worms and vines. Then focus on functional training and psychological counseling. For SLE, Professor Chen would like to give the SLE patients treatment according to their own constitution. Therefore, it enhanced the patients'ability of disease resistance and body reparation. This also improves the clinical effect and reduces mortality as well as prolongs the stabilization and remission of the disease. Professor Chen is good at using the Revised Xiaochaihu decoction for SLE treatment. The prescription was considered as the Chinese classic prescription, its cold-warm methods, toxic-purgative methods, up-descending regulations, comprising Shao-yang, smoothing San-jiao, regulating Qi. Revised Xiaochaihu decoction is a very refined as well as efficient and compatible with the human body. Toxic-purgative methods are used alternatively. He Considers both the exterior and interior of the body, reconciles theYin and Yang. Professor Chen thinks that theRevised Xiaochaihu decoction is the appropriate prescription for the SLE treatment. Apply itaccording to different patients'constitutions, it works every time.
2. Constitutional investigation:the SLE has extremely significant differences on gender women's incidence of disease is higher than men (P<0.01), there is a significant difference of incidence in the21-40year-old age group(P<0.05). In a survey done on patients with SLE, their constitutional types commonly found Qi-deficiency constitution Yang-deficiency constitution Yin-deficiency constitution and Impressed constitution. That age has a significant influence on patients of Yang-deficiency constitution and Wet-heat constitution. The duration of disease have a significant effect on patients of Yang-deficiency constitution.
3. Three kinds of treatment options:
Three kinds of treatment options are effective in clinicalefficacy. Among three of them, the effectiveness of the first group is the lowest while the third group is the highest. In terms of clinical safety, the second group is significantlyhigher than the other two groups.
CONCLUSION:The SLE has extremely significant differenceson gender; women' sincidence of disease is higher than men. SLE has a significant difference in all age group,higher incidence of young adult, more commonly occurs between the ages of21-40. In the nine kinds of constitutions, mixed constitutions are commonly exist, of which more patients are Qi-deficiency constitution. The Yang-deficiency constitution、 Yin-deficiency constitutionand Impressed constitution, older patients or patients with longer duration of disease are commonly seen in Yang-deficiency constitution. In the treatment option of treating patients from mild to moderate SLE, efficacy and safety are taken into consideration. Thus, we prefer to choose combined hormone and Xiaochaihu decoction for treatment, and apply it according to different patients'constitutions.
[方法]在中医体质理论的指导下,对广州中医药大学第一附属医院2010—-2011年门诊及住院部120例系统性红斑狼疮患者,从性别、年龄、体质类型等方面采用问卷调查的方式进行调查,并对其结果进行统计学分析；并将患者随机分成三组,第一组单纯使用醋酸泼尼松15mg/天,第二组用醋酸泼尼松15mg加小柴胡汤加减(小柴胡汤组以小柴胡汤为基础方,药物组成为：柴胡10g,党参15g,法半夏10g,黄芩10g,大枣10g,生姜5g,甘草5g。根据不同体质类型适当加味,平和质用原方；气虚质加黄芪30g；阳虚质加附子10g(先煎)；阴虚质加女贞子15g、旱莲草15g；痰湿质加茯苓15g、杏仁15g；湿热质加黄柏15g、苍术10g；瘀血质加田七10g；特禀质加升麻10g、防风10g。汤药统一由广州中医药大学第一附属医院煎药室煎煮,每方加入500m1清水,文火煎煮45分钟至150m1,每天一剂。如需用附子则加入750m1清水,先煎附子20分钟,再放入其它药物文火煎煮45分钟至150m1。),第三组用MPC组予醋酸泼尼松15mg/天+甲氨蝶呤片10mg/周+硫酸羟氯喹片400mg/天；记录三组治疗前及治疗后12周的SLEDAI评分、ANA、ds-DNA、CRP、ESR、C3、C4等数值、临床症状改变及服药后的各种不良反应,从而对三种治疗方案的有效性和安全性进行评价。
[结果]1.陈纪藩教授从事中医药临床、教学、科研和管理工作近50年,学识渊博,治学严谨,为人清廉,在中医药防治风湿病领域辛勤耕耘,擅长运用《金匮要略》及《内经》、《伤寒论》等经典著作的理法方药进行辨证论治,辨证上主张注重整体,治疗上推崇从本论治,调和阴阳,平补平泻。陈教授认为,风湿病的辩证须以整体观为指导思想,脏腑经络学说为基本理论；虚是风湿病发病的根本内因,多种病邪交错是其病机特点；调和阴阳是风湿病的治疗大法；辨病与辨证相结合,具体治法因人而异,具体包括攻补兼施、寒温并用、燥润互济等；方药运用上主张针对病因病位选药,加减重在精妙,且惯用药对,巧用虫药,不离藤类；注重功能锻炼和心理疏导。对于SLE,陈教授推崇调理不同SLE患者的不同体质,从而增强患者的抗病及修复能力,提高了临床疗效,降低死亡率,延长疾病的稳定期和缓解期；治疗上擅长用小柴胡汤加减治疗SLE,认为全方寒热并用,攻补兼施,升降协调,有和解少阳,疏利三焦,调达气机,宣通内外,运转枢机之效,为中医经典名方,因其用药精炼,配伍严谨,功效周全,进可攻,退可守,兼顾表里,调和阴阳。陈教授认为,小柴胡汤是SLE治疗的适合选方,根据患者不同体质适当加减,每每见效。
2.体质调查：性别在SLE发病上有极其显著差异,女性发病明显高于男性(P<0.01)；在21—40岁的发病与其它各年龄段有极显著差异(P<0.05)；对SLE患者体质类型调查中发现多见于气虚质、阳虚质、阴虚质及气郁质；年龄大小对阳虚体质、湿热体质的患者有显著影响,病程长短对阳虚体质的患者有显著影响。
3.在治疗轻、中度活动的系统性红斑狼疮患者,激素联合免疫抑制剂治疗方案可取得较好的疗效,但同时也较多的出现胃肠反应、骨髓抑制、感染等不良反应。单纯使用激素,虽也可取得一定疗效,但效果较弱。激素联合中药,一方面可增强临床疗效,另一方面也避免了使用免疫抑制剂常见的不良反应,特别使用于不能耐受免疫抑制剂的患者。
[结论]性别在SLE发病上有极显著性差异,女性发病明显高于男性；在各年龄段系统性红斑狼疮发病有着显著差异,以青中年发病率较高,一般多发生在21—40岁之间；在九种体质中,多见相兼体质,其中气虚质、阳虚质、阴虚质及气郁质发病人较多,年龄大或病程长患者多见阳虚质。在治疗轻、中度系统性红斑狼疮患者的方案中,从有效性及安全性方面考虑可优先选用激素联合小柴胡汤治疗方案,并可根据患者的体质对方药进行加减。
Objection:To summarize Professor Chen Jifan's academic ideas and clinical experience on rheumatism treatment, as well as his incisive opinion of diagnosis and treatment over the systemic lupus erythematous (SLE). Professor Chen Jifan realizes by combining the ancient doctors'knowledge about the pathogenesis of the sickness and the medicine of the treatment over SLE. This has formed the traditional Chinese treatment ideas of SLE based on constitutional research. By researching the constitution of the SLE patients, probing into the physical characteristics, factors and the cause of the disease of the SLE patients. Then apply the Revised Xiaochaihu decoction treatment onto the patients according to their different constitution. Purposeis to explore the pathogenesis of SLE, and observe the clinical efficacy of Revised Xiaochaihu decoction treatment of SLE, to achieve the use of Revised Xiaochaihu decoction to aftercare constitution.
METHORD:Follow the outline that has been laid out within the traditional Chinese constitutional theory. The research for120SLE patients who had the medical treatment in the outpatient department and inpatient department of the1st affiliated TCM hospital of Guangzhou TCM University from2010to2011. This investigation with the questionnaire survey based off gender, age, constitution aspects and so on. Then do the statistical analysis to the result; all the patients are randomly divided into three groups:The first group use Prednisone acetate15mg per day. The second group would use Prednisone acetate15mg and Revised Xiaochaihu decoction (Xiaochaihu decoction group is basically with Xiaochaihu decoction, including bupleurumlOg, lanceolata15g, prepared pinellia tuber10g, scutellaria lOg, jujube10g, ginger5g, glycyrrhiza5g. This will mix together with some of the medicine according to different constitutions. Gentleness type constitution just follow the original soup; Qi-deficiency constitution will need to be mixedwith Astragalus30g. Yang-deficiency constitution will need to mix with prepared aconite root lOg (boil first) and then the Yin-deficiency constitution will need to mix with ligustrum lucidum15g、eclipta prostrata15g.After that the phlegm and dampness constitution will need to mix with tuckahoe15g、almond15g; and dampness-heat constitution will need to mix with cortex phellodendri15g、finally the chinese atractylodes10g; combined with the Blood stasis constitution will need to mix with pseudo-ginseng lOg and special diathesis type constitution will need to mix with black cohosh10g、divaricate saposhnikovia root10g. All of this medicine soup should be boiled in the medicine boiled room of the1st affiliated TCM hospital of Guangzhou TCM University. After that place500ml water into each prescription and boil it for45minutes. Please make sure the fire is set at a low setting and only leave150ml of water and take one prescription each day. If it needs to be mixed with prepared aconite root, then you should place750ml of water into each prescription. Then boil the prepared aconite root for20minutes after that mix the other medicine with it and boil it for45minutes with a low fire setting and only leave150ml water.The third group will use MPH group with Prednisone15mg and Hydroxychlorquine400mg per day, and MTX10mg per week. The record of the SLEDAI score should be taken, and the figure of ANA、 ds-DNA、CRP、 ESR、C3、C4and so on. The changes in clinical symptoms and the variety of adverse reactions should be noted after taking the medicine from the three different groups. This should be noted before the treatment and six months after the treatment, so that we can evaluate the efficacy and safety to the three treatment options.
RESULT:1. Professor Chen Jifan has been engaged in clinical medicine, teaching, resear-ch and management for nearly50years. Professor Jifan is a very knowledgeable person when it comes to the field of traditional medicine and alternative treat-ments. A person who prides himself with bringing honestly as well as hard work to the workplace. Professor Jifan has a strong background in the field of rheum-atism traditional Chinese medicine prevention and treatment. Using the "Synopsis of Golden Chamber","Inner Canon of Huangdi" and "Treatise on Cold Pathogenic Diseases"and otherclassics'methods and prescriptions to diagnosis and treatment. He advocates pay close attention to the entirety diagnose also stresses highly that treatment should be fundamental and reconciles the Yin and Yang reinforcing and reducing. Professor Chen thinks that Deficiency is a fundamental internal cause of rheumatismand the characteristics of its pathogenesis are various sicknesses mixed together. Thus the best method of a rheumatism treatment is to reconcile the Yin and Yang, combine diseases and symptoms. The treatment is different from person to person, including toxic-purgitive methods, cold-warm drugs and dry-moist drugs etc. Prescription drugs are highly suggested selecting the medicine base on the cause and the current status of the disease, cautiously revise, use parallel medications, worms and vines. Then focus on functional training and psychological counseling. For SLE, Professor Chen would like to give the SLE patients treatment according to their own constitution. Therefore, it enhanced the patients'ability of disease resistance and body reparation. This also improves the clinical effect and reduces mortality as well as prolongs the stabilization and remission of the disease. Professor Chen is good at using the Revised Xiaochaihu decoction for SLE treatment. The prescription was considered as the Chinese classic prescription, its cold-warm methods, toxic-purgative methods, up-descending regulations, comprising Shao-yang, smoothing San-jiao, regulating Qi. Revised Xiaochaihu decoction is a very refined as well as efficient and compatible with the human body. Toxic-purgative methods are used alternatively. He Considers both the exterior and interior of the body, reconciles theYin and Yang. Professor Chen thinks that theRevised Xiaochaihu decoction is the appropriate prescription for the SLE treatment. Apply itaccording to different patients'constitutions, it works every time.
2. Constitutional investigation:the SLE has extremely significant differences on gender women's incidence of disease is higher than men (P<0.01), there is a significant difference of incidence in the21-40year-old age group(P<0.05). In a survey done on patients with SLE, their constitutional types commonly found Qi-deficiency constitution Yang-deficiency constitution Yin-deficiency constitution and Impressed constitution. That age has a significant influence on patients of Yang-deficiency constitution and Wet-heat constitution. The duration of disease have a significant effect on patients of Yang-deficiency constitution.
3. Three kinds of treatment options:
Three kinds of treatment options are effective in clinicalefficacy. Among three of them, the effectiveness of the first group is the lowest while the third group is the highest. In terms of clinical safety, the second group is significantlyhigher than the other two groups.
CONCLUSION:The SLE has extremely significant differenceson gender; women' sincidence of disease is higher than men. SLE has a significant difference in all age group,higher incidence of young adult, more commonly occurs between the ages of21-40. In the nine kinds of constitutions, mixed constitutions are commonly exist, of which more patients are Qi-deficiency constitution. The Yang-deficiency constitution、 Yin-deficiency constitutionand Impressed constitution, older patients or patients with longer duration of disease are commonly seen in Yang-deficiency constitution. In the treatment option of treating patients from mild to moderate SLE, efficacy and safety are taken into consideration. Thus, we prefer to choose combined hormone and Xiaochaihu decoction for treatment, and apply it according to different patients'constitutions.
引文
[1]张秡,王萍.张志礼教授治疗系统性红斑狼疮的临床经验[J].中国中西医结合皮肤性病学杂志,2003,2(3)：135-138.
[2]陈湘君,周高时,苏励,等.滋阴解毒法为主对SLE免疫紊乱调节作用的研究[J].辽宁中医杂志,1995,22(6)：257-259.
[3]朱方石,金实,汪悦.从肾虚毒瘀论治系统性红斑狼疮的理论机制探讨[J].中国中医药信息杂志,20007,7(11)：9.
[4]陈会如,李振洁.艾儒棣治疗系统性红斑狼疮的经验[J].浙江中医杂志,2003,38(2)：51—52.
[5]王欣.中医治疗系统性红斑狼疮的优势与进展[J].浙江中医杂志,1996,31(5)：234.
[6]刁金山,郑启友,刁长允,等.燥湿祛瘀法治疗系统性红斑狼疮的临床研究[J].河南中医,1995-15(2)：88—91.
[7]郑筱萸.中医药临床研究指导原则[M].北京：中医药科技出版社,2002：111-115.
[8]赵来泗,王瑞芳.系统性红斑狼疮辨证治疗体会[J].黑龙江中医药,2000,3(1)：25.
[9]范永升.中医药治疗系统性红斑狼疮的探讨[J].浙江中医杂志,2002,5：200.
[10]史俊萍,史宝印.分型辨治红斑狼疮的经验体会[J].辽宁中医杂志,1998,4：20.
[11]赵团结,于黎.系统性红斑狼疮分型辨治体会[J].河南中医,1999,6：17.
[12]左晓霞,陶立坚,高洁生.凯利风湿病学第7版[M].北京：人民卫生出版社,2006,1005,1081.
[13]万焰,刁庆春.遗传因素在系统性红斑狼疮发病机制中的作用[J].重庆医学,2010,21(39)：2973-2975.
[14]Sigal LH·Basic science for the clinician 42:handling the corpses: apoptosis, necrosis, nucleosomes and (quite poss bly) the immunopathogenesis of SLE·J Clin Rheumato,12007,13(1):44-48.
[15]王晓冰.细胞凋亡在系统性红斑狼疮发病机制中的作用[J].国际内科学杂志,2007,34(12)：720-722.
[16]SheriffA, GaiplUS, VollRE, etal·Apoptosis and systemic lupus erythematosus·Rheum Dis Clin North Am,2004,30 (3):505-527.
[17]叶冬青,胡以松,李向培,等.系统性红斑狼疮发病的环境因素及其与几种趋化因子基因的交互作用[J].中华流行病学杂志,2004,11(25)：949-953.
[18]Sanchez-Guerrero J, Liang MH, Karlson EW, etal·Postmenopausal estrogen therapy and the risk for developing systemic lupus erythematosus ·Ann Intern Med 122:430,1995.
[19]Sanchez-Guerrero J, Karlson EW, Liang MH, etal·Past use of oral contraceptives and the risk for developing systemic lupus erythematosus·Arthritis Rheum 40:804,1997.
[20]中华医学会风湿病学分会.系统性红斑狼疮诊治指南(草案)[J].中华风湿病学杂志,2003,7(8)：508-513.
[21]龙武彬,朱静.SLE患者4种炎症指标检测的临床意义[J].西部医学,2009,21(7)：1103一1104.
[22]Flances, Robertsma, Strippoligf, etal. Treatment of diffuse p-roliferative lupua nephtitis meta-analysis of randomized controlled trials. Am J Kidney D,2004,43 (2):197-208.
[23]Dooley MA, Ginzlere M.Newer therapteic approache for systemic lupus erythematosus Immunosuppressive agents[J].Rh Dis Clin North AM,2006,32(1):91-102.
[24]Remer CF, Weisman MH, Wallace DJ. Benefit of leflunomidein systemic lupus erythematosus:a pilot observational study[J]. Lupus,2001,10(7):480.
[25]张敏,门燕荣,李兴梅,等.中西医治疗系统性红斑狼疮的概况[J].中华实用中西医杂志,2008,21(8)：623-624.
[26]于盂学,曹金,李薇.生物制剂治疗系统性红斑狼疮的新进展[J].北京医学,2008,30(1)
[27]孙乐栋,钱芳,曾抗.系统性红斑狼疮的治疗[J].岭南皮肤性病科杂志,2008,15(4)：248-250.
[28]王琦,盛增秀.中医体质学说[M]。南京：江苏科技出版社,1982 1-5.
[29]匡调元.中医病理研究[M].上海：上海科技出版社,1980：66.
[30]何裕民.新编中医基础理论[M].北京：北京医科大学中国协和医科大学联合出版社,1996：113.
[31]王阔.冠心病心绞痛(胸痹心痛)与中医体质的相关性研究[D].辽宁：辽宁中医药大学,2010：12.
[32]雷旭杰.中医体质与强直性脊柱炎患者缓解期功能的相关性研究[D].广东：广州中医药大学,2007：12-13.
[33]王琦.中医体质学说[M].北京：中国医药科技出版社,1995：68-75.
[34]匡调元.论辨证与辨体质[J].中国中医基础医学杂志,2002,5(2)：1-5.
[35]牛向荣.柴胡药理作用研究概述[J].中国药师.2009,12 (9)：1310-1311
[36]王缨,朱建军,曾晓辉.小柴胡汤免疫-内分泌调节药理研究概述.辽宁中医杂志,2008,35(12)：1949
[37]季庆亮.小柴胡汤对免疫系统的作用[J].科技咨询导报.2007, (9)：86
[38]刘德宜,刘光智,张超,等.小柴胡汤免疫调节作用的实验研究[J].山东医药.2003,43(22)：27
[39]陈纪藩,金匮要略,北京：人民卫生出版社,2000,第一版：21.
[40]林昌松,关彤,刘晓玲,等.陈纪藩治疗类风湿关节炎临证经验述要.中医药学刊,2004，22(2)：214。
[41]刘敏.陈纪藩运用对药治疗痹病的经验.中华中医药杂志,2006,21(10)：604.
[2]陈湘君,周高时,苏励,等.滋阴解毒法为主对SLE免疫紊乱调节作用的研究[J].辽宁中医杂志,1995,22(6)：257-259.
[3]朱方石,金实,汪悦.从肾虚毒瘀论治系统性红斑狼疮的理论机制探讨[J].中国中医药信息杂志,20007,7(11)：9.
[4]陈会如,李振洁.艾儒棣治疗系统性红斑狼疮的经验[J].浙江中医杂志,2003,38(2)：51—52.
[5]王欣.中医治疗系统性红斑狼疮的优势与进展[J].浙江中医杂志,1996,31(5)：234.
[6]刁金山,郑启友,刁长允,等.燥湿祛瘀法治疗系统性红斑狼疮的临床研究[J].河南中医,1995-15(2)：88—91.
[7]郑筱萸.中医药临床研究指导原则[M].北京：中医药科技出版社,2002：111-115.
[8]赵来泗,王瑞芳.系统性红斑狼疮辨证治疗体会[J].黑龙江中医药,2000,3(1)：25.
[9]范永升.中医药治疗系统性红斑狼疮的探讨[J].浙江中医杂志,2002,5：200.
[10]史俊萍,史宝印.分型辨治红斑狼疮的经验体会[J].辽宁中医杂志,1998,4：20.
[11]赵团结,于黎.系统性红斑狼疮分型辨治体会[J].河南中医,1999,6：17.
[12]左晓霞,陶立坚,高洁生.凯利风湿病学第7版[M].北京：人民卫生出版社,2006,1005,1081.
[13]万焰,刁庆春.遗传因素在系统性红斑狼疮发病机制中的作用[J].重庆医学,2010,21(39)：2973-2975.
[14]Sigal LH·Basic science for the clinician 42:handling the corpses: apoptosis, necrosis, nucleosomes and (quite poss bly) the immunopathogenesis of SLE·J Clin Rheumato,12007,13(1):44-48.
[15]王晓冰.细胞凋亡在系统性红斑狼疮发病机制中的作用[J].国际内科学杂志,2007,34(12)：720-722.
[16]SheriffA, GaiplUS, VollRE, etal·Apoptosis and systemic lupus erythematosus·Rheum Dis Clin North Am,2004,30 (3):505-527.
[17]叶冬青,胡以松,李向培,等.系统性红斑狼疮发病的环境因素及其与几种趋化因子基因的交互作用[J].中华流行病学杂志,2004,11(25)：949-953.
[18]Sanchez-Guerrero J, Liang MH, Karlson EW, etal·Postmenopausal estrogen therapy and the risk for developing systemic lupus erythematosus ·Ann Intern Med 122:430,1995.
[19]Sanchez-Guerrero J, Karlson EW, Liang MH, etal·Past use of oral contraceptives and the risk for developing systemic lupus erythematosus·Arthritis Rheum 40:804,1997.
[20]中华医学会风湿病学分会.系统性红斑狼疮诊治指南(草案)[J].中华风湿病学杂志,2003,7(8)：508-513.
[21]龙武彬,朱静.SLE患者4种炎症指标检测的临床意义[J].西部医学,2009,21(7)：1103一1104.
[22]Flances, Robertsma, Strippoligf, etal. Treatment of diffuse p-roliferative lupua nephtitis meta-analysis of randomized controlled trials. Am J Kidney D,2004,43 (2):197-208.
[23]Dooley MA, Ginzlere M.Newer therapteic approache for systemic lupus erythematosus Immunosuppressive agents[J].Rh Dis Clin North AM,2006,32(1):91-102.
[24]Remer CF, Weisman MH, Wallace DJ. Benefit of leflunomidein systemic lupus erythematosus:a pilot observational study[J]. Lupus,2001,10(7):480.
[25]张敏,门燕荣,李兴梅,等.中西医治疗系统性红斑狼疮的概况[J].中华实用中西医杂志,2008,21(8)：623-624.
[26]于盂学,曹金,李薇.生物制剂治疗系统性红斑狼疮的新进展[J].北京医学,2008,30(1)
[27]孙乐栋,钱芳,曾抗.系统性红斑狼疮的治疗[J].岭南皮肤性病科杂志,2008,15(4)：248-250.
[28]王琦,盛增秀.中医体质学说[M]。南京：江苏科技出版社,1982 1-5.
[29]匡调元.中医病理研究[M].上海：上海科技出版社,1980：66.
[30]何裕民.新编中医基础理论[M].北京：北京医科大学中国协和医科大学联合出版社,1996：113.
[31]王阔.冠心病心绞痛(胸痹心痛)与中医体质的相关性研究[D].辽宁：辽宁中医药大学,2010：12.
[32]雷旭杰.中医体质与强直性脊柱炎患者缓解期功能的相关性研究[D].广东：广州中医药大学,2007：12-13.
[33]王琦.中医体质学说[M].北京：中国医药科技出版社,1995：68-75.
[34]匡调元.论辨证与辨体质[J].中国中医基础医学杂志,2002,5(2)：1-5.
[35]牛向荣.柴胡药理作用研究概述[J].中国药师.2009,12 (9)：1310-1311
[36]王缨,朱建军,曾晓辉.小柴胡汤免疫-内分泌调节药理研究概述.辽宁中医杂志,2008,35(12)：1949
[37]季庆亮.小柴胡汤对免疫系统的作用[J].科技咨询导报.2007, (9)：86
[38]刘德宜,刘光智,张超,等.小柴胡汤免疫调节作用的实验研究[J].山东医药.2003,43(22)：27
[39]陈纪藩,金匮要略,北京：人民卫生出版社,2000,第一版：21.
[40]林昌松,关彤,刘晓玲,等.陈纪藩治疗类风湿关节炎临证经验述要.中医药学刊,2004，22(2)：214。
[41]刘敏.陈纪藩运用对药治疗痹病的经验.中华中医药杂志,2006,21(10)：604.
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