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陈永 住院医师 上海华东医院 免疫风湿科

我是怎么征服银屑病的

陈永 住院医师 上海华东医院 免疫风湿科
发表于2018-02-09
人已读

灸不是土东西,灸是科学的。不中国人要用她,将来全世界人民都要用它治病。复旦大学附属华东医院免疫风湿科陈永

--毛泽东语 (是为题记)

银屑病,就是俗称的牛皮癣。有多难治呢?医生有句话叫看病不看癣,看过真丢脸。可见牛皮癣有多难治。激素乳膏,一涂就好,一停就发。由于其痒无比,其丑无比,它带给患者躯体和心理的危害和其难治性不必赘述。

作为一个西医内科主治医师,在下长期以来主张整合医学服务于患者,且对针灸学有着浓厚的兴趣。当然,牛皮癣光用一般的针灸就得呵呵了。在下曾经试过数例,均以失败告终。如果不是我的技术不行,那一定是国内有些同行对针灸治疗银屑病的报导可能是弄虚作假。

患者是我大学(原贵阳医学院,现贵州医科大学)同学的爱人。我这个同学目前在贵州省人民医院儿科就职。他爱人的是银屑病什么情况呢?

治疗前后2.jpg

腹部、胸部大片银屑病皮肤病变。

腰背部大片银屑病病变。

双下肢内外侧全都是银屑病病变。

关键是这个患者的银屑病已经有20年了。20年来,反复治疗均已失败告终。我同学和他也是结婚生子,虽然我同学在贵州最好的医院就职,对其爱人的病情也一筹莫展。有一天在大学同学的微信群里面聊天,她无意间问及我此病可有的医?为什么问我,因为我在大学里是小有名气的怪胎,考了医师资格证是西医队伍里面的叛徒。但看病,确实有一套。

我采用的方法叫做自体血穴位注射。多年以来,对该疗法的关注,使我相信其可能会在多种自身免疫性疾病中有鬼斧神工。同学和她爱人从贵阳就千里迢迢来到上海来找我。治疗方法是用20ml针管抽取15ml静脉血(注意要加抗凝剂),3ml利多卡因(打的穴位较多,可避免疼痛)。他们在上海的时间宝贵,隔2天一次,每次10个穴位左右,选穴主要是局部取穴和一些免疫调节功能的穴位,并无特殊。打了3次以后,患者觉皮肤不再发痒!每次注射我的同学在旁边拍照、录像。因为这是一个慢性的疾病,我估计要治疗许多次,所以要教会我的同学,毕竟他们无法在上海常驻。

回去以后,每周3次,皮疹消退的特别快。2个月以后,改用5ml注射器,每次5个穴位,期间小复发一次。继续4个月后,患者基本痊愈。什么样子呢?他们给我发来了照片

胸腹部银屑病病变完全消退(有色素沉着)

腰背部皮疹完全消退

双下肢皮疹完全消退。

对的!就是这么神奇。那么有没有复发?我叮嘱我同学,每半个月要巩固一次。但是她呵呵,医生嘛,太忙。至今已有两年,从来没有再发过。

自体血穴位注射是中国卫生部门批准的正规治疗,但是由于其需要采血(一般中医医师不会)、穴位注射(基本上所有西医师不懂),加之定价过于低廉,目前掌握的医师十分少了。

那么效果如此神奇,其治疗机理为那般?

我常常和医学同道尤其是基础医学研究者说起其机理,他们听后常常长吁短叹哦,原来如此。我将撰写的英文版机理猜测”copy如下,如果你看不懂,即使写成中文,你也不懂。

Acupuncture is originated in China nearly 2500 years ago for treating various illness[8]. Although full of disputation and sometimes been despised, its undeniable clinical effectiveness and increasing double-blinded, placebo-controlled studies in the past decades wins acceptance from both patients and health providers world widely. The mechanisms of action has being gradually investigated and illustrated from the studies on nerve-endocrine-immune system[9, 10] in certain degree. Except for a few clinical trials on injury of locomotor system[11, 12] were reported, self-blood acupuncture is rarely applied and investigated outside of China. The treatment was reported effect on eczema, urticarial, asthma, hepatitis, cancer related syndromes, etc. Around 930 cases of psoriasis treated with this method were reported in Chinese medical journals with satisfied benefit for patients. Although autologous blood acupuncture is an approved therapy by Chinese government and has an acceptable service price (specifically, less than 2 USD for each acupoints), covered by medical insurance, very few practitioners can carry out this technique nowadays.

Psoriasis is a long-lasting autoimmune disease, which is currently no cure available. The existing treatment options providing certain improving management however, not for this case and generally unsatisfied for most patients from impaired physical and psychological health to economic burden[13, 14]. Self-blood acupuncture seems to achieve an unbelievable effectiveness for this patient and reported psoriasis patients reported in China. Since no basic research in this area, the mechanism is absolute obscure. I hypotheses the mechanism of the therapy as: The pathogenesis of psoriasis vulgaris is mediated by T cells and dendritic cells. Inflammatory myeloid dendritic cells release IL-23 and IL-12 to activate IL-17-producing T cells, Th1 cells, and Th22 cells to produce abundant psoriatic cytokines IL-17, IFN-γ, TNF, and IL-22. These cytokines mediate effects on keratinocytes to amplify psoriatic inflammation[15].

However, these cytokines were originally produced to defend the pathogens such as streptococcus[16], Malassezia, and Candida albicans[17], which might be the cause of psoriasis. A pathogenic cross-talk between keratinocytes, dendritic cells, and T cells, sustained by TNF, IL-23 and IL-17 and supported by other immune cell players and further pro-inflammatory molecules, underlie the dysregulated immune response observed in psoriasis[15]. Besides of amount changes in cytokines, their gene mutations and structure abnormalities are also involved in autoimmune diseases[18, 19].

What will happen if those impaired immune cells and secreted cytokines transferred from venous blood to an acupoint, or more simplified, subcutaneous tissue and muscular tissue? An inflammatory reaction will be induced. After all, Inflammation is a biological response of body tissues to stimuli. Normally, there is no inflammatory cells exists in skeleton muscle, while the stimuli of patient’s blood components arouse a tropism of immune cells and their inflammatory reaction in the muscular tissue where the blood injected.

clear.jpg

Figure 2: Underline hypothesis of self-blood acupuncture

1. After injection of self-blood, a local inflammatory reaction is induced to absorb the blood components, which activate both innate and acquired immune reaction; 2. The blood components is regarded as personalized composite vaccine, which leads to a termination of immune tolerance to immune cells participated in psoriasis; 3. A physiological mild autoimmune reaction is established to control the pathological autoimmune reaction in psoriasis

Due to the immunological tolerance, the immune cells and their cytokines of the autoimmune diseases produced continuously in bone marrow and thymus then swing along the vessels. However, those blood components are self in immune system while non-self to muscular tissue, which gives a possible chance of autoantigens exposure, and leads to the termination of the tolerance to those hyperactive cells and their cytokines participated in the pathogenesis of psoriasis.

Therefore, it is hypothesized the autologous blood from a patient as personalized composite vaccination, and when this vaccine repeatedly injects to muscular tissue (where acupoints located) probably arouse body produce immune reaction to the components participated in psoriasis. The immune reaction in this process could regarded as mild physiological autoimmune reaction, which may achieve a new hemostasis with the autoimmune reaction in psoriasis (figure 2). Indeed, the underline hypothesis of autologous blood injection is based on assumption, needs to be explored.

其实该病例的治疗成功已发表于美国纽约Acupuncture & Electro-Therapeutics,虽然影响因子不太高,但是是替代医学中排名11SCI期刊,那么我大言不惭地认为这是世界第一次对自体血穴位注射的治疗原理进行分析(猜测)。

名片.jpg

期刊的主编如是说:Since your work can be valuable for many patients with similar problems, we would be happy to publish for the next issue. 由于你的工作可以让许多类似的患者获益,我们很高兴在下一期杂志刊出你的论文(Yoshiaki Omura, M.D.

当然在后期的改稿中,我用的治愈”cure被替换为complete remission(完全缓解)。主编说道:在美国,医生是不认为银屑病可以治愈的。

那我不禁感慨道:Make incurable disease curable.让不可治愈的疾病治愈。这就是中医药的魅力所在。

Make incurable disease curable.让不可治愈的疾病治愈。--陈永语(是为结语)

最后,感谢大学同学的信任,感谢管剑龙教授(我的导师)的宽容,感谢我的外公把我带入针灸学的神奇,感谢我们的祖先对医学的探索,感谢现代医学给了我认识中医的眼睛。

2017.9.18 夜夜不寐

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