基于东垣方探讨湿疹辨治思路

Discussion on differentiation and treatment of eczema based on Dongyuan prescription

湿疹是一种慢性、复发性、炎症性皮肤病,以皮肤瘙痒、多形皮损伴渗液倾向为临床特征,病程迁延难愈,婴幼儿、青少年为好发人群,我国发病率较高。西医药治疗以糖皮质激素、钙调磷酸酶抑制剂及抗组胺类药物为主,短期疗效显著,但长期应用不良反应较多。中医认为湿疹多因禀赋不耐或后天失养以致脏腑功能失调,风、湿、热等外邪侵袭机体,蕴蓄于肌肤所致,据病程及临床表现将其分为急性期、亚急性期、慢性期三期,故诊治湿疹当明辨病因病机,分期论治。总体而言,中医药辨证论治湿疹具有一定优势。文章基于李杲(号东垣)《脾胃论》相关方剂探讨湿疹的中医辨治思路,简述湿疹的病因病机和治疗原则,认为治疗时应以祛邪为第一要务,尤重“风”“湿”,固脾胃贯穿始终,兼调五脏。注重分期论治,急性期多以祛风除湿清热为主,亚急性期多以健脾祛湿为要,慢性期治以凉血滋阴、燥湿止痒为法。临床验证风药可应用于各期湿疹患者的治疗。以除风湿羌活汤加减、升阳除湿防风汤加减、凉血地黄汤加减等辨治湿疹具有较好临床疗效,并附验案一则,以期进一步丰富中医药辨治湿疹的临床方案,提高诊治疗效。

eczema is a chronic,recurrent,inflammatory skin disease,with itchy skin,polymorphic skin lesions with exudation tendency as clinical features,the course of the disease is protracted and difficult to heal,infants and adolescents are the common population,the overall incidence in China is high.Western medicine is mainly treated with glucocorticoids,calcineurin inhibitors and antihistamines,with significant short-term efficacy but many adverse reactions in long-term application.TCM believes that eczema is mostly caused by natural endowment deficiency or poor-nourishment after birth,resulting in dysfunction of the internal organs,and exopathogen such as wind,humidity,and heat invade the body and contain in the skin.According to the course and clinical manifestations of the disease,it is divided into three stages:acute stage,subacute stage and chronic stage,so the diagnosis and treatment of eczema should identify the cause and pathogenesis,and the treatment should be staged.In general,TCM has certain advantages in the treatment of eczema.The article briefly describes the etiology,pathogenesis and treatment principles of eczema,and believes that the treatment should take eliminating pathogens as the first priority,especially wind and humidity,tonifying the spleen and stomach throughout,and recuperating the five internal organs.Pay attention to the treatment of stages,the acute stage is mainly to disperse pathogenic wind,humidity and heat,the subacute stage uses the invigorating spleen and eliminating dampness method,and the chronic stage is treated with cool blood to nourish Yin(阴),removing dampness to stop itchin.Based on the relevant prescriptions in LI Gao’s Piwei Lun(《脾胃论》),the author discusses the TCM treatment ideas of eczema,and clinically verifies that wind medicine can be applied to the treatment of eczema patients in various stages.The use of dehumidify with the Qianghuo decoction(羌活汤),invigorate vital function with the Fangfeng decoction(防风汤),cool the blood with Dihuang decoction(地黄汤),etc.to distinguish and treat eczema has good clinical efficacy,and a test case is attached,which is briefly described below,in order to further enrich the clinical program of traditional Chinese medicine for the differentiation and treatment of eczema and improve the diagnosis and treatment efficiency.