白癜风证治若干思考

Some Thoughts on Vitiligo Diagnosis and Treatment

从文献研究入手论述"白癜风"是中医病名,批评中医界喜用生僻病名的陋习;结合临床研究体会,指出当临床面临"少症难辨"时,需要在对疾病临床深入研究的基础上,把握对疾病发病规律的整体性思考与病变不同时期特点的把握,并据此而建立起切合实际的临床思维;认为白癜风进展期主要表现特点与病机为"风",治则方药要有"祛风"的思考。稳定期白癜风,"久病多虚、多瘀",主要表现为肝肾不足的"虚"与瘀阻脉络的"瘀",治疗当以补益肝肾与活血通络为主要治则,再辅以祛风和血。基于"中药色象理论",指出白癜风临床用药在辨证论治的基础上可考虑优先选用深颜色的药物。白癜风优化治疗的基本原则是:分期论治、中西医结合、全身和局部治疗相结合、内治与外治相结合、适当忌口、酌情配合光疗、坚持3个月以上治疗。

Starting from literature research, this thesis expounds that vitiligo （BaidianJeng in Chinese）, and critici- zes the bad habit of naming diseases with uncommon te,＇ms among the Chinese medicine circle. Combining with the clini- cal research experience, the thesis points out the necessity of integrated thinking over the occurrence regularity of vitiligo and the observation of the characteristics at different pathological phases on the basis of in - depth clinical study of vitiligo and the terminal establishment of practical and realistic clinical thinking, when confronting the lack of syndromes in clini- cal diagnosis. Since wind is the pathogenesis and the main manifestation of vitiligo in progressive stage, wind - expelling should be taken into consideration in medicinal prescriptions. As is stated in the saying, ＂chronic disease invites thrther deficiency and more stasis＂, stasis of choroid and deficiency of liver and kidney is the main syndrome of vitiligo during the stable phase. Therefore, nourishing liver and kidney and activating blood circulation should be the main therapeutic principles, supplemented with wind - expelling and the regulation of blood flow. On the basis of the Color - Effect Theory of traditional Chinese medicine, this thesis finally points out that priority should be given to dark color drugs in vitiligo clinical treatment basing on dialectic therapeutics. In conclusion, the general principles for optimizing the therapeutics of vitiligo include： staging treatment, integration of traditional Chinese and western medicine, combination of systemic and local treaunent, combination of internal governance and external treatment, avoidance of certain tbod, phototherapy, treatment of more than 3 months.