“郁乃痤”之浅见

The Humble Opinion of “YuNaiCuo”

[目的]从"阳郁"的角度阐述痤疮病因病机。[方法]从"阳郁"的角度对痤疮的不同证型进行分析,阐述病因病机以及其相应的治疗见解,并列举验案一则。[结果]中医外科学教科书中将痤疮分三型论治"肺经风热型""肠胃湿热型""痰湿瘀滞型",所用方药多为苦寒,久服易伤及脾胃之阳,致寒湿内生,长期不愈者可出现寒、湿、瘀互结之象。由此观之,以"阳郁"为病机可解释痤疮的不同证型。受《内经》"郁乃痤"之启示,存在"阳郁"的患者均可适当予以温阳散寒、行气解郁之治法,往往能取得较好疗效。验案中患者辨为寒湿蕴结、卫阳郁滞证,予"麻黄附子细辛汤"治之,随症加减,佐以清热解毒、健脾利湿、活血化瘀、软坚散结,疗效满意。[结论]阳郁是痤疮的重要病机,临床上遇到阳郁型痤疮,宜治以"温阳解郁"之法,可用麻黄附子细辛汤加减。

[Objective] To narrate the cause of acne from＂Yang depression＂.[Methods] From the point of view of ＂Yang depression＂, the ditferent syndromes of aene were analyzed, and the etiology, pathogenesis and corresponding therapeutic views were expounded, and a sample case was cited. [Results] There are three types of acne in the textbook of Chinese medicine surgery： acne with pattern of wind-heat in lung channel, ache with heat bimting in the intestines and stomach and acne with syndrome of stagnation and congelation of phlegm-damp, the prescription used is mostly bitter cold, which can easily hurt the spleen and stomach, cause cold-dampness inside, lead to the pathogenesis of cold, wet and blood stasis while taking it for a long time. In view of this, the ＂Yang depression＂ can be used to explain the different syndromes leading to acne. Inspired by the Neijing, the patients with ＂Yang depression＂ can be properly treated by warming Yang and relieving depression. The patient in the case is discriminated as the type of obstruction of defensive Yang, it was satisfied to see that using the prescription of Zhongjing： the Decoction of Ephedra Aconite and Asarum. And we can also use formula variation in accordance with signs, like clearing heat and removing toxin, invigorating spleen and draining dampness, activating blood and resolving stasis, softening and resolving hard mass. [Conclusion] Depression of the Yang is an important pathogenesis of acne. We are suggested to treat the ache of ＂Yang depressions＂ with the method of ＂warm Yang and relieve depression＂, which can be used as the prescription of Zhongjing.