从“风血”论治荨麻疹

Treating Urticaria Experience from"Blood"

“治风先治血,血行风自灭”语出明代医家李中梓《医宗必读》。在阐述行痹的治疗方法中提到“治行痹者,散风为主,御寒利湿仍不可废,大抵参以补血之剂,盖治风先治血,血行风自灭。”李氏的防风汤及如意通圣散中都使用了补血活血的当归,从中更能看出从血论治这一理论体系的重要性,充分表明理血在风证进展和治疗中起着关键性的作用。荨麻疹多由风血合病,风邪善行数变,致使此病发无定时,发无定处。而风邪又分“内风”和“外风”,风或从外生,或从内生。风从外生,多由风邪夹杂寒邪、热邪、湿邪侵袭肌表,多兼有卫外不固的症状,风从内生,多由脏腑功能受损失调或因七情内伤等多种致病因素诱发,而临床上无论是血寒、血热、血虚、血瘀皆可化风而引起瘾疹,风邪为临床多数荨麻疹病患的根本致病因素。而李氏提出“治风先治血,血行风自灭”的治疗思想指导临床切合实际,对风邪致病证型的皮肤病的诊疗意义非常。临床上发现荨麻疹大多病情缠绵难愈,易致邪气入里,遂应辨清其标本虚实,历代医家主张以治血理血为重,兼以疏风和营之法。导师张燚深入剖析荨麻疹的病因病机及治法,提出将荨麻疹分为血寒生风、血热生风、血虚生风、血瘀化风,4个证型,并自拟中药方剂应用于临床,取得显著疗效。

"The rule of treating the wind syndrome is to treat blood first and the normal blood circulation could resolve the wind syndrome".It is the recorded in LI Zhongzi's Yizong Bidu in Ming Dynasty.In the treatment of the phlegm,he mentioned that"the treatment of Bi syndrome due to wind is dispersing.And the treatment for keeping out the cold and relieving dampness is still not abolished,and it probably uses the prescriptions for supplementing the blood.Because the rule of treating the wind syndrome is to treat blood first and the normal blood circulation could resolve the wind syndrome.Both Fangfeng Decoction and Ruyi Tongsheng Powder have Danggui(Angelica)for supplementing blood and activating blood circulation.It shows the importance of the theoretical system of blood treatment,which fully demonstrates that blood plays a key role in the progress and treatment of wind syndrome.The urticaria is mostly caused by wind and blood.The wind evil is divided into"internal wind"and"external wind".The external wind is due to cold evil,heat evil and damp evil invading.The internal wind is due to dysfunction of Zang-fu organs or emotion injury.In clinic,various factors such as blood cold,blood heat,blood deficiency or blood stasis,can cause urticaria.The wind evil is the fundamental cause of clinical urticaria patients.However,LI’s treatment idea of“treating the wind syndrome is to treat blood first and the normal blood circulation could resolve the wind syndrome”guides the clinical practice,and it is very meaningful for the diagnosis and treatment of skin diseases caused by wind.Clinically,most of the patients with urticaria have a difficult condition,and they are prone to cause evils invading the body.They should distinguish their specimens from falsehood.From the study of his thoughts,the author’s tutor deeply analyzed the etiology,pathogenesis and treatment of urticaria,and proposed to divide urticaria into wind due to blood cold,wind due to blood heat,wind due to blood deficiency and wind due to blood stasis syndromes.And self-made Chinese medicine prescriptions applied to the clinic have achieved significant results.