基于《黄帝内经》理论探讨尿毒症皮肤瘙痒的治疗思路

A New Approach of Treatment of Uremic Skin Pruritus Based on the Theory of Huangdi Neijing

尿毒症皮肤瘙痒(UP)是肾衰竭终末期常见的并发症,属于中医"痒风""风瘙痒""肾毒风"等范畴,中医多认为是由于脾肾两虚、浊毒壅盛,风、湿、瘀、毒、虚交织为害而致,治疗多从养血祛风、补益脾肾、祛毒化浊、活血行瘀等着手,但仍有不效者。《内经》有云:"皮毛者,肺之合也。心布于表,肾治于里。三焦膀胱者,腠理毫毛其应",就是说肺、心、三焦膀胱与肌腠密切相关,临证当需重之。通过对"肺合皮毛""心布于表""三焦膀胱与毫毛相呼应"等理论的探讨分析,旨在为尿毒症皮肤瘙痒探求治疗新思路,同时提示同道,临床当注重审察病机,打破固有思维。

Uremic skin pruritus(UP)is a common complication of end-stage renal failure(ESRD),which belongs to the category of"itching wind","pruritus wind"and"kidney poisoning wind"in traditional Chinese medicine.Traditional Chinese medicine mostly thinks that spleen and kidney deficiency,turbidity and toxicity are blocked,wind,dampness,blood stasis,toxin and deficiency are harmful to each other.Treatment mostly includes nourishing blood and dispelling wind,nourishing liver and kidney,removing toxin and removing turbidity,activating blood circulation and removing blood stasis,but still ineffective.In the Huangdi Neijing,there are clouds:"Fur is the combination of lungs,Heart spreads on the surface,kidney treats,The bladder of Triple Energizer should be treated with mushroom and hairs".so Lung,heart and triple energizer bladder are closely related to muscular mushroom,and clinical symptoms should be emphasized.Therefore,this article explores and analyses the"pulmonary hair combined with skin","heart cloth on the surface"and"triple energizer bladder corresponds to hairs",which provides a new way of thinking.At the same time,it warns clinicians to pay attention to examining the pathogenesis and break the inherent thinking.