新析痤疮因证论治

A New Analysis on the Treatment of Acne Based on Syndrome

[目的]重新分析痤疮的病因病机及辨证论治。[方法]剖析历代文献及近现代名家著作及教科书,分析列举痤疮的不同证型及治法方药,并举验案一则加以说明。[结果]根据痤疮的病因病机,笔者认为痤疮的辨证分型不止教科书上所描述的肺经风热、湿热蕴结、痰湿凝结三型,还应该有心火亢盛、肝胆湿热、肾阴不足、气滞血瘀、冲任不调、阳气郁滞等六型。同时以上九型应分别施予不同的治法方药,以期取得满意疗效:肺经风热证予枇杷清肺饮加减;湿热蕴结证予枇杷清肺饮合黄连解毒汤加减;痰湿凝结证予海藻玉壶汤合参苓白术散加减;心火亢盛证予导赤散加减;肝胆湿热证予龙胆泻肝汤加减;肾阴不足证予知柏地黄丸加减;气滞血瘀证予桃红四物汤加减;冲任不调证予柴胡疏肝散加减;阳气郁滞证予麻黄细辛附子汤加减。所举病案中患者脾虚湿困、阳气郁滞,湿困肌肤化热,方用参苓白术散合麻黄附子细辛汤加减,健脾化湿、温阳解郁,兼清热解毒,三诊即愈。[结论]痤疮的中医治疗宜详细分析,分清主要因素与次要因素,分清主证与兼证,因证论治,方有良效。

[Objective]To reanalyze the etiology,pathogenesis,treatment based on syndrome differentiation of acne. [Methods]Starting from the ancient literature,the works of famous scholars and textbooks from the past to the present,the different types and therapeutic methods and prescriptions of acne were analyzed and one case was presented for example. [Results]According to the etiology and pathogenesis of acne,it is considered that the syndrome of acne is not only the three types described in textbooks: Wind heat of lung meridian syndrome,accumulation of dampness and heat syndrome,coagulation of phlegm and dampness syndrome,but also the six other types of hyperactivity of heart fire syndrome,dampness and heat of liver meridian syndrome,deficiency of kidney Yin syndrome,Qi stagnation and blood stasis syndrome,disharmony of the Chong and conception channels syndrome and stagnation of Yang Qi syndrome. In order to obtain satisfactory curative effect,different prescriptions should be adopted according to different syndromes. Patients of wind heat of lung meridian syndrome can select modified Pipa Qingfei Decoction;patients of accumulation of dampness and heat syndrome can select modified Pipa Qingfei Decoction combined with Huanglian Jiedu Decoction;patients of coagulation of phlegm and dampness can select modified Haizao Yuhu Decoction combined with Shenling Baizhu Decoction;patients of hyperactivity of heart fire can select modified Daochi San;patients of dampness and heat of liver meridian can select modified Longdan Xiegan Decoction;patients of deficiency of kidney Yin can select modified Zhibai Dihuang Pill;patients of Qi stagnation and blood stasis can select modified Taohong Siwu decoction;patients of disharmony of the Chong and conception channels can select modified Chaihu Shugan Decoction;patients of stagnation of Yang Qi can select Mahuang Fuzi Xixin Decoction. In the medical record,the patient was spleen deficiency and dampness,Yang Qistagnation,and dampness trapped in skin and turned into heat,who was treated with Shenling Baizhu Decoction combined Mahuang Fuzi Xixin Decoction to invigorate the spleen and resolve dampness,warm Yang to relieve the depression and clear away heat and toxicity,and the patient recovered after the third treatment.[Conclusion]In the traditional Chinese treatment of acne,the cause of acne should be analyzed in detail,and the main syndrome and concurrent syndrome should be distinguished,so as to treat based on syndrome to obtain a significant effect.