夏永良应用“玄府郁闭”理论治疗青春期后痤疮的经验浅析

Analysis of XIA Yongliang’s Experience in Applying the Theory of “Xuanfu Depression” in Treating Acne after Puberty

[目的]基于“玄府郁闭”理论,探讨夏永良老师治疗湿热郁闭型青春期后痤疮的临床经验。[方法]通过查阅《黄帝内经》《素问玄机原病式》及后世医药典籍,分析“玄府郁闭”的理论依据,收集整理夏师门诊诊治的湿热郁闭型青春期后痤疮病例,并总结相关治疗经验及用药特色,最后分析典型案例进一步论述夏师临证经验。[结果]夏师认为,湿热郁火之邪可致玄府闭塞、气津不通而发生痤疮,治疗中应以麻黄连轺赤小豆汤为基础,清里之湿热,开表之玄府,畅其气津,祛其郁阻,则痤疮可消。所举验案,夏师辨为湿热内蕴、经络瘀滞之证,治拟清热利湿、宣郁通络之法,方以麻黄连轺赤小豆汤合升降散、葛根芩连汤加减,辄收佳效。[结论]夏师治疗湿热郁闭型青春期后痤疮以开通玄府为基础,标本兼顾,并注重食饮有节,起居有常,其临床经验值得学习和借鉴。

[Objective] To discuss the clinical experience of Professor XIA Yongliang in treating acne after puberty with damp-heat depression type, basing on the theory of “Xuanfu depression”. [Methods] Through consulting Huangdi Neijing, Etiology Based on Plain Questions and later medical classics, this paper analyzed the theoretical basis of “Xuanfu depression”, collected the cases of Professor XIA’s outpatient diagnosis and treatment of acne after puberty with damp-heat depression type, summarized the relevant treatment experience and medication characteristics, and further discussed Professor XIA’s clinical experience by analysis of a typical case.[Results]Professor XIA believes that the evil of damp-heat and stagnation of fire can cause the occlusion of Xuanfu and the impassability of Qi and fluid, which finally results in acne after puberty. Therefore, the treatment of acne after puberty should be based on Mahuang Lianyao Chixiaodou Decoction to clear the damp-heat in the interior and open the Xuanfu in the exterior. If the Qi and the fluid are unobstructed, the evil of damp-heat can be removed, and the acne after puberty can be eliminated. The attached medical record was identified as damp-heat connotations and meridian stasis, Professor XIA treated with clearing heat and dampness, promoting depression and dredging the meridians, modified Mahuang Lianyao Chixiaodou Decoction and Shengjiang Powder and Gegen Qinlian Decoction were used for treatment and good results were achieved. [Conclusion] Professor XIA believes that the treatment of acne after puberty with dampheat stagnation type should be based on opening the Xuanfu, treating both manifestation and root cause of disease, paying attention to daily routine and regular diet. His clinical experience is worth learning and reference.