小儿皮肤病湿热伤络证的辨证要点与临证经验

Essence of syndrome differentiation and clinical experience in childhood dermatosis with the pattern of dampness-heat hurting blood vessels

小儿皮肤病是中医儿科常见的疾病类别之一,其病因多样、证候多元。由于家长喂养不当、饮食失于调护等原因导致小儿皮肤病湿热伤络证在临床中较为多见。从病因多样、围绕生理特点,证候多元、聚焦湿热伤络分析小儿皮肤病的特点。湿热相搏、灼伤血络为小儿皮肤病湿热伤络证的关键病机。辨证应着眼于辨皮损、辨病因、辨病程阶段、辨脏腑、辨舌脉。临证治疗应根据小儿的生理、病理特点,不宜照搬成人治法,以清热燥湿、凉血和血为基本治法,治疗上选用三黄四物汤为主方,同时应关注皮损、内外合治,辨析病程、把握疾病进展,重视补益肺气、调理脾胃、疏利肝胆、清心养心。结合临床验案对小儿皮肤病湿热伤络证的诊疗思路与用药经验进行介绍。

Childhood dermatosis,one of the common diseases in pediatrics in traditional Chinese medicine,has various etiological factors and multiple patterns.Childhood dermatosis with the pattern of dampness-heat hurting blood vessels has been more common due to improper feeding,inadequate dietary care,etc.The characteristics of childhood dermatosis are analyzed from its diverse etiologies,physiological characteristics,various patterns and dampness-heat hurting blood vessels as its focus.The struggle between dampness and heat,and heat scorching blood vessels are the key pathogenesis of childhood dermatosis with the above-mentioned pattern.In pattern identification,priority is given to the differentiation of skin lesions,etiology,disease staging,viscera,tongue and pulse.In clinical treatment,the physiological and pathological characteristics of children should be taken into consideration while treatment strategies for adult patients are not recommended which are centered on clearing heat and drying dampness,cooling and regulating blood.As for its treatment method,Sanhuang Siwu Decoction is chosen as the main prescription.At the same time,attention is given to skin lesions,integrated internal and external treatment,the disease staging,disease progression,and importance is attached to invigorating the lung Qi,regulating the spleen and stomach,soothing the liver and gallbladder,and clearing and nourishing the heart.Combined with a clinical case,this paper introduces the treatment ideas and medication experience of childhood dermatosis with the pattern of dampness-heat hurting blood vessels.