基于“心常有余,脾常不足”论治儿童特应性皮炎

Treatment of children atopic dermatitis based on asthenic susceptibility of spleen

特应性皮炎又名特应性湿疹,是一种慢性、复发性、炎症性皮肤病。其病因尚不明确,可能与遗传、免疫、环境等因素有关。儿童特应性皮炎为临床常见病,中医通常认为此病与先天胎毒遗热、后天脏腑失调及外感风湿热邪等因素相关。特应性皮炎发病阶段分为婴儿期、儿童期、青少年与成人期、老年期。临床中发现儿童期特应性皮炎患者居多。皮损表现与婴儿期相比,患儿皮损更局限,渗出较婴儿期减轻,红斑颜色变暗、变浅,多呈慢性苔藓化表现,皮损界限不清,主要累及四肢屈侧,以肘窝及腘窝为著。病处阴位,与湿热之邪密切相关。儿童期发病年龄为2~12岁,此时期儿童脏腑娇嫩,形气未充,加之乳食不知自节,易伤脾胃,舌苔多表现为舌尖红、苔白厚腻,辨证为心火脾虚证,因此“脾常不足”为本病根本。文章基于“心常有余,脾常不足”的脏腑相关理论,结合小儿“脏腑娇嫩,形气未充”的生理病理特点,发现本病病机以脾虚为本,心火为标。据此,临床上疏风散邪,清心健脾,从心脾来论治儿童特应性皮炎,取得了良好效果。文章结合案例介绍从心脾治疗儿童特应性皮炎,以期为临床提供参考。

Atopic dermatitis(AD),also known as atopic eczema,is a chronic,recurrent and inflammatory skin disease.The etiology is still unclear,which may be related to genetic,immune,environmental and other factors.Children atopic dermatitis is a common clinical disease.TCM generally believes that this disease is related to factors such as congenital fetal toxin heat,acquired viscera disorder and dampness heat.The onset stages of AD are divided into infancy,childhood,adolescence and adulthood,and old age.Most of the patients with childhood AD have been found clinically.Compared with infancy,the skin lesions are more limited,the exudation is less than in infancy,the erythema becomes darker and lighter,and the skin lesions are mostly chronic lichenification,and the skin lesions are not clearly defined,mainly involving the flexor side of the limbs,mainly the elbow fossa and popliteal fossa.The Yin(阴)position of the disease is closely related to the evil of humid heat.The age of onset in childhood is 2~12 years old,during this period,children's organs are delicate,the shape is not full,coupled with milk and food do not know self-synchronization,easy to hurt the spleen and stomach,tongue moss is mostly manifested as red tip of the tongue,moss white and thick,differentiation is the heart fire and spleen deficiency,so spleen is often insufficient is the root of the disease.Based on the theory of the heart is often surplus,the spleen is often insufficient,combined with the physiological and pathological characteristics of children's delicate internal organs and unfilled Qi(气),found the pathogenesis of this disease is spleen asthenia,based on the characteristics of children’s uncontrolled diet and easy to hurt the spleen and stomach.Therefore,the treatment of children atopic dermatitis from the heart and spleen can often achieve good results.This article introduces the treatment of children atopic dermatitis from the heart and spleen,with a view to providing a reference for clinical practice.