麻黄类方治疗痤疮发微

TCM remedies containing Mahuang in the treatmen of acne

痤疮作为皮肤科的一种常见疾病,发病率越来越高,发病年龄越来越小,一些重症痤疮甚至影响患者的心理健康。痤疮的中医辨证多分为肺经风热、胃肠湿热、痰湿瘀滞三型,多从清肺热、清利湿热、祛痰化瘀等“里”的层面治疗,一般治疗时间需要3个月左右。从古至今,多位医家从“郁乃痤”角度阐述了痤疮的发病病机:“阳气被郁、寒湿郁结,郁久则可生痤疮、小疖”,那么痤疮从“郁”而治,即“火郁发之、表者发之”,使“邪”直接从皮肤排出体外,则比清热解毒、祛湿化瘀等治法将“邪”从血液里或者二便排出体外更快捷,更高效。常用的升阳解表中药有麻黄、升麻、柴胡、葛根、白芷、皂角刺等辛味药,其中麻黄既能发表出汗、开毛孔皮肤、泄卫中风热,又能调血脉、破癥坚积聚,是“解表郁”的最佳选择。多位医家在治疗痤疮的经验文献中提到麻杏石甘汤、麻黄连翘赤小豆汤、五积散、葛根汤、麻黄升麻汤、麻黄附子细辛汤等含麻黄的方子疗效显著。笔者自拟的麻黄类方是在麻杏石甘汤和麻黄连翘赤小豆汤的基础上加桑白皮、枇杷叶、丹参、赤芍、路路通、虎杖、黄芩等药化裁而来,其主治湿热郁结型痤疮,临床观察此方的疗效显著,并且治疗疗程明显短于常规疗法。

Acne is a very common disease in dermatology.The incidence rate of the disease is getting higher and higher,the age of onset is getting younger and younger,and some severe acne even affects the mental health of patients.According to TCM syndrome differentiation,acne is divided into three types:wind heat in lung meridian,damp heat in gastrointestinal tract,phlegm dampness and blood stasis.The treatment is mainly from the“inside”level of clearing lung heat,eliminating dampness-heat,expelling phlegm and removing blood stasis,etc.The general treatment time takes about 3 months.Since ancient times,many doctors have explained the pathogenesis of acne from the perspective o“f Stagnation leads to acne”,they believe that“If Yangqi(阳气)is depressed,cold and dampness are stagnated,and acne and small boils can occur if they are stagnated for a long time.”In terms of treatment,it starts from relieving stagnation,namely,evacuating depressive fire,evacuating exterior pathogen directly from the skin out of the body,which is faster and more efficient than clearing heat and detoxifying,removing dampness and blood stasis and other treatment methods.The commonly used TCM medicines for promoting Yang and relieving exterior symptoms include Mahuang(Ephedra),Shengma(Cimicifuga),Chaihu(Bupleurum),Gegen(Pueraria),Baizhi(Angelica dahurica),Zaojiaoci(Gleditsia sinensis)and other pungent drugs.Among them,Mahuang can not only promote sweating,open pores and skin,relieve Weifen(卫)heat,but also regulate blood vessels and break the accumulation of disease,which is the best choice for“relieving exterior depression”.Many doctors have mentioned in the experience of acne treatment literature that the Mahuang-containing prescriptions such as Maxing Shigan decoction(麻杏石甘汤),Mahuang Lianqiao Chixiaodou decoction(麻黄连翘赤小豆汤),Wuji San(五积散),Gegen decoction(葛根汤),Mahuang Shengma decoction(麻黄升麻汤),Mahuang Fuzi Xixin decoction(麻黄附子细辛汤)are effective.The self-prescribed TCM remedies containing Mahuang is based on Maxing Shigan decoction and Mahuang Lianqiao Chixiaodou decoction,and Sangbaipi(Mulberry bark),Pipaye(Loquat leaf),Danshen(Salvia miltiorrhiza),Chishao(Radix Paeoniae),Lulutong(Fructus Liquidambaris),Huzhang(Knotweed),and Huangqin(Scutellaria)are added.It mainly targets acne with dampness and heat stasis,the clinical observation of this formula proves that it has a remarkable effect,and the treatment course is obviously shorter htan the conventional treatment.