李凤仙从三焦辨治湿疹经验总结

LI Fengxian’s experience in treating eczema from the aspect of triple energizer based on syndrome differentiation

湿疹为皮肤科临床常见病,是一种由多种内外因素引起的真皮浅层及表皮炎症,临床上急性期皮损以丘疱疹为主,有渗出倾向,慢性期以苔藓样变为主,均伴有瘙痒。西医治疗该病时常以口服抗组胺药物,急性期加糖皮质激素,外用糖皮质激素类药物为主,远期疗效欠佳,部分患者容易反复发作,缠绵难愈,常影响患者工作和生活,给患者的身心健康造成极大的困扰。本病的发生,总由禀赋不耐,风、湿、热邪阻滞肌肤所致,而其核心病机为湿热蕴肤,治疗常以祛湿贯穿始终。三焦辨证是湿热病辨证纲领之一,三焦各种证候标志着湿热病变发展变化过程中的三个不同阶段。疾病的初期阶段在上焦,多在肺心,中焦多在脾胃,下焦多在肝肾。李凤仙主任在数十年的临床实践中,形成了从三焦辨治湿疹的学术思想,认为本病初期多在上焦肺心,中后期和亚急性湿疹多在中焦脾胃,慢性湿疹和乏脂性湿疹多在下焦肝肾,治疗以开上、宣中、渗下,调畅三焦气机为主,上焦病证治以清热祛风,凉血利湿为主,中焦病证治以健脾利湿为主,而下焦病证治以滋补肝肾,养血祛风为主,体现“治上焦如羽,非轻不举;治中焦如衡,非平不安;治下焦如权,非重不沉”的治疗原则,取得了良好的临床疗效,为临床治疗该病开辟了新思路。

Eczema is a common clinical dermatological disease.It is a kind of superficial dermal and epidermal inflammation caused by a variety of internal and external factors.Clinically,the skin lesions in the acute stage are mainly herpetic humus with a tendency to exudate,and the chronic lesions were mainly lichen-like lesions,all of which were accompanied by pruritus.In western medicine,oral antihistamines are often used to treat the disease;the glucocorticoid is added in the acute phase,and topical glucocorticoid drugs are also used.Its long-term efficacy is poor.Some patients are prone to repeated attacks,and the disease is difficult to cure,often affecting the work and life of patients,causing great distress to the physical and mental health of patients.The disease is mainly caused by wind,dampness and heat blocking the skin due to constitutional insufficiency,and its core pathogenesis is dampness and heat accumulation on the skin.The dampness removal method is often used throughout the treatment.The syndrome differentiation of triple energizer is one of the guidelines for the syndrome differentiation of damp-heat disease.The various syndromes of triple energizer marks three different stages in the development and change of damp-heat lesions.Upper-jiao(上焦)dysfunction is the initial stage of disease,mostly in the lung and heart.Middle-jiao(中焦)dysfunction is mainly in the spleen and stomach.Lower-jiao(下焦)dysfunction is mainly in the liver and kidney.Based on decades of clinical practice,Director LI Fengxian formed the academic thought of distinguishing and treating eczema from the aspect of triple energizer.Director LI Fengxian believes that the disease at the early stage is mainly in the lung and heart of the upper-jiao,the disease at late stage and subacute eczema are mainly in the spleen and stomach of the middle-jiao,and chronic eczema and hyposteatous eczema are mostly in the liver and kidney of the lower-jiao.The treatment is mainly to regulate Qi movement(气机)of the triple energizer,namely opening the upper-jiao,diffusing the middle-jiao Qi and dredging the lower-jiao.The treatment of upper-jiao disease is mainly to clear heat and dispel wind,cool blood and diuresis;the treatment of middle-jiao disease is mainly to strengthen spleen and diuresis;the treatment of lower-jiao disease is mainly to nourish the liver and kidney to nourish blood and dispel wind.This therapy has obtained good clinical effects and provides a new idea for the clinical treatment of eczema.