从乌蛇荣皮汤治验谈名老中医李可皮肤病辨治思想与应用

Talking About Professor LI Ke’s Thought of Distinguishing and Treating Dermatosis and Its Clinical Application by Effective⁃ness of Treatment of Wushe Rongpi Decoction

[目的]总结李可教授的皮肤病辨治思想,并阐发其临证应用。[方法]以《李可老中医危急重症疑难病经验专辑》中“乌蛇荣皮汤皮科治验录”篇为研究对象,解读乌蛇荣皮汤的制方背景及组成,并进行医案分析,阐述李老辨治皮肤病的思想精粹,并结合临床阐发自身应用乌蛇荣皮汤的经验。[结果]乌蛇荣皮汤由桃红四物汤加桂枝汤化裁而来,契合皮肤病血虚、血瘀、湿热和风毒等证候关键,具有清热利湿、活血通络、养血祛风之功,对多种皮肤病均有显著效果。李老的皮肤病辨治思想可总结为“见皮治皮,永无愈期”“皮病责风,治先从血”“皮病治肺,宣补表气”“积年痼疾,必蕴伏毒”“分清缓急,因势利导”“固护脾肾,辨别寒温”“随施小方,取其专用”以及“内外合治,效捷为要”八点,对皮肤病诊治具有很大启发。临证运用乌蛇荣皮汤又当控制药量、忌用毒药以及配合外治等。所举医案中,患者不慎感邪,病程迁延,辨为湿热毒蕴证,以乌蛇荣皮汤化裁治疗数月,多年顽疾得愈。[结论]李老对皮肤病的辨治具有独到见解,面对复杂疾病,能够做到理法明确,方药执简驭繁,病重药重,缓急有序,对皮肤病诊治具有积极指导意义。

[Objective]To summarize Professor LI Ke’s thoughts on differentiation and treatment of dermatosis and elucidate the clinical application.[Methods]Taking Experience Record of Effectiveness of Treating Dermatosis by Wushe Rongpi Decoction in Experience Album of Critical and Difficult Diseases of Traditional Chinese Medicine of Professor LI Ke as the research object,the background and composition of Wushe Rongpi Decoction were interpreted,and the medical case analysis was carried out,from which the essence of LI Ke’s thoughts of distinguishing and treating dermatosis was expounded,and the experience of applying Wushe Rongpi Decoction was expounded in combination with clinical analysis.[Results]Wushe Rongpi Decoction was made from Taohong Siwu Decoction and Guizhi Decoction,it was suitable for the key syndroms of dermatosis such as blood deficiency,blood stasis,dampness-heat and wind toxicity,and it had the functions of clearing heat and dampness,promoting blood circulation,nourishing blood and dispelling wind,and had significant effects on various dermatosis.Professor LI Ke’s thoughts of differentiation and treatment dermatosis can be summarized as“treat the skin disease from skin,there is never a cure date”“skin disease imputes to wind evil,treatment begins with blood”“skin disease treated from lung,dispersion and nourishing defensive Qi”“a disease that has persisted for years,must produce and persist hidden poisons”“distinguish between priorities and priorities,capitalize on the trend”“protect the spleen and kidney,distinguish cold and warm”“casually use minor prescriptions and select its specific use”and“combined internal and external treatments,and quick effect are the most important”eight points in all,and the diagnosis and treatment of dermatosis have great inspiration.Clinical use of Wushe Rongpi Decoction should control the amount of drug,avoid using poison and cooperate with external treatment.In the medical cases mentioned above,the patient was invaded by pathogenic factor inadvertently and the course of the disease was prolonged,which was identified as the syndrome of dampness and heat toxicity.The patient was treated with Wushe Rongpi Decoction for several months,and the disease was cured.[Conclusion]Professor LI Ke had unique insights on the differentiation and treatment of dermatosis.In the face of complex diseases,he achieved clear theory,prescription and medicines were simple to handle,the dosage of medication was based on the severity of the disease,which had positive guiding significance for the diagnosis and treatment of dermatosis.