许树才教授运用麻黄桂枝各半汤治疗老年性皮肤瘙痒症临证经验

Professor XU Shucai’s clinical experience in treating senile skin pruritus with the Mahuang Guizhi Geban decoction

老年性皮肤瘙痒症指无明显原发皮损,仅有瘙痒的一种皮肤疾病,女性多于男性,好发于冬季。其发病机制尚不完全清楚,可能与多种因素有关,病因复杂,病情反复。现代医学对老年性皮肤瘙痒症的治疗以预防宣传教育、冷却剂、麻醉药、抗组胺药、糖皮质激素、阿片受体拮抗剂及5-羟色胺受体拮抗剂等为主,这些药物短期内疗效显著,但长期使用会出现不良反应,对老年人的身体状况有极大挑战。此病易反复发作,治疗周期长且迁延不愈,瘙痒难耐,使患者焦虑、抑郁、失眠,且使经济负担加重,对患者的生理心理状况造成了较大的负面影响。中医治疗本病有两种手段,一种以中药内服辨证论治为主,另一种是外治法,通常以针灸、穴位注射、穴位埋线、穴位按摩、拔罐、刮疹、中药熏蒸等为主。临床中各医家使用不同内治法、外治法治疗老年性皮肤瘙痒症,疗效确切。近些年来,中医药治疗此病明显优于单纯西药治疗,许树才教授结合临床经验,以中医传统理论为基础,提出脾虚为本、瘀热为标的病因病机,运用麻黄桂枝各半汤加减组方用药,治疗上以顾护脾胃、透发瘀热、养血润燥为基础,疗效显著,为中医临床治疗老年性皮肤瘙痒症提供参考。

Senile pruritus refers to a skin disease that has no obvious primary skin lesions but only itching.It is more common in females than males and is more common in winter.Its pathogenesis is not completely clear,and may be related to many factors.The etiology is complex,and the condition is repeated.The treatment of senile pruritus in modern medicine is mainly based on prevention and education,coolants,anesthetics,antihistamines,glucocorticoids,opioid receptor antagonists and serotonin receptor antagonists.These drugs are effective in short term,but there will be adverse reactions in the long-term use,which is a great challenge to the physical condition of the elderly.Because the disease is prone to recurrent attacks,with long treatment cycle,prolonged illness,long-term itching,emotional anxiety and depression,insomnia and increased economic burden,it has a great negative impact on the physiological and psychological status of patients.TCM treatment of this disease includes two means,one is the treatment based on syndrome differentiation of TCM,the other is external treatment,such as acupuncture,acupoint injection,acupoint catgut embedding,acupoint massage,cupping,scraping,TCM fumigation and so on.Clinically,different therapies are effective in the treatment of senile pruritus.In recent years,TCM has significant advantages in the treatment of this disease compared with Western medicine alone.Based on the clinical experience and based on the traditional theory of TCM,Professor XU Shucai put forward the etiology and pathogenesis of spleen deficiency as the basis and blood stasis and fever as the target.He used the modified combination of the Mahuang Guizhi Geban decoction(麻黄桂枝各半汤)to treat this disease.The treatment is based on protecting the spleen and stomach,dispersing the stasis heat,nourishing blood and moistening dryness,with remarkable curative effects,providing a reference for the clinical treatment of senile skin pruritus in TCM.