基于五脏一体观探析从肝辨治寻常型银屑病

Exploring the treatment of psoriasis vulgaris from the liver based on holism of five organs

寻常型银屑病是临床中最常见的银屑病类型,疾病主要表现为皮肤表面出现红色斑丘疹,覆有银白色鳞屑,拭去可见出血点,伴有瘙痒等症状。银屑病与中医“白疕”相对应,病虽发于体表,然司外揣内。肝主疏泄,心主血脉,肺主皮毛,脾主运化,肾为先天之本,五脏精津、气血共同作用于肌肤才使得皮肤润泽。五脏之关键脏腑在于肝,以肝为切入点,结合五脏一体观进行整体辨治。文章提出肝脾湿热、肝心火旺、肝火犯肺、肝郁肾虚的寻常型银屑病主要病机,并施以相对应治法,协同治疗,祛邪补虚,和五脏,实肌肤。经临床验证,治疗上以治肝为主,兼顾他脏,基于五脏一体观思想,从肝辨治寻常型银屑病顺应整体观念,调和气血,调整阴阳,辨证施以对应治法,以达肝畅条达,五脏清明,从而使皮肤疮消肌愈,“屑”去肤安,取得良好疗效。因考虑到本病病程长,易反复发作,患者多伴有抑郁、精神焦虑等情志问题,在治疗时重视调肝治肝,运用疏肝解郁、清热解毒、清心凉血等法随证治之,基于五脏一体观进行辨证论治,使郁遏得疏,脏虚得养,疏泄有序,阴平阳秘,诸脏平和,取得较好的临床效果。

Psoriasis vulgaris is the most common type of psoriasis in the clinic,the disease is mainly manifested as a red maculopapular rash on the surface of the skin,covered with silvery-white scales,and bleeding spots can be seen when swabbed,accompanied by itching and other symptoms.Psoriasis corresponds to psora in TCM,although the disease occurs on the body surface,its internal pathogenic factors can be inferred from the outside symptoms.The liver is in charge of drainage,the heart is in charge of blood vessels,the lung is in charge of fur,the spleen is in charge of transportation,the kidney is the congenital origin,and the essence,fluid,Qi(气)and blood of five-zang organs(五脏)work together on the skin to make the skin moist.The key viscera of the five-zang organs is the liver.With the liver as the entry point,combined with the concept of integrated five-zang organs,the holistic differentiation and treatment are carried out.We put forward that the main pathogenesis of psoriasis of common type is dampness and heat in the liver and spleen,hyperactivity of fire in heart and liver,invasion of the lung by liver-fire,and depression in the liver and kidneys,and apply the corresponding treatment method to treat the disease,so as to eliminate the evils and replenish the deficiencies,and to make the skin more moist.It is clinically proved that the treatment is mainly based on the liver,taking other organs into consideration.Based on the idea of the integral view of the five organs,the treatment of psoriasis of common type from the liver conforms to the principle of the overall concept,can regulate the Qi and blood,adjust the Yin(阴)and Yang(阳),so as to make the sores of the skin subside and muscle heal,and obtain good curative effects.Because psoriasis vulgaris has a long course of disease and is prone to recurrence,and patients are often accompanied by emotional problems such as depression and mental anxiety,the treatment of this disease should pay attention to regulating the liver and treating the liver,and use methods such as soothing the liver and relieving depression,clearing heat and detoxifying,clearing the heart and cooling the blood.In the treatment of psoriasis vulgaris based on the integrated concept of the five organs,the depression can be sparse,the visceral deficiency can be nourished,the discharge is orderly,the Yin and Yang in equilibrium,and the organs are peaceful,so as to achieve better clinical results.