艾儒棣从“皮积”论治原发性皮肤淀粉样变经验

AI Rudi's Experience in Treating Primary Cutaneous Amyloidosis from the Perspective of"Skin Accumulation"

总结艾儒棣教授从“皮积”论治原发性皮肤淀粉样变(PCA)的临证经验。PCA的皮损形态、病理特点与中医积病具有相似性,据此提出“皮积”的概念,认为正虚邪犯、痰瘀锢表为PCA的核心病机,多属本虚标实证,其中正气虚馁、腠理空疏为发病之本,邪留肌表、津血失布、痰瘀胶结为致病之标。治疗上以固本清源为核心,内治以健脾补肾、祛痰化瘀、软坚散结为法,自拟二仙四参汤、桂枝茯苓丸合化坚二陈丸、加味消瘰丸加减治疗;外治以驱邪消积、疏通津血为要,予自拟润肌膏热烘促进皮损软化剥脱、猪胆汁药浴开腠驱邪、牛脊髓封包濡养肌肤。

This paper summarized professor AI Rudi's clinical experience in treating primary cutaneous amyloi⁃dosis(PCA)from the perspective of"skin accumulation".The morphology and pathological characteristics of PCA are similar to those of accumulation diseases in traditional Chinese medicine,proposing the concept of"skin accumu⁃lation".It is believed that the core pathogenesis of PCA is the invasion of pathogenic factors while healthy qi is in defi⁃ciency,and phlegm and stasis consolidating the exterior,which can be mainly categorized into the type of root defi⁃ciency and branch excess.Depleted healthy qi and loose striae and interstices are the root,while pathogen lingering in the skin surface,fluids and blood failure to be distributed,and binding of phlegm and stasis are the branch of the disease.The main treatment principle is consolidating the root and clearing the source.For internal treatment,it is recommended to fortify the spleen and nourish kidney,dispel phlegm and dissolve stasis,soften hardness and dissi⁃pate masses,with Self-made Erxian Sishen Decoction(二仙四参汤),Guizhi Fuling Pills(桂枝茯苓丸),Huajian Erchen Pills(化坚二陈丸)and Modified Xiaolei Pills(加味消瘰丸).For external treatment,it is important to dispel pathogens and disperse accumulation,scatter and unblock fluids and blood,and hot baking with self-made Ruiji Paste(润肌膏)can be used to promote softening and peeling of skin lesions,and medicinal bath with pig bile to open striae and dispel pathogen,bovine spinal cord sealing to nourish the skin.