从血论治激素依赖性皮炎经验

Experience in treating hormone dependence dermatitis from the perspective of blood

激素依赖性皮炎是长期不合理使用激素制剂而引起的一种炎症性皮肤病。从血分的血热毒蕴证、血瘀证、血虚风燥证、血虚寒凝证4个证型讨论激素依赖性皮炎的病因机制和辨证论治。对于皮损鲜明、发病快、来势猛的血热毒蕴证患者,前期治疗重在凉血且用药足量,以清泻血中火毒,外治配合放血或冷喷等疗法以免拖延病程;对于皮损晦暗、硬结肿块、瘀难消退的血瘀证患者,内治以疏肝理血、化瘀消痰等治法,外治配合刺络拔罐祛除瘀血等疗法,加强局部血液循环和新陈代谢;对于皮损干燥脱屑、瘙痒难愈的血虚风燥证患者,内治以滋养阴血,外治配合湿敷、面膜以润泽养肤,注重面部屏障的保护及修复;对于皮损潮红,伴畏寒肢冷的血虚寒凝证患者,内治以温经养血,外治配合火针,共奏温阳散寒、祛瘀养血、兼清虚热之效。中医内、外治法结合治疗激素依赖性皮炎充分发挥了中医特色与优势,附验案一则以供临床参考。

Hormone dependence dermatitis(HDD)is an inflammatory skin disease caused by long-term irrational use of hormone preparations.This paper discusses the etiological mechanism and treatment based on pattern differentiation of HDD from four patterns of blood heat and toxin accumulation,blood stasis,blood deficiency-induced wind dryness,and blood deficiency with cold retention.For patients with blood heat and toxin accumulation pattern characterized by distinct skin lesions,rapid onset,and severe symptoms,the early treatment focuses on cooling the blood with sufficient medication to clear heat and remove toxins in blood,combined with external treatments such as blood-letting or cold spray to prevent prolongation of the disease course.For patients with blood stasis pattern characterized by dull skin lesions,induration,mass,and ecchymosis that is difficult to subside,internal treatments focus on soothing the liver and regulating blood,transforming stasis and dispersing phlegm,combined with external treatments such as blood-letting and cupping to remove blood stasis and promote local blood circulation and metabolism.For patients with blood deficiency-induced wind dryness pattern characterized by dry skin lesions,desquamation and intractable pruritus,internal treatment focuses on enriching yin and nourishing the blood,combined with external treatments such as wet compresses and facial masks to moisten and nourish skin,with emphasis on protecting and repairing the facial barrier.For patients with blood deficiency with cold retention pattern manifested by flushed skin lesions accompanied by aversion to cold and cold limbs,internal treatment focuses on warming meridians and nourishing blood,combined with external treatments such as fire needling to achieve the effects of warming yang and di spersing cold,eliminating stasis and nourishing blood,and clearing deficiency heat.The combination of internal and external Chinese medicine treatments for HDD fully leverages the characteristics and advantages of Chinese medicine.A verified medical record is provided for clinical reference.