林咸明教授针药结合治疗特应性皮炎学术经验探赜

Professor LIN Xianming’s Academic Thoughts on the Treatment of Atopic Dermatitis with Combination of Acupuncture and Medication

[目的]总结林咸明教授针药结合治疗特应性皮炎的临证经验,为临床提供参考。[方法]通过跟师随诊、收集、分析林教授治疗特应性皮炎的验案,明确特应性皮炎多因先天体质特异或后天失调,加之感受外邪而发病,并从“针灸止痒安神”“经方调体固本”两方面解释林教授针药结合治疗特应性皮炎的临床经验,并附医案一则加以验证。[结果]林教授认为,特应性皮炎病机关键在于先天体质特异,并感受“湿”“热”等病邪郁于皮肤,从而产生瘙痒症状。随着病情进展,剧烈瘙痒影响患者情志,异常情绪同时又加重瘙痒,形成痒-抓循环。在临床治疗中,林教授认为纠正特异体质是防止复发的关键,倡导“针灸止痒安神”“方药调体固本”。在外以针灸止痒调神,改善患者瘙痒和异常情绪,防止痒-抓循环的产生;在内以经方调体,遵循“人-病-方”的遣方思路,根据患者不同体质特征再加以辨证施治,灵活加减,改善患者特异体质。病案中患者存在多年过敏病史,疾病迁延不愈,剧烈瘙痒与情绪异常并存,针刺以止痒调神,改善瘙痒与异常情绪,辨其体质为小柴胡体质,以小柴胡汤调节免疫功能,调节病体,终得良效。[结论]林教授治疗特应性皮炎以“止痒”“调神”“调体”为诊治原则,以针灸止痒安神、以经方调体固本,内外兼调、标本兼治,临床疗效突出,拓宽了临床治疗特应性皮炎的诊疗思路,其临证经验值得学习和推广。

[Objective]To summarize Professor LIN Xianming’s clinical experience in treating atopic dermatitis(AD)with combination of acupuncture and medication,and to provide clinical reference.[Methods]Through the following-up of Professor LIN’s treatment of AD,collection and analysis of cases,it is clear that AD is mostly caused by congenital or acquired disorders,combined with the infection of external pathogens.Professor LIN’s clinical experience in the treatment of AD is explained from the two aspects of“acupuncture and moxibustion for relieving itching and calming the mind”and“regulating body with classical prescription”,and a medical case was attached as proof.[Results]Professor LIN believes that the key of the pathogenesis of AD lies in the innate constitution,and the feeling of“dampness”and“heat”and other diseases depressed in the skin,resulting in itching symptoms.With the progression of the disease,severe pruritus affects patients’emotions,and abnormal emotions aggravate itching at the same time,forming an itch-scratch cycle.In clinical treatment,Professor LIN believes that correcting idiosyncratic constitution is the key to no recurrence of the disease,and advocates“acupuncture and moxibustion for relieving itching and calming the mind”and“regulating body with classical prescription”.Acupuncture and moxibustion can relieve itching and regulate the mind,relieve the abnormal itching mood of patients,and prevent the generation of itching-scratching cycle;classical prescription can improve the specific constitution of patients,from the idea of“person-disease-prescription”,and treat the patients according to their different physical characteristics.In this case,the patient had a history of allergy for many years,and the disease was prolonged,with severe pruritus and abnormal mood coexisting.Acupuncture can relieve the itch and regulate the mind to improve the pruritus and abnormal mood.At the same time,the constitution was identified as Xiaochaihu Decoction,the prescription used Xiaochaihu Decoction to regulate immune function,regulate the body,and obtain good effect.[Conclusion]Professor LIN treats AD with the principle of“relieving itching”“regulating the mind”and“regulating the body”as the principles of diagnosis and treatment,using acupuncture to relieve itching,regulating the body to strengthen the foundation,treating both internal and external symptoms and root causes,with outstanding clinical efficacy.It broadens the thinking of traditional Chinese medicine diagnosis and treatment,and its experience is worthy of clinical application and promotion.