赵明华辨治皮肤病经验
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摘要
[目的]介绍赵明华辨证论治皮肤病的临床经验和学术观点。[方法]通过跟随赵师门诊,抄录处方、记录相关医案、分析典型案例,重点整理痤疮、脂溢性皮炎、带状疱疹等常见皮肤疾患的治疗案例,从理、法、方、药四个环节详尽论述其治疗皮肤病的临床经验以及学术观点,并分别列举验案加以佐证。[结果]赵师治疗皮肤病遵循"异病同治"的原则,坚持辨证为先,将阴阳辨证贯穿诊疗全程。认为皮肤病在内主要责之肝脾肾,在外则以风、火、燥、湿为主,内外二因又相互影响。即使疾病各异,赵师仍以健脾祛湿为治疗大法,依据病证不同而兼用清肝泻火、滋水涵木之法;同时对于寒热虚实错杂者,从调畅气机出发,抓住中焦升降、少阳半表半里两个气机枢纽,使阴阳出入升降有序,阴阳调和。对于寒热错杂之粉刺,赵师以参苓白术散、四逆散为主方,温中与清热并用;对于寒热错杂之面游风,赵师以半夏泻心汤为主方,重在调畅中焦之气机;对于痰湿内蕴之蛇串疮,赵师先用大柴胡汤合小陷胸汤加减峻泻其邪,而后以四君子汤扶其正气,使少阳阳明湿热得去,中焦正气得复。[结论]赵师辨证论治皮肤病特色鲜明,以健脾祛湿为基本大法,审证求因,对于病情复杂者擅用调畅中焦、少阳气机之法,临床疗效显著,值得借鉴和推广。
[Objective] To introduce ZHAO Minghua's clinical experience and academic point of view for treating dermatosis. [Methods] ZHAO Minghua's experience is discussed from the aspects of pathogenesis, therapeutic principles and prescription,by transcribing the prescriptions, recording the basises and analyzing the typical ones, in which the treatment cases of acne, seborrheic dermatitis and herpes zoster were sorted out emphatically. Cases were enumerated separately. [Results] In the process of diagnosis and treatment, ZHAO Minghua follows the principle of "same treatment for different diseases",putting "treatment based on syndrome differentiation" first, and differentiation of Yin and Yang runs through. ZHAO Minghua points out emphatically that liver, spleen and kidney are mainly responsible for the dermatosis, while external factors are wind, fire, dryness and dampness. And the internal and external factors influence each other. Though they are different diseases, ZHAO Minghua attaches importance to damp evil, the common pathological factor. Corresponding to these, ZHAO Minghua has formed her own features in the rules of treatment, taking "invigorate spleen and eliminate dampness" as the principal method, using the methods of "clear liver and drain fire" and "enriching water to nourish wood" according to the syndrome differentions.As to Deficiency-excess mixing, Cold-heat complex pattern, Middle-Jiao and Shaoyang(semi-exterior-interior) has won a prominent position, regulates Qi activity by recovering the function of ascending usables and descending unusables, which rebalances the harmony between Yin and Yang to cure the disease.To treat acne whose syndrome intermingled heat and cold, ZHAO Minghua chose Shenlingbaizhu Powder and Sini Powder as the main prescription to clear heat and warm the middle burner; as to seborrheic dermatitis with simultaneous occurrence of cold and heat, Banxiaxiexin decoction was used to help Qi fuction of the middle burner to ascend and descend in order; and the Dachaihu decoction and Xiaoxianxiong decoction were used to cure herpes zoster with phlegm-damp retention by cleaning Shaoyang-Yangming damp-heat while the Sijunzi decoction strengthening the Qi of the middle-Jiao.[Conclusion] ZHAO Minghua's syndrome differentiation and treatment of dermatosis is distinctive, she applies the rules of "invigorate spleen and eliminate dampness", "clear liver and drain fire" and "enriching water to nourish wood" skillfully. Notably, ZHAO Minghua is good at treating difficult miscellaneous dermatosis by regulating Qi activity of Middle-Jiao and Shaoyang. ZHAO Minghua 's experience is clinically effective and worthy of reference and promotion.
[Objective] To introduce ZHAO Minghua's clinical experience and academic point of view for treating dermatosis. [Methods] ZHAO Minghua's experience is discussed from the aspects of pathogenesis, therapeutic principles and prescription,by transcribing the prescriptions, recording the basises and analyzing the typical ones, in which the treatment cases of acne, seborrheic dermatitis and herpes zoster were sorted out emphatically. Cases were enumerated separately. [Results] In the process of diagnosis and treatment, ZHAO Minghua follows the principle of "same treatment for different diseases",putting "treatment based on syndrome differentiation" first, and differentiation of Yin and Yang runs through. ZHAO Minghua points out emphatically that liver, spleen and kidney are mainly responsible for the dermatosis, while external factors are wind, fire, dryness and dampness. And the internal and external factors influence each other. Though they are different diseases, ZHAO Minghua attaches importance to damp evil, the common pathological factor. Corresponding to these, ZHAO Minghua has formed her own features in the rules of treatment, taking "invigorate spleen and eliminate dampness" as the principal method, using the methods of "clear liver and drain fire" and "enriching water to nourish wood" according to the syndrome differentions.As to Deficiency-excess mixing, Cold-heat complex pattern, Middle-Jiao and Shaoyang(semi-exterior-interior) has won a prominent position, regulates Qi activity by recovering the function of ascending usables and descending unusables, which rebalances the harmony between Yin and Yang to cure the disease.To treat acne whose syndrome intermingled heat and cold, ZHAO Minghua chose Shenlingbaizhu Powder and Sini Powder as the main prescription to clear heat and warm the middle burner; as to seborrheic dermatitis with simultaneous occurrence of cold and heat, Banxiaxiexin decoction was used to help Qi fuction of the middle burner to ascend and descend in order; and the Dachaihu decoction and Xiaoxianxiong decoction were used to cure herpes zoster with phlegm-damp retention by cleaning Shaoyang-Yangming damp-heat while the Sijunzi decoction strengthening the Qi of the middle-Jiao.[Conclusion] ZHAO Minghua's syndrome differentiation and treatment of dermatosis is distinctive, she applies the rules of "invigorate spleen and eliminate dampness", "clear liver and drain fire" and "enriching water to nourish wood" skillfully. Notably, ZHAO Minghua is good at treating difficult miscellaneous dermatosis by regulating Qi activity of Middle-Jiao and Shaoyang. ZHAO Minghua 's experience is clinically effective and worthy of reference and promotion.
引文
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[14]张学军.皮肤性病学[M]北京:人民卫生出版社,2013.
[2]张立志,许能贵.“诸痛痒疮皆属于心”在针灸临床应用举隅[J].中国针灸,2016,36(8):788,798.
[3]李天慧,雷晓楠,牛拾可,等.“诸痛痒疮,皆属于心”在皮肤病治疗中的应用[J].国医论坛,2015,30(1):61-62.
[4]朱丹溪.丹溪心法[M].北京:人民卫生出版社,2007:8.
[5]唐容川.血证论[M].北京:人民卫生出版社,2005:12.
[6]叶天士.临证指南医案[M].北京:人民卫生出版社,2006:40.
[7]陈自明.妇人大全良方[M].北京:中国医药科技出版社,2011:65.
[8]叶桂.温热论[M].张志斌,整理.北京:人民卫生出版社,2007:16-17.
[9]尤在泾.尤在泾医学全书[M].孙中堂,主编.北京:中国中医药出版社,1999:119.
[10]叶天士.本草经解[M].北京:学苑出版社,2011.
[11]成无己.伤寒明理论[M].北京:学苑出版社,2009:31.
[12]李中梓.李中梓医学全书[M].包来发,主编.北京:中国中医药出版社,1999.
[13]赵辨.中国临床皮肤病学[M].南京:江苏科学技术出版社,2010:741-742.
[14]张学军.皮肤性病学[M]北京:人民卫生出版社,2013.