重症难治性特应性皮炎的中医药治疗思路探讨  

Discussion on Thoughts of Treatment of Severe Refractory Atopic Dermatitis with Traditional Chinese Medicine

作　　者：林颖 莫秀梅 李红毅 张彩云 刘俊峰 晏烽根 叶思祺 陈达灿 LIN Ying;MO Xiu-Mei;LI Hong-Yi;ZHANG Cai-Yun;LIU Jun-Feng;YAN Feng-Gen;YE Si-Qi;CHEN Da-Can(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120 Guangdong,China;Guangdong Provincial Clinical Research Certerof Chinese Medicine Dermatology,Guangzhou 510120 Guangdong,China;The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China)

机构地区：[1]广州中医药大学第二附属医院,广东广州510120 [2]广东省中医皮肤临床医学研究中心,广东广州510120 [3]广州中医药大学第二临床医学院,广东广州510006

出　　处：《广州中医药大学学报》2021年第12期2807-2811,共5页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药防治难治性慢病重点实验室建设项目(编号:2018B030322012);广东省中医院陈达灿名医工作室建设项目(编号:Y0096);广东省中医药局科研项目(编号:20182042);广东省重点领域研发计划项目(粤财科教[2020]52号)。

摘　　要：探讨中医药诊治重症难治性特应性皮炎的思路。儿童及成人的重症难治性特应性皮炎在基本病机上存在差异,儿童多为脾虚为本,心火为标,两者交互主导;成人病机复杂,以脾肾两虚为本,湿邪为标,二者互为因果,且多见兼夹证。因患者年龄、病期及病程的不同,临床可见心火脾虚证、脾虚湿蕴证、脾肾阳虚证、脾虚湿瘀证等基本证型。辨治时需抓住脾虚和湿邪两大辨治要点,即主张治病求本从脾论治,兼顾他脏;湿邪为患需治湿邪,同调兼夹证。具体用药时,需注意培土祛湿药的运用,采用炒制的中药灵活调整药物性味,小儿用药当清和。中医药的介入在重症难治性特应性皮炎的诊治中具有重要意义,中医药辨证论治可有效控制病情,减少或者延缓疾病复发,改变过敏进程,达到改善患者长远生活质量的治疗目标。This paper discusses the thoughts of traditional Chinese medicine(TCM)in treating severe refractory atopic dermatitis(SRAD). There are some differences in the basic pathogenesis of SRAD in children and adults.The pathogenesis of children SRAD is mainly characterized by spleen deficiency as the root cause and heart fire as the symptom, and the two aspects were mutually dominated. The pathogenesis of adult SRAD is complex,characterized by the deficiency of both spleen and kidney as the root cause and pathogenic damp as the symptom,and the two aspects interacts as both cause and effect and often interweaves with other syndromes. The clinical manifestations of the SRAD patients vary in the age,disease stage and course of disease,and can be classified into the basic syndromes types of heart fire and spleen deficiency syndrome, spleen deficiency with dampness accumulation syndrome,yang deficiency of spleen and kidney syndrome,spleen deficiency with dampness and stasis syndrome in clinical practice. During the differentiation and treatment, the two key points of spleen deficiency and pathogenic damp should be grasped,that is to say,the treatment should be based on the spleen and other zang-fu viscera should also be taken into account,and the pathogenic damp should be removed together with other syndromes. For the medication,spleen-replenishing and dampness-eliminating herbs can be adopted and the stir-fried herbs are more effective to adjust the properties of the medicine by flexible usage,and the herbs for children should be clear and neutral. The intervention of TCM plays an important role in the diagnosis and treatment of SRAD, which can effectively control the disease progression based on syndrome diagnosis and differentiation, reduce or delay the recurrence of the disease, delay allergy progression, so as to achieve the therapeutic goal of improving the long-term quality of life of patients.

关 键 词：重症难治性特应性皮炎 脾虚 心火 脾肾两虚 湿邪 从脾论治 

分 类 号：R275.9[医药卫生—中西医结合]