徐国梅教授基于络病学说分期辨治黄褐斑经验  

Professor Xu Guomei's Experience in Treating Melasma by Stages based on the Theory of Collateral disease

作　　者：陆东亚 陈曦[2] 张新荣 梁娜 费莎妮 刘水清 刘小奇 杨健仁 赵锦鹏 黄安宁 徐国梅 LU Dongya;CHEN Xi;ZHANG Xinrong(Bejing University of traditional Chinese Medicine,Bejing 100029,China;Dongzhimen Hospital,Beijing University of traditional Chinese Medicine,Bejing 100700,China;Dongxiaokou community health service center,Changping District,Bejing 102200,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东直门医院,北京100700 [3]北京市昌平区东小口社区卫生服务中心,北京102200 [4]大兴区中西医结合医院,北京100163 [5]北京中医药大学第三附属医院,北京100029

出　　处：《四川中医》2023年第9期1-5,共5页Journal of Sichuan of Traditional Chinese Medicine

基　　金：国家自然科学基金青年科学基金项目(编号:81804106);教育部科技发展中心产学研创新基金(编号:2021JH008);北京中医药大学第三附属医院横向课题(编号:303-02-227)。

摘　　要：黄褐斑是一种临床常见的损容性皮肤病,易诊难治。徐国梅教授将黄褐斑的血管因素作为切入点,认为黄褐斑皮损处毛细血管扩张增生的典型病理改变是络血运行失其常度的外在表现,但不同临床分期的络病学病因病机与治法用药不尽相同。活动期黄褐斑以实证、热证居多,病因病机以阳热怫郁、络脉亢变为主,常伴有火热灼络、络道损伤,治法以辛凉疏散、解毒宁络为主,常辅以凉血止血的炭药以清热凉血、复络化瘀。稳定期黄褐斑多本虚标实,病机多有脾肾阳虚、痰湿泛络和肝肾阴虚、络虚毒蕴,治疗宜温补脾肾、助阳通络,滋补肝肾、养血通络。本文总结并探讨徐教授治疗黄褐斑的经验,并附医案一则予以佐证,以期为临床治疗拓宽思路。Melasma is a common clinical disfiguring dermatosis,which is easy to diagnose and difficult to treat.Professor Xu Guomei takes the vascular factors of melasma as a breakthrough point,and believes that the typical pathological changes of telangiectasia and hyperplasia in the skin lesions of melasma are the external manifestations of the abnormal circulation of collaterals.However,the etiology,pathogenesis,treatment and prescription of collateral disease theory in different clinical periods are not completely the same.In the active stage,the majority of melasma syndromes are excess syndrome and heat syndrome.The etiology and pathogenesis are mainly collaterals hyperplasia caused by accumulation of yang and heat,which are often accompanied by collaterals burning caused by fire pathogen.The main treatment methods are protecting collaterals from fire pathogen by pungent and cool herbs,often supplemented by charcoal drug for clearing heat,cooling blood,repairing collaterals and removing blood stasis.In the stable stage of melasma,it is a syndrome of deficiency in origin and excess in superficiality.The pathogenesis mostly includes spleen and kidney yang deficiency,phlegm dampness accumulated in collaterals,liver and kidney yin deficiency,and collaterals deficiency and toxin accumulation.The treatment should be warming spleen and kidney,tonifying yang and dredging collaterals,or nourishing liver and kidney,raiseing blood and unblocking collaterals.This article summarizes and discusses professor Xu Guomei's experience in the treatment of melasma,and a medical case is attached to prove it,in order to broaden the thinking for clinical treatment.

关 键 词：黄褐斑 络病学说 分期辨治 活动期 稳定期 炭药 

分 类 号：R249[医药卫生—中医临床基础] R758.45[医药卫生—中医学]