新析三焦分期辨治蛀发癣  

New Analysis on Staging Treatment of Moth Tonsurans Based on Tri-Jiao Syndrome Differentiation

作　　者：赵东瑞 麻晓玲 梁文丽 史华洁 蒋越 ZHAO Dongrui;MA Xiaoling;LIANG Wenli(Wenzhou Chinese Medicine Hospital of Zhejiang Chinese Medical University,Wenzhou(325000),China)

机构地区：[1]浙江中医药大学附属温州市中医院,浙江温州325000 [2]温州医科大学附属第一医院

出　　处：《浙江中医药大学学报》2024年第4期475-478,497,共5页Journal of Zhejiang Chinese Medical University

基　　金：温州市科技局基础性医疗卫生科技项目(Y20220244)。

摘　　要：[目的]重新分析蛀发癣的病因病机及三焦分期辨治。[方法]通过查阅有关古今文献资料,结合临床经验分析、归纳,总结蛀发癣的不同证型及治法方药,并附上医案一则予以验证。[结果]根据病程,可将蛀发癣分为早、中、晚三期,随着疾病进展,病位分属三焦不同脏腑,病性由实转虚。笔者认为,该病早期在上焦心肺,病性属实,其中肺经风热型予枇杷清肺饮加减,若为心火炽盛型则予导赤散合黄连解毒汤加减;该病中期在中焦肝胆脾胃,病性属实或虚实夹杂,其中肝胆湿热型予龙胆泻肝汤加减,若为脾虚湿困型则予参苓白术散或除湿胃苓汤加减;该病晚期在下焦之肾,兼肝脾虚损,病性属虚,其中脾肾阳虚型予四神丸合右归丸加减,若为肝肾不足型则予六味地黄丸加减。所举验案中患者素体脾虚,湿阻中焦,上泛于头顶肌肤,方用除湿胃苓汤加减,健脾补肾,兼以清热祛湿,三诊后取得明显疗效。[结论]蛀发癣的三焦分期辨治紧扣病因病机,注重标本兼治,疗效确切,为中医药防治该病提供了新的思路。[Objective]To reanalyze the etiology,pathogenesis,treatment of moth tonsurans by stages based on tri-Jiao syndrome differentiation.[Methods]Starting from the relevant ancient and modern literature,combining with clinical experience for analysis and induction,the different types,therapeutic methods and prescriptions of moth tonsurans were generalized and one case was presented for example.[Results]According to the course of the disease,moth tonsurans can be divided into early,middle and late stages.With the progress of the disease,its location belongs to different viscera in tri-Jiao,and the nature of disease changes from excess syndrome to deficiency syndrome.It is considered that the early stage of the moth tonsurans locates in the heart and lung of the upper-Jiao,and the nature of disease belongs to excess syndrome.For the wind heat of lung meridian syndrome,modified Pipa Qingfei Decoction can be given;if it is the syndrome of hyperactive heart fire in the early stage,modified Daochi Powder combined with Huanglian Jiedu Decoction can be given.The middle stage of the moth tonsurans locates in the liver,gallbladder,spleen and stomach of the middle-Jiao,and the nature of disease belongs to excess syndrome or deficiency and excess syndrome.For the liver-gallbladder dampness-heat syndrome,modified Longdan Xiegan Decoction can be given;if it is the syndrome of splenasthenic hygrosis in the middle stage,modified Shenling Baizhu Powder or Chushi Weiling Decoction can be given.The late stage of the moth tonsurans locates in the kidney of the lower-Jiao and also has deficiency of the liver and spleen,and the nature of disease belongs to deficiency syndrome.For the spleen-kidney Yang deficiency syndrome,modified Sishen Pill combined with Yougui Pill can be given.If it is the syndrome of liver and kidney deficiency in the late stage,modified Liuwei Dihuang Pill can be given.In the medical record,the patient was of spleen weakness and damp blockage of middle-Jiao all along,leading to the dampness on the top of the head skin

关 键 词：蛀发癣 脂溢性脱发 三焦分期 医案 除湿胃苓汤 标本兼治 

分 类 号：R651[医药卫生—外科学]