慢性湿疹的脏腑辨证及传变规律
|
摘要
目的:文献分析慢性湿疹临床证候的脏腑传变。方法:检索中国知网数据库,纳入1990年至2015年(25年)慢性湿疹文献;依据脏腑辨证,确定患病人群的病机定位;遵循五行生克,确定湿疹病程脏腑定位的传变规律。结果:1 311例湿疹患者的脏腑定位为肝(35.69%),脾(25.25%),心(22.12%),肾(13.80%),肺(3.13%)。结合患者体质特征,提示湿疹发病为"先天肾虚与后天脾虚"双驱动;即湿疹立法"温肾阳治本,渗脾湿治标",肝阴虚为桥联本标的常见表象,以佐药治之。结论:遵循脏腑传变,慢性湿疹病机源于肾虚,症见脾湿,联在肝阴虚;传变动力是立法遣药的客观依据。
Objective: To analyze relevant literatures on the zang-fu viscera variable regularity of clinical syndromes of chronic eczema. Methods: The China knowledge network database(CNKI) was searched, and the literatures on chronic eczema from 1990 to 2015 were included. The pathogenesis localizations of patients were determined, based on the syndrome differentiation of zang-fu viscera. The variable regularity of zang-fu viscera localizations of chronic eczema progress were determined, based on the theory of mutual generation and restriction of five phases. Results: The 1 311 cases of chronic eczema were included. The percentages of zang-fu viscera locations were distributed as follows: liver(35.69%), spleen(25.25%), heart(22.12%), kidney(13.80%), and lung(3.13%). Combining with the patients' allergic constitution, it was suggested that the pathogenesis of chronic eczema was both congenital kidney deficiency and acquired spleen deficiency. Namely, the therapeutic rule of chronic eczema was ‘warming kidney-yang for treating essence, eliminating spleen dampness for treating symptoms'. Liver-yin deficiency was common manifestation of bridging essence and symptoms, and it was treated with assistant drugs. Conclusion: Following the variable regularity of zang-fu viscera, the pathogenesis of chronic eczema is kidney deficiency, spleen dampness can be seen in its symptoms, and its bridge is liver-yin deficiency. Its variable power is its objective evidences of determining the therapeutic rules and medication.
Objective: To analyze relevant literatures on the zang-fu viscera variable regularity of clinical syndromes of chronic eczema. Methods: The China knowledge network database(CNKI) was searched, and the literatures on chronic eczema from 1990 to 2015 were included. The pathogenesis localizations of patients were determined, based on the syndrome differentiation of zang-fu viscera. The variable regularity of zang-fu viscera localizations of chronic eczema progress were determined, based on the theory of mutual generation and restriction of five phases. Results: The 1 311 cases of chronic eczema were included. The percentages of zang-fu viscera locations were distributed as follows: liver(35.69%), spleen(25.25%), heart(22.12%), kidney(13.80%), and lung(3.13%). Combining with the patients' allergic constitution, it was suggested that the pathogenesis of chronic eczema was both congenital kidney deficiency and acquired spleen deficiency. Namely, the therapeutic rule of chronic eczema was ‘warming kidney-yang for treating essence, eliminating spleen dampness for treating symptoms'. Liver-yin deficiency was common manifestation of bridging essence and symptoms, and it was treated with assistant drugs. Conclusion: Following the variable regularity of zang-fu viscera, the pathogenesis of chronic eczema is kidney deficiency, spleen dampness can be seen in its symptoms, and its bridge is liver-yin deficiency. Its variable power is its objective evidences of determining the therapeutic rules and medication.
引文
[1]Nutten S.Atopic dermatitis:Global epidemiology and risk factors.Annals of Nutrition&Metabolism,2015,66(1):8-16
[2]Hay R J,Johns N E,Williams H C,et al.The global burden of skin disease in 2010:An analysis of the prevalence and impact of skin conditions.Journal of Investigative Dermatology,2014,134(6):1527-1534
[3]Eyerich K,S Eyerich,T Biedermann.The multimodal immune pathogenesis of atopic eczema.Trends in Immunology,2015,36(12):788-801
[4]Jihyun L,S Sagwook,C Sanghyun.A comprehensive review of the treatment of atopic eczema.Allergy Asthma&Immunology Research,2016,8(3):181-190
[5]Barnes L,G Kaya,V Rollason.Topical corticosteroid-induced skin atrophy:A comprehensive review.Drug Safety,2015,38(5):493-509
[6]E J Feldman.Cutaneous reactions to corticosteroids.Cutaneous Drug Eruptions.Springer London,2015:353-359
[7]孙志高,路军章,周杉京,等.中医药治疗湿疹的研究进展.中华中医药杂志,2017,32(8):3617-3619
[8]徐公国,李强,付青姐,等.湿疹的病因病机及中医药治疗研究进展.实用医药杂志,2014,31(3):268-270
[9]王铁柱,史琦,阎玥,等.从肺脾论治湿疹.世界中医药,2017,12(2):369-372
[10]刘学伟.慢性湿疹从肝脾论治探析.中国中医基础医学杂志,2013,19(5):501-502
[11]余恒先.施梓桥以扶正为主治疗慢性湿疹经验.辽宁中医杂志,1997(11):483-484
[12]中华医学会皮肤性病学分会免疫学组.湿疹诊疗指南(2011年).中华皮肤科杂志,2011,44(1):5-6
[13]何佳丽,高如宏,徐静.除湿胃苓汤加减治疗皮肤病体会.江西中医药,2015(8):19-21
[14]任哲,任锡祥.四物汤加减治疗皮肤顽症经验.山西中医学院学报,2016,17(6):57-58
[15]张凯辉,王利兰,田野.王利兰主任运用一贯煎治疗更年期女性常见皮肤病的临床经验介绍.世界中医药,2015,10(7):1043-1046
[16]王廷刚.消风散治疗荨麻疹、口周疮、药疹.实用中医内科杂志,2017,31(6):64-65
[17]欧阳恒.六味地黄丸在皮科临床上的应用.中国中医药信息杂志,2008,15(1):82-83
[18]梁静,陈波,李志道.李志道教授运用阳和汤治疗慢性湿疹经验.四川中医,2011(9):8-9
[19]霍俊方,高天旭.高体三教授运用真武汤治疗杂病临床辨析.中医学报,2013,28(1):45-47
[20]陈金妍,杨飞,谭从娥.肾阳虚证免疫研究进展.陕西中医,2016,37(6):763-764
[21]谭从娥,王米渠.肾阳虚证免疫功能相关基因筛选及其表达分析.现代中西医结合杂志,2011,20(22):2731-2732
[22]李笋,王培源,钟萍,等.金匮肾气丸对肾阳虚变应性鼻炎缓解期小鼠Th1/Th2细胞因子的影响.中药新药与临床药理,2013,24(3):258-260
[23]郑妮亚.温补肾阳法在肾阳虚型变应性鼻炎中的应用.中国民间疗法,2015(7):44-45
[24]T Zheng,J H Yu,M H Oh,et al.The atopic march:progression from atopic dermatitis to allergic rhinitis and asthma.Allergy Asthma&Immunology Research,2011,3(2):67-73
[25]刘仕瑛.再论肝肾阳同源.黑龙江中医药,1988,31(5):9-10
[26]于振宣.肝肾母子相生浅析.湖北中医杂志,1982,4(4):6-8
[2]Hay R J,Johns N E,Williams H C,et al.The global burden of skin disease in 2010:An analysis of the prevalence and impact of skin conditions.Journal of Investigative Dermatology,2014,134(6):1527-1534
[3]Eyerich K,S Eyerich,T Biedermann.The multimodal immune pathogenesis of atopic eczema.Trends in Immunology,2015,36(12):788-801
[4]Jihyun L,S Sagwook,C Sanghyun.A comprehensive review of the treatment of atopic eczema.Allergy Asthma&Immunology Research,2016,8(3):181-190
[5]Barnes L,G Kaya,V Rollason.Topical corticosteroid-induced skin atrophy:A comprehensive review.Drug Safety,2015,38(5):493-509
[6]E J Feldman.Cutaneous reactions to corticosteroids.Cutaneous Drug Eruptions.Springer London,2015:353-359
[7]孙志高,路军章,周杉京,等.中医药治疗湿疹的研究进展.中华中医药杂志,2017,32(8):3617-3619
[8]徐公国,李强,付青姐,等.湿疹的病因病机及中医药治疗研究进展.实用医药杂志,2014,31(3):268-270
[9]王铁柱,史琦,阎玥,等.从肺脾论治湿疹.世界中医药,2017,12(2):369-372
[10]刘学伟.慢性湿疹从肝脾论治探析.中国中医基础医学杂志,2013,19(5):501-502
[11]余恒先.施梓桥以扶正为主治疗慢性湿疹经验.辽宁中医杂志,1997(11):483-484
[12]中华医学会皮肤性病学分会免疫学组.湿疹诊疗指南(2011年).中华皮肤科杂志,2011,44(1):5-6
[13]何佳丽,高如宏,徐静.除湿胃苓汤加减治疗皮肤病体会.江西中医药,2015(8):19-21
[14]任哲,任锡祥.四物汤加减治疗皮肤顽症经验.山西中医学院学报,2016,17(6):57-58
[15]张凯辉,王利兰,田野.王利兰主任运用一贯煎治疗更年期女性常见皮肤病的临床经验介绍.世界中医药,2015,10(7):1043-1046
[16]王廷刚.消风散治疗荨麻疹、口周疮、药疹.实用中医内科杂志,2017,31(6):64-65
[17]欧阳恒.六味地黄丸在皮科临床上的应用.中国中医药信息杂志,2008,15(1):82-83
[18]梁静,陈波,李志道.李志道教授运用阳和汤治疗慢性湿疹经验.四川中医,2011(9):8-9
[19]霍俊方,高天旭.高体三教授运用真武汤治疗杂病临床辨析.中医学报,2013,28(1):45-47
[20]陈金妍,杨飞,谭从娥.肾阳虚证免疫研究进展.陕西中医,2016,37(6):763-764
[21]谭从娥,王米渠.肾阳虚证免疫功能相关基因筛选及其表达分析.现代中西医结合杂志,2011,20(22):2731-2732
[22]李笋,王培源,钟萍,等.金匮肾气丸对肾阳虚变应性鼻炎缓解期小鼠Th1/Th2细胞因子的影响.中药新药与临床药理,2013,24(3):258-260
[23]郑妮亚.温补肾阳法在肾阳虚型变应性鼻炎中的应用.中国民间疗法,2015(7):44-45
[24]T Zheng,J H Yu,M H Oh,et al.The atopic march:progression from atopic dermatitis to allergic rhinitis and asthma.Allergy Asthma&Immunology Research,2011,3(2):67-73
[25]刘仕瑛.再论肝肾阳同源.黑龙江中医药,1988,31(5):9-10
[26]于振宣.肝肾母子相生浅析.湖北中医杂志,1982,4(4):6-8