湿疹的治法与方剂配伍规律研究
摘要
湿疹是一种以皮疹特征命名的常见的过敏性炎症性皮肤病，现代医学对其发病机理尚未完全阐明。其致敏原有很多，流行病学表明湿疹的患者群较大，其症状也给患者带来很大的痛苦，对该病的防治是重要的医学及社会问题。但现代医学用受体阻滞剂、免疫调节剂等治疗方法，虽可控制症状，但长期应用可发生多种不良毒副作用反应，且停药后常出现皮损恶化即所谓“反跳现象”。
中医对于湿疹认识很早，且中医典籍拥有丰富的治疗湿疹的学术资源，显示出中医药在治疗湿疹上有巨大优势。但是这些学术资源需要得到有效整理，来推动湿疹辨证论治理论与方法的继承与应用。
通过对中医文献中治疗湿疹的学术资源整理和归纳表明：湿疹的病因为先天禀赋不足，或饮食不节，嗜酒或过食辛辣鱼腥，伤及脾胃，脾失健运，湿热内蕴，复外感风湿热邪，内外合邪，两相搏结，浸淫肌肤，郁于腠理而发为本病。其中“湿”为发病的主要因素。湿疹的病机演变规律为：初期风热蕴结肌肤，湿尚不显，属风热湿毒之证，表现为皮肤瘙痒、出现红斑、丘疹斑，自觉灼热；病情进展，湿与风、热结合，湿热蕴蒸，属湿热毒盛之证，为极盛期，表现为皮肤水疱、大疱、糜烂、渗液；脾为湿困，湿性重浊粘滞，病程缠绵反复，属脾虚湿盛之证；湿热久羁阻遏气机，气郁化火耗伤阴血，或长期渗水失液，耗血伤阴，化燥生风，转成血虚风燥之证，表现为皮肤肥厚、干燥、鳞屑、皲裂。针对以上病因病机，治疗湿疹的常用方法有疏风祛湿、养血祛风、清热利湿、清脾泻火、清心导湿、清肝化湿、健脾除湿、滋阴除湿、养血润燥法等。
通过对古今中医文献中有关治疗湿疹(内治法)的大量方剂之遣药制方进行统计分析，表明其组方配伍特点与用药规律为：主要针对风湿热三邪，根据具体证型，以祛风除湿清热为基本治疗法则，以解表、清热、利水渗湿、燥湿止痒、芳香化湿、补益六类药物为构成治疗湿疹方剂的主要药类，根据证候、病机变化，酌情配伍组成方剂，并适当化裁。其中防风、蛇床子等25味中药为常用优选药物。通过临床120例湿疹患者的治疗观察证实了上述辨证施治能在临床上取得良好的疗效，总有效率为95.84％。中医药治疗湿疹拥有巨大的优势。
Eczema is a kind of common anaphylaxis inflammation skin disease that named after its cutaneous rash feature. Modern medical science pathogens and pathogenesis mechanism have not been expounded completely. Epidemic disease is studied and the results show that the eczema patient population is large and its symptom causes great suffering to patients. The prevention and treatment of this disease is an important medical and social problem. Immunomodulators, Antihistamines ,etc. are usually used in Modern medical science, although they control symptoms relatively promptly, but long-term application may cause various bad reaction and side effects. Stopping medication too suddenly might cause hyperreflexia and worsen the skin problem.
Many ancient books and records of traditional chinese medicine have discussed about the eczema treatment by differentiation of syndrome. Such materials illustrate the advantage of treating eczema using traditional chinese medicine. However, these rich academic resources need to be arranged efficiently in order to promote and inherit the therapeutic methods of eczema.
Reviewing TCM literature, Treatment by Differentiation of Syndrome and combination of author' s clinical experience, TCM believes the etiology for eczema can be caused by insufficiency of innate endowment, or of the improper diet or drinking or excessive intake of wind-stirring acrid or fishy food, which impair the spleen and stomach and cause the dysfunction of spleen in transportation and give rise to dampness-heat brewing in the interior. With the invasion of the wind-damp-heat pathogens from the exterior, the endogenous and exogenous pathogens combine and contend with each other, the nosogenetic substance overflows the skin and lies depressed in the interstice to bring on the disease. The Dampness is the main pathogenic factor. Governed by the excess syndrome at an initial stage, the eczema has the characteristics of. acute onset. While the dampness is not yet conspicuous, the alternate attacks result in itchy skin, erythema and papule appearing on the body surface and the subjective feeling of burning sensation, which are all the manifestations of the wind-heat-damp toxin syndrome. With the progress of the condition, the dampness integrates with the wind-heat. The damp-heat brews, steams and accumulates on the skin, thus causing the appearance of vesicle, bulla, erosion, effusion, which are the manifestations of the syndrome of exuberant damp-heat toxin, This is the heyday of the evolution of eczema. If spleen is encumbered by dampness, as dampness by nature is heavy and turbid, sticky and stagnant, hence the disease is prolonged and persistent, and develops into the syndrome of spleen insufficiency with exuberant dampness, The enduring damp-heat is apt to obstruct the qi activity. Depressed qi transforming into fire is bound to damage the yin-blood. Or the percolation of the water-humor depletes the blood and yin overtime to bring about dryness and engender wind.Hence the skin is deprived of the nourishment and becomes thickening, drying, cracking and with scales, which are the manifestations of the syndrome of wind-dryness due to blood deficiency.
From the above evolution of pathogenesis, the therapeutic methods commonly used are: dispelling wind and eliminating dampness, nourishing blood and dispersing wind method, clearing heat and promoting diuresis, clearing spleen and draining fire, clearing heart and abducting dampness, clearing liver and resolving dampness, fortifying spleen and eliminating dampness method, transforming stasis and percolating dampness, nourishing yin and dispelling dampness, nourishing blood and moistening dryness method and so on and so forth.
By collecting and analysing the statistics of the prescriptions in recipes for eczema treatment from the TCM literature both ancient and modern, we explore the major therapeutic methods as Disperse Wind, Dispell Dempness and Clearing Heat. The prescription are basically combined with exterior-releasing herbs, heat-clearing herbs, eliminating dampness herbs, itch relief herbs, tonifying and replenishing herbs. Finally conclude the best 25 herbs routinely used as the basic therapeutic method for eczema, such as "fang feng" (Radix Saposhnikoviae), "she chuang zi" (Fructus Cnidii),etc.
According to the above-mentioned research result, the clinical observation was carried out by 120 eczema patients to prove the therapeutic efficacy of the herbs. The total effective rate reached 95.84%. This result not only verifies this thesis and medication Iaw for the eczema' s treatment by differentiation of syndromes, it also shows that the precious experience and knowledge by traditional Chinese medicine is worth our efforts to further inherit and develop.
中医对于湿疹认识很早，且中医典籍拥有丰富的治疗湿疹的学术资源，显示出中医药在治疗湿疹上有巨大优势。但是这些学术资源需要得到有效整理，来推动湿疹辨证论治理论与方法的继承与应用。
通过对中医文献中治疗湿疹的学术资源整理和归纳表明：湿疹的病因为先天禀赋不足，或饮食不节，嗜酒或过食辛辣鱼腥，伤及脾胃，脾失健运，湿热内蕴，复外感风湿热邪，内外合邪，两相搏结，浸淫肌肤，郁于腠理而发为本病。其中“湿”为发病的主要因素。湿疹的病机演变规律为：初期风热蕴结肌肤，湿尚不显，属风热湿毒之证，表现为皮肤瘙痒、出现红斑、丘疹斑，自觉灼热；病情进展，湿与风、热结合，湿热蕴蒸，属湿热毒盛之证，为极盛期，表现为皮肤水疱、大疱、糜烂、渗液；脾为湿困，湿性重浊粘滞，病程缠绵反复，属脾虚湿盛之证；湿热久羁阻遏气机，气郁化火耗伤阴血，或长期渗水失液，耗血伤阴，化燥生风，转成血虚风燥之证，表现为皮肤肥厚、干燥、鳞屑、皲裂。针对以上病因病机，治疗湿疹的常用方法有疏风祛湿、养血祛风、清热利湿、清脾泻火、清心导湿、清肝化湿、健脾除湿、滋阴除湿、养血润燥法等。
通过对古今中医文献中有关治疗湿疹(内治法)的大量方剂之遣药制方进行统计分析，表明其组方配伍特点与用药规律为：主要针对风湿热三邪，根据具体证型，以祛风除湿清热为基本治疗法则，以解表、清热、利水渗湿、燥湿止痒、芳香化湿、补益六类药物为构成治疗湿疹方剂的主要药类，根据证候、病机变化，酌情配伍组成方剂，并适当化裁。其中防风、蛇床子等25味中药为常用优选药物。通过临床120例湿疹患者的治疗观察证实了上述辨证施治能在临床上取得良好的疗效，总有效率为95.84％。中医药治疗湿疹拥有巨大的优势。
Eczema is a kind of common anaphylaxis inflammation skin disease that named after its cutaneous rash feature. Modern medical science pathogens and pathogenesis mechanism have not been expounded completely. Epidemic disease is studied and the results show that the eczema patient population is large and its symptom causes great suffering to patients. The prevention and treatment of this disease is an important medical and social problem. Immunomodulators, Antihistamines ,etc. are usually used in Modern medical science, although they control symptoms relatively promptly, but long-term application may cause various bad reaction and side effects. Stopping medication too suddenly might cause hyperreflexia and worsen the skin problem.
Many ancient books and records of traditional chinese medicine have discussed about the eczema treatment by differentiation of syndrome. Such materials illustrate the advantage of treating eczema using traditional chinese medicine. However, these rich academic resources need to be arranged efficiently in order to promote and inherit the therapeutic methods of eczema.
Reviewing TCM literature, Treatment by Differentiation of Syndrome and combination of author' s clinical experience, TCM believes the etiology for eczema can be caused by insufficiency of innate endowment, or of the improper diet or drinking or excessive intake of wind-stirring acrid or fishy food, which impair the spleen and stomach and cause the dysfunction of spleen in transportation and give rise to dampness-heat brewing in the interior. With the invasion of the wind-damp-heat pathogens from the exterior, the endogenous and exogenous pathogens combine and contend with each other, the nosogenetic substance overflows the skin and lies depressed in the interstice to bring on the disease. The Dampness is the main pathogenic factor. Governed by the excess syndrome at an initial stage, the eczema has the characteristics of. acute onset. While the dampness is not yet conspicuous, the alternate attacks result in itchy skin, erythema and papule appearing on the body surface and the subjective feeling of burning sensation, which are all the manifestations of the wind-heat-damp toxin syndrome. With the progress of the condition, the dampness integrates with the wind-heat. The damp-heat brews, steams and accumulates on the skin, thus causing the appearance of vesicle, bulla, erosion, effusion, which are the manifestations of the syndrome of exuberant damp-heat toxin, This is the heyday of the evolution of eczema. If spleen is encumbered by dampness, as dampness by nature is heavy and turbid, sticky and stagnant, hence the disease is prolonged and persistent, and develops into the syndrome of spleen insufficiency with exuberant dampness, The enduring damp-heat is apt to obstruct the qi activity. Depressed qi transforming into fire is bound to damage the yin-blood. Or the percolation of the water-humor depletes the blood and yin overtime to bring about dryness and engender wind.Hence the skin is deprived of the nourishment and becomes thickening, drying, cracking and with scales, which are the manifestations of the syndrome of wind-dryness due to blood deficiency.
From the above evolution of pathogenesis, the therapeutic methods commonly used are: dispelling wind and eliminating dampness, nourishing blood and dispersing wind method, clearing heat and promoting diuresis, clearing spleen and draining fire, clearing heart and abducting dampness, clearing liver and resolving dampness, fortifying spleen and eliminating dampness method, transforming stasis and percolating dampness, nourishing yin and dispelling dampness, nourishing blood and moistening dryness method and so on and so forth.
By collecting and analysing the statistics of the prescriptions in recipes for eczema treatment from the TCM literature both ancient and modern, we explore the major therapeutic methods as Disperse Wind, Dispell Dempness and Clearing Heat. The prescription are basically combined with exterior-releasing herbs, heat-clearing herbs, eliminating dampness herbs, itch relief herbs, tonifying and replenishing herbs. Finally conclude the best 25 herbs routinely used as the basic therapeutic method for eczema, such as "fang feng" (Radix Saposhnikoviae), "she chuang zi" (Fructus Cnidii),etc.
According to the above-mentioned research result, the clinical observation was carried out by 120 eczema patients to prove the therapeutic efficacy of the herbs. The total effective rate reached 95.84%. This result not only verifies this thesis and medication Iaw for the eczema' s treatment by differentiation of syndromes, it also shows that the precious experience and knowledge by traditional Chinese medicine is worth our efforts to further inherit and develop.
引文
(1) 陈佑邦．《中华人民共和国中医药行业标准·中医病证诊断疗效标准》国家中医药管理局，1994：146
(2) 中华人民共和国药典委员会编．中国药典．2000年版．北京：化学工业出版社，2001
(3) 王本祥等．现代中药药理学．天津．天津科学技术出版社，1997
(4) 褚跃成．清热药的药理作用．邯郸农业高等专科学校学报，2002，19(3)：28～29
(5) 邱赛红等．芳香化湿药开胃作用机理的实验研究．中药药理与临床，1997，13(2)：1
(6) 孙晓红等．防风的临床应用与研究．北华大学学报(自然科学版)，2004，5(2)：138～141
(7) 李軍暉等．荆芥的药理作用．四川生理科学杂志，2004，26(3)：133～136
(8) 牛跃华，陈锡林．中药蝉蜕传统应用和现代研究概况．浙江临床医学，2000，2(4)：281～282
(9) 顾瑶华，秦民坚．我国药用菊花的化学及药理学研究新进展．中国野生植物资源，2004，23(6)：7～9
(10) 刘伟等．苦参的研究进展．时珍国医国药，2006，17(5)：829～830
(11) 王家新，李利山．黄芩甙药理作用．中国药理学通报，2003，11(2)：84～85
(12) 许新梅，刘秀香．中药白鲜皮的临床应用．现代中西医结合杂志，2003，12(16)：1772～1773
(13) 刘涛等．中药龙胆草的研究进展．辽宁中医杂志，200431(1)：85
(14) 李峰，贾彦竹．黄柏的临床药理作用．中医药临床杂志，2004，16(2)：191
(15) 余园嫒等．黄连的药理研究进展．重庆大学学报(自然科学版)，2006，29(2)：107～111
(16) 韩淑苓．金银花的研究概况．中国乡村医药杂志，2003，10(12)：45～46
(17) 张海燕．连翘化学成分及药理活性的研究进展．中药材，2000，23(10)：657～660
(18) 卢端萍，王勇．地黄药理作用及临床应用研究进展．海峡药学，2004，16(3)：23～26
(19) 阮金兰等．赤芍化学成分和药理作用的研究进展．中国药理学通报，2003，19(9)：965～970
(20) 王祝举等．牡丹皮的化学成分和药理作用．国外医药，植物药分册，2006，21(4)：155～159
(21) 李玉平，李林．获苓的临床新用途．职业与健康，2000，16(8)：122
(22) 贾良栋．中药泽泻的研究概况．时珍国医国药，2005，16(9)：923～924
(23) 伍月红，方绵霞．萆薢的药理作用与临床应用．广东药学，2005，15(3)：69～72
(24) 戴岳等．地肤子70％醇提物抑制速发型及迟发型变态反应．中国现代应用药学杂志，2001，18(1)：8～10
(25) 袁娟丽，谢金鲜．中药蛇床子药理研究进展．广西中医学院学报，2004，7(1)：73～76
(26) 聂淑琴等．5种产地苍术提取物主要药理作用比较研究．中国中医药信息杂志，2001，8(2)：27
(27) 邓永健等．当归的化学成分及药理作用研究进展．新疆中医药，2006，24(5)：109～113
(28) 田庆来等．甘草有效成分的药理研究进展．天然产物研究与开发，2006，18：343～347
(29) 杨翠平等．白术的研究进展．中药材，2002，25(3)：206～208
(30) 宋毅等．夜交藤抗炎抑菌作用的实验研究．华西药学杂志，2003，18(2)：112～114
(31) 陈华圣等．夜交藤袋泡剂与水煎剂对动物中枢作用的比较研究．湖南中医杂志，2000，16(1)：54～55
(32) 郑筱萸．中药新药临床研究指导原则(试行)．中国医药科技出版社．北京2002，295～298
(2) 中华人民共和国药典委员会编．中国药典．2000年版．北京：化学工业出版社，2001
(3) 王本祥等．现代中药药理学．天津．天津科学技术出版社，1997
(4) 褚跃成．清热药的药理作用．邯郸农业高等专科学校学报，2002，19(3)：28～29
(5) 邱赛红等．芳香化湿药开胃作用机理的实验研究．中药药理与临床，1997，13(2)：1
(6) 孙晓红等．防风的临床应用与研究．北华大学学报(自然科学版)，2004，5(2)：138～141
(7) 李軍暉等．荆芥的药理作用．四川生理科学杂志，2004，26(3)：133～136
(8) 牛跃华，陈锡林．中药蝉蜕传统应用和现代研究概况．浙江临床医学，2000，2(4)：281～282
(9) 顾瑶华，秦民坚．我国药用菊花的化学及药理学研究新进展．中国野生植物资源，2004，23(6)：7～9
(10) 刘伟等．苦参的研究进展．时珍国医国药，2006，17(5)：829～830
(11) 王家新，李利山．黄芩甙药理作用．中国药理学通报，2003，11(2)：84～85
(12) 许新梅，刘秀香．中药白鲜皮的临床应用．现代中西医结合杂志，2003，12(16)：1772～1773
(13) 刘涛等．中药龙胆草的研究进展．辽宁中医杂志，200431(1)：85
(14) 李峰，贾彦竹．黄柏的临床药理作用．中医药临床杂志，2004，16(2)：191
(15) 余园嫒等．黄连的药理研究进展．重庆大学学报(自然科学版)，2006，29(2)：107～111
(16) 韩淑苓．金银花的研究概况．中国乡村医药杂志，2003，10(12)：45～46
(17) 张海燕．连翘化学成分及药理活性的研究进展．中药材，2000，23(10)：657～660
(18) 卢端萍，王勇．地黄药理作用及临床应用研究进展．海峡药学，2004，16(3)：23～26
(19) 阮金兰等．赤芍化学成分和药理作用的研究进展．中国药理学通报，2003，19(9)：965～970
(20) 王祝举等．牡丹皮的化学成分和药理作用．国外医药，植物药分册，2006，21(4)：155～159
(21) 李玉平，李林．获苓的临床新用途．职业与健康，2000，16(8)：122
(22) 贾良栋．中药泽泻的研究概况．时珍国医国药，2005，16(9)：923～924
(23) 伍月红，方绵霞．萆薢的药理作用与临床应用．广东药学，2005，15(3)：69～72
(24) 戴岳等．地肤子70％醇提物抑制速发型及迟发型变态反应．中国现代应用药学杂志，2001，18(1)：8～10
(25) 袁娟丽，谢金鲜．中药蛇床子药理研究进展．广西中医学院学报，2004，7(1)：73～76
(26) 聂淑琴等．5种产地苍术提取物主要药理作用比较研究．中国中医药信息杂志，2001，8(2)：27
(27) 邓永健等．当归的化学成分及药理作用研究进展．新疆中医药，2006，24(5)：109～113
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