1.首都医科大学附属北京中医医院肝病科 北京 100010
2.北京中医药大学研究生院
3.山西省肿瘤医院肝胆胰胃外科
孟令涵,男,在读硕士生
# 徐春军,男,教授,主任医师,博士生导师,主要研究方向:中西医结合防治肝脏疾病,E-mail:xu1409@sina.com
纸质出版日期:2023-11-30,
网络出版日期:2023-10-19,
收稿日期:2023-05-21,
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孟令涵, 陶婧娜, 王修丰, 等. 基于“有诸内者,必形诸外”论治胆汁淤积性瘙痒[J]. 北京中医药大学学报, 2023,46(11):1599-1604.
MENG Linghan, TAO Jingna, WANG Xiufeng, et al. Discussion on treatment of cholestatic pruritus based on the theory that "inside diseases show signs outside"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(11):1599-1604.
孟令涵, 陶婧娜, 王修丰, 等. 基于“有诸内者,必形诸外”论治胆汁淤积性瘙痒[J]. 北京中医药大学学报, 2023,46(11):1599-1604. DOI: 10.3969/j.issn.1006-2157.2023.11.016.
MENG Linghan, TAO Jingna, WANG Xiufeng, et al. Discussion on treatment of cholestatic pruritus based on the theory that "inside diseases show signs outside"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(11):1599-1604. DOI: 10.3969/j.issn.1006-2157.2023.11.016.
胆汁淤积性瘙痒是一种常见的肝系疾病,是由于肝内或肝外原因导致胆汁流动障碍、胆汁淤积造成的瘙痒,属中医学“痒风”范畴。本文基于中医学“有诸内者,必形诸外”理论,深入探讨胆汁淤积性瘙痒的病因病机及治疗。本文认为其病机包括湿热蕴结、蒸灼于外,血虚生风、燥伤腠理,以及瘀血阻络、肌肤不荣。治疗视疾病的外在表现以度其内在病机,治法包括清解湿热、凉血调神,方选龙胆泻肝汤、麻黄连轺赤小豆汤等;滋阴养血、祛风润燥,方选四物汤、当归饮子、滋燥养荣汤之类;以及活血通络、调和阴阳,方选桃红四物汤、大黄䗪虫丸之属。此外,患者的心理症状如焦虑、抑郁等不良情绪也需被重视,治疗时应清心凉血、安神定志。风药在瘙痒治疗中也发挥了重要作用,如荆芥、防风等。治疗当重视诸“内”与诸“外”之整体性,唯是始能解疾病之忧,轻患者之疾苦。
Cholestatic pruritus is a common hepatobiliary disease caused by inhibited bile flow and bile stasis due to intrahepatic or extrahepatic causes. It is in the "
Yangfeng
" category in traditional Chinese medicine. This paper discusses the etiology
pathogenesis and treatment of cholestatic pruritus
based on the theory that "inside diseases show signs outside" in traditional Chinese medicine. The pathogenesis includes dampness-heat accumulation and steaming out
blood deficiency with wind intrusion and dryness damaging striae and interstices
and static blood blocking collaterals
resulting in pruritus and unsmooth skin. The treatment approach is based on the manifestation of the "external" disease to eliminate the internal pathogenesis
focusing on clearing heat and resolving dampness
cooling blood and regulating the mind
with formulas such as
Longdan Xiegan
Decoction and
Mahuang Lianyao Chixiaodou
Decoction; nourishing yin and enriching blood
dispelling wind and moisturizing dryness
using formulas like
Siwu
Decoction
Danggui Yinzi
and
Zizao Yangrong
Decoction; promoting blood circulation and dredging collaterals
harmonizing yin and yang
with formulas like
Taohong Siwu
Decoction and
Dahuang Zhechong
Pill being considered. Furthermore
psychological symptoms such as anxiety and depression need to be taken seriously and treated by clearing heart fire
cooling the blood and calming the mind. Wind drugs also play an essential role in the treatment of pruritus
such as Jingjie (schizonepetae herba)
Fangfeng(Saposhnikoviae Radix) and so on. The treatment should pay attention to the holistic nature of all "internal" and all "external"
only in this way can we solve the worries of the disease and alleviate the sufferings of patients.
有诸内者,必形诸外胆汁淤积性瘙痒中医药治疗
inside diseases show signs outsidecholestatic pruritustreatment of traditional Chinese medicine
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