| 引用本文:李丹阳1，吕添2，于莹3，朱泽兵1，徐菁1，段行武1.论特应性皮炎核心病机与辨治思路[J].世界中医药,2024,(02):. |
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| 论特应性皮炎核心病机与辨治思路 |
| Discussion of the Core Pathogenesis and Thinking of Treatment Based on Syndrome Differentiation of Atopic Dermatitis |
| 投稿时间：2022-07-06 |
| DOI：10.3969/j.issn.1673-7202.2024.02.011 |
| 中文关键词: 特应性皮炎 核心病机 辨治思路 动态可变性 先天禀赋不足 后天脏腑失调 多角度辨治 |
| English Keywords:Atopic dermatitis Core pathogenesis Thinking of treatment based on syndrome differentiation Dynamic variability Lack of innate endowment Acquired disorders of viscera Treatment based on syndrome differentiation from multiple perspectives |
| 基金项目:国家自然科学基金面上项目（82074436）——基于褪黑素调控氧化应激作用探讨凉血安神法治疗银屑病伴睡眠障碍的作用机制；国家中医药管理局中医药行业科研专项（2015468001）——基于远期疗效优势的“肺脾为核心的脏腑整体辨证的湿疹干预研究 |
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| 中文摘要: |
| 特应性皮炎（AD）是皮肤科常见的慢性复发性、瘙痒性、炎症性皮肤病。笔者认为，AD的核心病机在于先天禀赋不足，后天脏腑失调，其中尤以脾胃失调为本。而根据本病发病的不同年龄段和不同疾病阶段，其核心病机又具有动态可变性。婴儿期及儿童期AD病位在心，与脾、肾相关，急性期以心火亢盛为主；亚急性期以心火脾虚交织互见为主；慢性期及稳定期多表现为热盛伤阴导致的阴虚血燥、血虚血燥，或久病耗伤导致的脾肾不足。青少年及成人AD病位在脾，与肝、肾密切相关，急性期病机多为肝经湿热，血热生风；慢性期多为脾虚湿蕴，燥湿互化；稳定期多为脾虚血燥、阴虚血燥或脾肾不足。老年AD病位在肾，与脾密切相关，急性期病机多为顽湿蕴肤，慢性期及稳定期多为脾肾不足。对于其辨治思路的把握应从以下几点入手：重视先天肾精，加强调理禀赋；固护后天脾胃，调养五脏；从年龄、分期、虚实等多角度辨治，标本兼顾；重视预防调护，内外并重，关注整体。采用中医多种治疗手段，调理禀赋，辨证论治，同时发挥中医优势，对于指导AD临床诊治具有重要的意义。 |
| English Summary: |
| Atopic dermatitis(AD) is a common chronic，recurrent and pruritus inflammatory skin disease in dermatology.The author believes that the core pathogenesis of AD lies in the lack of innate endowment and the acquired disorders of viscera，especially the disorder of spleen and stomach.According to the different age groups and stage of the disease，the core pathogenesis has dynamic variability.AD in infancy and childhood is located in the heart，and related to the spleen and kidney.In the acute stage，it is mainly characterized by hyperactivity of heart fire.The subacute stage of AD is mainly characterized by intermingling of heart fire and spleen deficiency.The chronic and stable phases of AD are mostly manifested as yin deficiency and blood dryness due to impairment of yin by excessive heat，blood deficiency and blood dryness，or spleen and kidney deficiency caused by impairment of prolonged illness.In adolescents and adults，AD is located in the spleen，which is closely related to the liver and kidney.In the acute stage，the pathogenesis of AD is mainly dampness and heat in liver channel，and blood heat producing wind.In chronic phase，spleen deficiency and dampness accumulation，dryness and dampness intermingled.In the stable stage，spleen deficiency and blood dryness，yin deficiency and blood dryness，or spleen and kidney deficiency.In the elderly，AD is located in the kidney and closely related to the spleen.The pathogenesis of AD in the acute phase is mostly stubborn wet accumulation in skin，while in the chronic and stable phases，it is mostly spleen and kidney deficiency.The grasp of thinking of treatment based on syndrome differentiation should start from the following points：paying attention to the innate kidney essence，strengthening the regulation of endowment，guarding the acquired spleen and stomach，nourishing the five viscera，treatment based on syndrome differentiation from multiple perspectives including age，stage，deficiency and excess，and treating both manifestation and root cause of disease，paying attention to prevention and care，both internally and externally，and paying attention to the whole.It is of great significance for guiding the clinical diagnosis and treatment of AD by adopting a variety of treatment methods of traditional Chinese medicine，regulating endowment，treatment based on syndrome differentiation，and giving full play to the advantages of traditional Chinese medicine. |
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